Reform mental healthcare

Despite bipartisan efforts over the past two decades, Virginia continues to have a sub-standard mental health system out of keeping with the state’s reputation for strong management, its resources, and its commitment to help all Virginians reach their full potential.  As an experienced physician with training in psychiatry and long-time community leader on mental health care, Dr. Ralph Northam is committed to making Virginia a national leader in mental health diagnosis, treatment, and research.

Across the nation and in Virginia, mental health conditions and substance use disorders are afflicting towns and cities in every aspect of life, including schools, families, relationships, workplaces, and community spaces.

In 2013, mental illness cost $201 billion nationally in direct health care expenditures. Almost one in five Virginians suffers from a mental health or substance use disorder, affecting families and communities in every corner of the state.

Improving and expanding access

  • Making Virginia the national leader in the use of telehealth Northam will expand the use of telemedicine to improve access to treatment for mental health and substance use disorders by:
    • Supporting enhanced training models for telehealth and telehealth facilitated mental health services using virtual learning management solutions and hands on training.
    • Expanding models for integrated behavioral health services in primary care supported by telemedicine.
    • Building upon the soon-to-be launched Project Echo program for case conferences for substance use disorders to develop models for mental health and pain management.
    • Supporting Medicaid coverage for telehealth services in schools to include mental health services- only speech therapy via telehealth is currently covered under Medicaid with all other IEP related special needs services requiring in-person treatment.
  • Advocate for and enforce mental health parity Building on current efforts, Dr. Northam will work with the Bureau of Insurance to ensure that Virginia is in compliance with state and federal mental health parity requirements and that Virginians are receiving the behavioral health benefits covered in their insurance plans. In addition to helping Virginians access behavioral health care services in a timely manner, this will also ensure that safety net services are available for those without insurance.
  • Access all available federal dollars to improve access to care, building on efforts already underway to expand coverage for the seriously mentally ill.
  • Leverage the state’s certificate of need process to encourage private health systems to increase their community commitment to mental health care when seeking approval of high margin services such as diagnostic imaging or ambulatory surgery.

System reform and accountability

Mental Health America ranks Virginia 38th in the nation on mental health care.  In part due to its reluctance to seek federal funds, whether through Medicaid expansion or other strategies used in both expansion and non-expansion states, and the commonwealth spends only 52 percent of the national average on community based mental health care. In order to modernize the system to reflect the needs of Virginians, Dr. Northam will:

Build upon and expand the current work being done in Virginia to transform and modernize the mental health system.

  • Standard services across the state The legislators on the Deeds Commission, the Department of Behavioral Health and Developmental Services (DBHDS), Virginia Association of Community Services Boards and many stakeholder groups have made progress in identifying a blueprint for a standard set of behavioral health services and have sought ways to increase access and accountability in the state’s public behavioral health system, most notably STEP VA.
    • Dr. Northam will work with these stakeholders to continue support and development of these efforts so that all communities in Virginia offer the same high quality services to any Virginian in need of care, regardless of ability to pay.   As part of this effort, less well performing community servicers boards will be encouraged to merge or partner with better performing CSBs in their region.
  • Right-size the footprint of state hospitals while maintaining needed beds and reinvesting in the community As Virginia focuses on expanding community-based services, the state must simultaneously work to decrease the rising state hospital census and sell excess property and close unneeded buildings to focus on providing both needed bed and needed community supports.  Any savings will be reinvested in the system.
  • Housing as health care Housing is one of many social determinants of health that plays a key role in an individual’s needs.
  • Support DBHDS and the Department of Housing and Community Development (DHCD) in their efforts to expand the availability of permanent supportive housing and encourage similar public-private partnerships with heath systems and other community partners.
  • Treat mental health as an illness not a crime People in jails have higher rates of chronic behavioral and physical health conditions than the general population. Approximately 63 percent of men and 75 percent of women entering jails display symptoms of a mental health disorder. After discharge, lack of ongoing treatment contributes to relapse and jail recidivism.  Work with public safety agencies to get mentally ill people needed services including jail diversion and increased discharge planning, not a jail cell.

Strengthen accountability to ensure that resources are used efficiently to expand system capacity and simultaneously improve the quality of outcomes.

  • Measuring outcomes and performance Support current work to identify appropriate and meaningful public outcomes and performance measures to enable all Virginians to receive the same quality of care and expectation of wellness. Use performance outcomes to guide decisions about merger of poorly performing CSBs with higher performing ones.
  • Increasing accountability and transparency Request that the Department of Behavioral Health and Developmental Services update the Community Services Boards Performance contracting process to require Community Services Boards to submit plans on how they can meet capacity and required outcomes measures, thus enabling DBHDS to provide targeted assistance to CSBs and to take action prompt when CSBs do not perform. Implement the same type of performance expectations on state agency staff.
  • Ensuring crisis bed availability at all times An important achievement in Virginia’s mental health reform was 2014 legislation that ensured that no person in crisis needing hospitalization would be turned away due to lack of bed availability. This has led to a steep rise in state hospital census. Work with DBHDS and stakeholders to update bed of last resort legislation to ensure Virginians in need of crisis treatment can continue to receive quality, effective services as they begin their journey to recovery. Set a zero tolerance policy for performance failures that prevent access to needed services.
  • Re-establish an independent quality of care oversight office, reporting directly to the Governor’s Office with responsibility for state facilities, community services boards, and mental health services offered by jails and state correctional facilities. Provide all needed access to records, interviews, and other information required to provide effective oversight.   Appoint a qualified physician to head this office, whose role will be distinct from the “green eye shade” financial auditing done by the State Inspector General.

Focus on children

Increase the focus on adolescents and young adults, the populations in which the first episodes of mental illness often occur.

  • Transition age youth Support the work of DBHDS and stakeholder partners in increasing availability of evidence based early intervention and treatment models such as “First Episode” tailored to the unique needs of young adults, ages 16-24.
  • Family peer supports Promote the use of family peer recovery supports to help families access a wide range of information, care, and resources from families who have experienced similar challenges.
  • Create the Pediatric Mental Health Collaborative. The Collaborative will leverage expertise from stakeholders around the state including the Virginia Academy of Pediatrics, the Children’s National Health System, and our schools, state agencies, and other partners to design and implement a series of pilot programs creating child mental health access teams. These teams will respond in real-time to pediatricians who need assistance managing their patients’ mental health needs by providing clinical mental health consultation.
  • Leverage the state’s substantial investment in a new Virginia Treatment Center for Children to develop a word class children’s mental health care system in the commonwealth

Combat stigma of mental health

Dr. Northam will use the Office of the Governor to combat the stigma of mental Illness. Mental health care should be treated in the same compassionate manner as physical health care. The stigma around mental health care has persisted too long and needs to end, starting here in Virginia.

  • Anti-stigma campaign Work with Virginia universities and community partners to develop public awareness campaigns and materials, issue public service announcements, promote Mental Health Awareness Month and Mental Illness Awareness Week, and use those efforts to conduct outreach for behavioral health services.
  • Mental health first aid Promote the use of Mental Health First Aid Trainings in schools and university settings for administrators, educators, families, and students as much as possible.


For Virginia's Future

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