Youngkin official calls for redesign of mental health services

Virginia's new Chief Transformation Officer's work so far has focused at speeding up unemployment insurance benefits and cutting waiting times at the DMV — and now he's looking at a redesign of the state's mental health services.

In a report to Gov. Glenn Youngkin and the chairs of the General Assembly money committees, Chief Transformation Officer Eric Moeller said he will direct $1.3 million to the Department of Behavioral Health and Developmental Services for that redesign effort.

He is looking for proposals about the structure and operation of Virginia's mental hospitals — the department operates eight for adults and one for children and teenagers.

For decades, advocates, state legislators and even some state officials complained that Virginia spends too much of a limited mental health budget on hospitals and not enough on community services.

But the political challenge of closing large institutions each with hundreds of employees has limited the state's options.

More recently, Virginia's "bed of last resort" law and sharp rises in patients after courts send people charged with crimes to state hospitals, have filled some of the facilities to capacity, and in some cases beyond.

Moeller also wants a look at how the behavioral health department delivers regional services, as well as at the work of the 40 Community Services Boards, which state and local governments jointly fund.

The boards are responsible for providing services in communities — everything from responding when individuals threaten suicide and offering outpatient services to running group homes and having teams of doctors, nurses and social workers who make daily or even more frequent visits to individuals with illnesses so severe that they would otherwise have to be in a hospital.

Virginia's underfunded mental health system has been a challenge for legislators and governors for decades.

A General Assembly joint commission has been digging into the mental health system's challenges and pushing reforms through the legislature for eight years.

Its efforts so far include laws aimed at stopping "streeting" of people with mental illness — that is, giving up on finding hospital beds for people in crisis.

Another law pushed by the commission tries to make sure access to critical care doesn't depend on where an individual lives.

This law requires all CSBs to offer nine essential services, including same-day assessment for people with significant mental health issues, crisis services, primary care screening and outpatient services.

Pressing the legislature to fully fund this effort and to tackle the chronic and worsening shortage of direct care staff has been another major effort of the commission.

"Afraid there has not been much discussion of the Administration's plan," said state Sen. Creigh Deeds, D-Bath, who launched the legislature's commission after his son's suicide in 2013 when he was unable to find a place for care in a crisis.

"Earlier this year, the Commissioner advised me they were thinking about a decentralization plan, but I have not been privy to the details," added Deeds, referring to the commissioner of the Behavioral Health department.

State Sen. Monty Mason, D-Williamsburg, another member of the commission, said it has been working hard to shift Virginia's mental health spending split, now at 70% for institutions and 30% for community, to look more like the rest of the nation, where the split is more like 30% for hospitals and 70% in the community.

"It's always good when a governor is interested," he said. "I just hope they look at the reviews and work we've been doing, and don't just try to start from scratch."

Moeller's redesign proposal, meanwhile, will also focus on the department's services for people with developmental disabilities.

Virginia has closed all but one of its institutions for these individuals and has stepped up funding for community supports.

It did so to settle U.S. Department of Justice findings of civil rights violations by keeping people in more restrictive situations than were necessary.

Moeller's report also details plans to direct nearly $2 million to a two-phase effort to improve the way the state buys goods and services, with an eye to securing "quick win savings."

The plan calls for $1 million for a consultant to help describe a strategy for the Virginia Economic Development Partnership and $300,000 for a pilot program to develop common tools and language for state employee performance improvement plans.

He's also looking to direct a total of $870,000 for follow-up work to improve customer service and reduce the amount of manual processing of paperwork at the Virginia Employment Commission.

There will also be follow-up work at the Department of Motor Vehicles to enhance customer service, improve management tools and reduce operating costs.

In addition, he wants to use $1.3 million to create a pool of project management experts who can be dispatched to help agencies with high-priority programs.

Youngkin created the chief transformation officer post in a January executive order to "drive changes improving the effectiveness and efficiency of our government through tracking key performance metrics." The officer serves in the governor's Cabinet.

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