FOR MENTAL-HEALTH CARE SYSTEM, MUCH-NEEDED HELP IS ON THE WAY
In the midst of budget woes, legislation supporting mental-health care survives cuts.
By Doug Childers

Gov. Timothy M. Kaine proposed that $42 million of his two-year budget be spent on increasing mental health services and outpatient care.

When he became a state senator five years ago, Ken T. Cuccinelli II saw an opportunity to help improve Virginia’s mental health care system.

“I’m a court-appointed attorney in patient commitment hearings,” said Cuccinelli, a Republican from Fairfax. “I’m the only member of the General Assembly who works in the mental health care process. So I’ve been seeing firsthand the many shortcomings of the system.”

Getting mental health care bills passed wasn’t easy, though.

“If you look at the amount of money spent per capita, Virginia ranks near the bottom” for mental health care, said Paula Price, executive director of Mental Health America of Virginia. “Some of the services we offer are innovative, but we have a long way to go.”

This year is different. Gov. Timothy M. Kaine proposed that $42 million of his two-year budget be spent on increasing mental health services and outpatient care. And while the commonwealth’s budgetary woes have put the brakes on a number of bills, mental health-related legislation has survived largely intact, due in part to last year’s shootings at Virginia Tech.

“If you look at the budget process so far, the one thing nobody has really disturbed is the $42 million of spending for mental health care,” Cuccinelli said in late February. “Everything is on the table except that.”

He added that “99 percent” of the motivation behind this year’s mental health care-related legislation was driven by the Virginia Tech shootings. “Virginia Tech brought unfortunate but much needed attention to our mental health system.”

Inadequate funding for mental health care in the past wasn’t a sign of inadequate legislative support, said James Reinhard, M.D., commissioner of the Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services. “There are strong advocates for mental health in the General Assembly.”

“There are so many people who can’t get care. There aren’t enough beds or case managers. People go in with an immediate problem, and they can’t get care for 30 days.” Paula Price, executive director of Mental Health America of Virginia.

He added, “As much a tragedy as Virginia Tech was, people in the system were aware that there were problems in mental health care” before the shootings. The Virginia Tech shootings thus became “an example of what we had to fix.”

Cuccinelli sponsored 21 bills that addressed mental health issues in this year’s session of the General Assembly. Nine were rolled into an omnibus bill that was unanimously approved in early March.

The money that will be infused into the system is good news for mental health care providers, Price said. “It’s a matter of access and services being available, particularly with community service boards. They have not been able to meet the demands put on them.”

Access to care “is a huge issue,” she added. “There are so many people who can’t get care. There aren’t enough beds or case managers. People go in with an immediate problem, and they can’t get care for 30 days.”

Depending on how the funds are allocated, this year’s legislation could have a positive impact on the drive to attract nurses to careers in mental health care. Currently, less than five percent of the work force of registered nurses work in the field of psychiatric nursing, said Elizabeth Merwin, Madge M. Jones professor of nursing in the University of Virginia’s School of Nursing.

“We in mental health are always in competition with all areas of nursing to recruit and retain nurses,” Merwin said.

Virginia suffers from two sorts of shortages in psychiatric nursing, she added: “One when there’s a position and it’s difficult to fill, and the other when there’s a need for a position but no funds to pay for it.”

If the funds generated by this year’s legislation create new positions for psychiatric nurse practitioners and psychiatric clinical nurse specialists as well as for generalist psychiatric nurses,

“This could go a long way to filling much-needed positions in the community,” Merwin said.
Virginia’s state-run mental hospitals employ 614 registered nurses and 300 licensed practical nurses, according to the Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services.

While she lauds the good intentions behind this year’s bumper crop of mental health care legislation, Price worries that it may have a downside, as well.

“Some of the legislation has been promoted because of the desire to protect the public from people with violent tendencies, and people with mental-health issues have been unfairly put into that category,” she said. “The fact of the matter is that people with mental-health issues are more often the victims of crime rather than the perpetrators of crime.”

Besides, Price said, while this year’s legislation will help mental health care in the commonwealth, the work is not finished. “Can we say it’s done? I certainly hope not. We have a million miles to go yet.”