For Region Ten, more money means more responsibility

For Region Ten, more money means more responsibility

 First in a two-part series on mental health reform

Spurred by last year’s mass shooting at Virginia Tech, state legislators this spring unanimously passed a package of bills that will bring more people into a mental health care system that is already stretched thin. While the state gave the Department of Mental Health roughly $42 million—what has been called a “down payment”—local agencies are staring down a potential increase in referrals that would test staff capacity.

State Delegate Rob Bell, who chaired the mental health subcommittee, is hopeful that by treating those with mental health issues sooner it will eventually require less “rock bottom” care.

The new legislation relaxes the standard of involuntary commitment, lowering the level of perceived threat needed to detain a person at risk of harming themselves or others. Under the new standard, says Delegate Rob Bell, a sponsor of the legislation, the state can now involuntarily commit a person before they “hit rock bottom.”

“There was pretty broad consensus that the current standard …was not working,” says Bell. “This very, very jagged care—that you can’t go in until you hit rock bottom—certainly wasn’t serving the therapeutic model, it wasn’t serving the public safety model and it wasn’t doing a whole lot for the civil liberties side.”

Making it easier to involuntarily commit a person means more people in the system. And that decision made at the state level will trickle down to community services boards (CSB), the local providers for mental health services. Region Ten serves as the CSB for the city of Charlottesville and the counties of Albemarle, Fluvanna, Louisa and Nelson. Robert Johnson, the executive director of Region Ten, says that while he’s happy to receive extra funding in such a dry year, the new commitment standard could stretch his resources razor thin.

“The expectation is that broadening the language means that more folks will be caught in the net of needing services,” he says. “We’re very happy to receive the additional dollars in a bad year. We’re expecting those dollars will increase the number of folks referred to our services. It’s probably going to test our case-management resources, to handle the mandatory outpatient requirements.”

While he’s pleased about $42 million more in state mental health spending, Region Ten Executive Director Robert Johnson is expecting an increase in referrals that will “test our case-management resources.”

While the standard of commitment will be relaxed, the maximum commitment time will drop from 180 days to just 30. Quicker turnaround means more recommitment hearings, which must now be attended by a Region Ten staff member under the new legislation. In 2005, Virginia Tech shooter Seung-Hui Cho was court-ordered to receive outpatient treatment, but no one followed up on that order.

In the past, says Johnson, Region Ten had attended roughly half the recommitment hearings because its presence wasn’t required and staff members had more important priorities. Requiring a Region Ten employee to attend all recommitment hearings will double the CSB’s workload. Factor in the increased number of recommitment hearings due to the lowered maximum stay, and Region Ten is in danger of being overwhelmed.

The extra money from the state will likely mean three additional positions for Region Ten. One of the positions will be a mandatory outpatient coordinator to track patients who have been ordered by courts to receive outpatient treatment.

Bell says that the legislation, while increasing the responsibilities of CSBs, also give them more flexibility. By catching people before they bottom out, the thinking goes, their recovery time—and time spent in the mental health system—will be less.

“There’s some hope—and we’ll have to see how this plays out—that a little earlier care before someone hits rock bottom might enable you to smooth out the lows,” says Bell, “and, over the course of five years, not increase overall care that much.”

Bell says that the $42 million is “significantly more” than the costs incurred by the changes in commitment standards and additional oversight. In the midst of a statewide budget crunch, the millions coming from Richmond are nothing to sniff at. But the mental health system, which for years has been underfunded, must now find a way to expand its services.

“Everyone knows we need more dollars,” says Johnson. “And we know we’ve got to do the job.”

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