New report reveals gaps in Virginia's mental health system as both parties pledge to make it a priority

RICHMOND, Va. (WRIC) — A new study from the state’s watchdog agency reveals major gaps in Virginia’s mental health system.

The report from the Joint Legislative Audit and Review Commission is expected to serve as a roadmap for new investments in the 2023 legislative session. Both sides of the aisle are pledging to spend big money on improving treatment services. 

“Mental health services are going to be my top priority,” Senate Finance Committee Chair Janet Howell (D-Fairfax) said after JLARC’s presentation on Monday, Dec. 12. “I think this report is amazingly timely and is going to be very useful in guiding our discussions and decisions.”

Gov. Glenn Youngkin has also pledged to make it a priority. He’s expected to roll out a “Behavioral Health Redesign Plan” on Wednesday. Earlier this week, Youngkin also announced a new task force focused on cutting down wait times for crisis mental health services.

“Improving our behavioral health system is at the top of my Day 2 Agenda. It is critical that we address the mental health crisis and prioritize caring for Virginians,” Youngkin said in a press release on Dec. 12.

JLARC’s report focused on Community Services Boards (CSB). The network of 40 public providers offers a range behavioral health services to adults and youth with serious conditions across the state.

The study said CSBs served 20% more patients in 2022 compared to a decade ago, as the prevalence of mental illness increases in Virginia and nationally.

Meanwhile, staffing challenges appear to be growing. The report says turnover rates have increased over the past decade, with a sharp increase in the most recent fiscal year. JLARC said the General Assembly should consider raises for direct care staff.

Roughly a third (32%) of current CSB emergency services staff said they were considering leaving in the next twelve months, with more than half of that group (59%) citing uncompetitive pay as a main reason. The vast majority of CSB directors (90%) reported substantial challenges recruiting qualified staff.

The report said CSB emergency services staff play a critical role in state psychiatric hospital utilization by conducting screenings and recommending temporary detention orders (TDO) for individuals unwilling to be admitted to treatment voluntarily. They’re also required to find appropriate facilities for those who need inpatient treatment.

The study found that between September 2021 and July 2022, an average of 33 adults and 10 children were stuck on the state hospital waitlist daily. Some individuals were released from emergency departments without receiving any psychiatric treatment, despite being deemed a threat to themselves or others, because their TDO expired before a bed became available.

JLARC found an investment in residential crisis stabilization units (RCSUs) could help alleviate some of the pressure on the hospital system by providing short term treatment for lower intensity cases. The report said Virginia likely needs to roughly double those beds.

Senator Creigh Deeds (D-Bath), who leads the General Assembly’s Behavioral Health Commission, agrees RCSUs should be a focus in the 2023 session.

“It has been an area of focus. It has been hard to get people’s attention all of the time but I’m hopeful that we can move forward,” Deeds said in an interview on Tuesday, Dec. 13. “A lot of people who are in crisis don’t need to be in hospitals. They need to be treated and stabilized and then returned to community services.”

As for increasing compensation for CSB staff, Deeds said they’re looking at a package exceeding $150 million. He said the Democrat-controlled Senate tried to include more money for pay raises in the spending plan approved earlier this year, but it was cut by $100 million in a compromise with the Republican-controlled House.

“The reality is that, for so long, mental health services were chronically underfunded and it is just going to take a lot more work, a lot more investment to get it right,” Deeds said.