Mental Health Study Group Receives Updates on Impact of COVID-19, Other Issues Affecting Behavioral Health System

November 20, 2020

The Joint Subcommittee to Study Mental Health Services in the Commonwealth in the 21st Century met electronically on November 16 to take stock of the effects of the pandemic on the state’s behavioral health system and to plan for possible legislative and budget initiatives for the upcoming 2021 legislative session, as well as to discuss the long-term future of the Joint Subcommittee’s work.

Subcommittee members received a briefing from Senate Finance and Appropriations Committee Legislative Analyst Mike Tweedy, who provided an overview of budget actions related to behavioral health funding during the April reconvened session and the recently-concluded special session. Due to the economic uncertainty caused by the pandemic, $441.9 million in health and human services-related funding was unallotted, or paused, during the April reconvened session, of which approximately $135 million was community-based mental health funding. The Governor’s August budget proposed to convert most of the unallotted funding into budget reductions. The legislature was able to restore $222.4 million in HHR spending, largely by offsetting the restored spending with expected savings in Medicaid managed care rates. Key funding restorations included $30.2 million to continue the rollout of STEP-VA services; $17.5 million to support discharge assistance planning to help individuals return home from state hospitals, and $7.5 million for pilot projects with private hospitals to reduce the census pressures on state hospitals, which continue to struggle with overcrowding. The legislature also provided $3 million to support community care or mobile crisis teams that will respond to behavioral health crises pursuant to the “Marcus Alert” legislation passed during the special session, as well as funding for state staff to implement the program.

Department of Behavioral Health and Developmental Services Commissioner Alison Land reported on the impact of the pandemic to state hospitals, which have struggled with growing numbers of admissions in the past several years. In order to mitigate the risk of COVID-19 spreading within the facilities, the Department has been working with Community Services Boards (CSBs) to assist in discharging patients who no longer have a clinical need for hospitalization. An Executive Order issued in August allows state hospitals an exemption from serving as the “bed of last resort” for individuals not under an emergency custody order if the hospital is already operating at 100 percent capacity – a provision which Commissioner Land acknowledged has caused some delays in admissions, but has not left anyone without a bed. Several hospitals have also had to close to new admissions temporarily due to COVID-19 outbreaks. Commissioner Land reiterated the need for community-based services to assist in individuals’ return home from state hospitals and to avoid the need for hospitalization; other elements of the Department’s strategy for census mitigation include workforce recruitment and retention efforts and work with CSBs and community hospitals to divert admissions. Commissioner Land provided an update on the status of STEP-VA, the state’s major initiative to offer a standard array of community-based services statewide. The budget signed by the Governor this week includes a restoration of approximately $11 million in funding for crisis services (mobile crisis and crisis dispatch), an element of STEP-VA that will also assist in implementation of the Marcus Alert legislation.

Jennifer Faison, Executive Director of the Virginia Association of Community Services Boards, shared an update on the CSBs’ work to ensure continuity of services during the pandemic. CSBs swiftly pivoted to providing services through telehealth, and will be assisting DBHDS with staffing the “warm line” that is assisting Virginians who are struggling with mental health needs during the pandemic. She discussed the importance of continuing to build on evidence-based models to support the goals of the Marcus Alert legislation.

Senator Creigh Deeds, who chairs the Joint Subcommittee, announced that the subcommittee’s three workgroups would meet in the coming weeks and decide on potential legislative or budget requests for the 2021 session. Since legislators will be restricted in the number of bills they may introduce in the upcoming session and the session may be limited in duration, the Joint Subcommittee’s initiatives may also be somewhat limited this year. Members also discussed the December 1, 2021, expiration of the Joint Subcommittee’s authorization, with several members expressing a desire to establish a permanent separate entity to work on mental health issues, rather than incorporating this portfolio into the work of another existing study commission.

VACo Contact: Katie Boyle

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