Is $42 Million More Enough?

Last week, Virginia Governor Tim Kaine announced his proposal for adding an additional $42 million dollars in help shore help the state's mental health system. The money is designed to add more case managers, psychiatrists, and other staff to the work force of the already overwhelmed and jaded public mental health system. This infusion was in direct response to the massacre at Virginia Tech this past spring. To be honest, I am not sure how I feel about this proposal. The Commonwealth of Virginia after years of budget prosperity is operating at a deficit to the point where the state began cutting operating budgets from five to ten percent. These cuts included the Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services (DMHMRSAS). People at that department were offered early retirement, positions empty locked, and positions simply abolished. So on one side to hear a proposal that adds $42 million to the system instead of no increases or cutbacks is a welcome sight. But, is it enough to save a sinking ship? Is it enough to eliminate the problem of the lack of inpatient psychiatric bed space for patients who truly need hospitalization who eventually stay in hospital emergency rooms for 24 to 72 hours at a time waiting for a bed? No, because the money is not meant for addressing the issue. Additionally, the proposed changes in the commitment law to lower the standard used to indicate the potential dangerousness of a patient diagnosed with a mental health or substance abuse condition will increase the number of individuals needing a hospital bed. With no increased bed capacity that will lead to patients who are evaluated and judged as dangerous waiting in hospital ERs and in many cases waiting at home with easy access to guns and drugs. Is it enough to significantly improve outpatient service capacity across the state? No, because there are currently forty community service boards (CSBs) across Virginia. If the $42 million was split evenly across all the boards it would add slightly over a million dollars to their budgets. The smaller Boards would be impacted significantly by this in the positive. The larger Boards would have the infusion of new money be just an insignificant trickle in their operating budgets. The money will likely be allocated based on the size of the Boards thus, sending additional money spread out very thinly across the state. It is also quite possible that the increase in funding for case managers could be offset by changes in Medicaid reimbursement for the service from the current monthly bundled rate to a strictly fee for service system that pays based on fifteen minute service increments. One colleague at a small CSB advised me that this change would result in a $2 million reduction in funds. That reduction would be greater at a larger CSB. In the end, the additional money to add more case managers, psychiatrists, emergency services clinicians, and other staff could reduce the long waiting lists for outpatient care, improve the monitoring and support for individuals in the community who suffer from a mental illness or substance abuse disorder, and provide more doctor time available for psychiatric patients. These are all welcome signs, but is it enough to make a difference? Is it enough to totally stop a Virginia Tech-like massacre from ever happening again?

In the end, I will support the increases as the increases are better than the alternatives. The alternatives are continued scant funding for mental health, substance abuse, and mental retardation services that puts Virginia at the bottom of the country in this area. The alternative is budget cuts that will make matters exponentially worse. The alternative is trying to keep the sinking ship afloat with less and less workers willing to stay in the field trying to shore up the holes. The alternative is ignoring the people that will be affected the most by what is decided: our consumers of behavioral health care.

Anyways, my mother taught me to never bite the hand that feeds me.