The proposal — intended to shore up a strained behavioral health system that serves as a public safety net for people in need of care — is one of many changes, including $1 billion in tax cuts, that Youngkin wants to make to the two-year budget lawmakers will consider when they meet in Richmond in mid-January.
“We face a level of mental health and substance abuse use issues never seen before, all too often resulting in violence, suicide and murder,” Youngkin said in a video of the announcement made at a suburban Richmond hospital. “The behavioral health crisis is not unique to Virginia but let’s be clear, here in Virginia we are in crisis.”
Virginia’s state-run psychiatric hospitals have been stressed for years. Officials last year closed several public hospitals to new admissions when the pandemic exacerbated overcrowding and staff shortages. Youngkin’s plan aims to provide precrisis, crisis and recovery services to patients before they need inpatient psychiatric care.
On Monday, his office created a Prompt Placement TDO Task Force to quickly find services for people court-ordered to crisis care who often languish in emergency departments for days, require constant law enforcement minding and may be transported far from their families and support systems when a bed is available.
Youngkin announced his behavioral health initiative, called Right Help, Right Now, at Parham Doctors’ Hospital, a campus of Henrico Doctors’ Hospital, operated by HCA, which hospital officials say is the largest private provider of mental health care in the state.
Public and private hospitals have been at odds over who is responsible for patients with nowhere to go; private hospitals admit the highest number of patients in crisis, but mental health advocates say they avoid the most challenging cases, leaving a state hospital to handle violent and agitated patients.
Youngkin said the scale of the problem is huge: jails, emergency departments and hospitals are seeing too many people in crisis and law enforcement, teachers and health-care providers are overwhelmed. He lamented Virginia’s ranking of 48th in the nation in youth mental health, which plummeted from 21st the previous year, according to data from Mental Health Virginia. The rating is based on several factors, including the number of young people with at least one major depressive episode in the past year, the number of those who did not receive mental health services and the number with private insurance that did not cover mental or emotional problems.
Virginia’s reform efforts have long been driven by tragedies that thrust the state into the national spotlight: a high-profile shooting in 2007 by an unstable undergraduate student who killed 32 people at Virginia Tech; the 2013 suicide of state Sen. R. Creigh Deeds’s son, Gus, who attacked his father after efforts to secure emergency mental health treatment fell through. Last month a man colleagues said displayed troubling behavior fatally shot six people at a Chesapeake Walmart.
John Littel, Youngkin’s secretary of health and human resources, said in an interview Thursday that the plan was informed by months of meetings, surveys and a comprehensive review of recommendations of the Behavioral Health Commission, informally known as the Deeds Commission. In the fall, the state hired McKinsey consultants to complete the work.
The plan is inspired by the Arizona model, which links crisis hotlines, mobile crisis units and intake centers like the kind Youngkin proposes expanding to deliver care in the first 24-hours of a mental health emergency, Littel said.
Littel acknowledged staffing would be a challenge, but said it’s too soon to say how many people must be hired; a detailed implementation plan is scheduled to be completed early next year, including a dashboard tracking initiatives.
“We recognize that it’s going to take some really extreme efforts to ensure that we have a pipeline,” he said. “I don’t think we have any magic wand here.”
Anna Mendez, executive director at the Haven, a day shelter and homelessness services provider in Charlottesville, said she was hesitant to downplay the potential for transformative change but noted that next steps would be critical. For example, although the plan includes $8 million for housing for 100 people with serious mental illness, she said that without qualified discharge planners to place clients “100 new slots won’t matter.”
“What is left to be determined is are we willing to invest in paying people enough money that they’re going to want to do the work to make this happen,” she said.
Deeds (D-Bath) said he was impressed by the level of engagement from Youngkin, who called him Saturday to fill him in on the plan, but said two or three times as much funding is needed to address the dearth of services, including the workforce shortage. Statewide, the agencies that form the spine of Virginia’s public behavioral health system, community service boards, have a 28 percent vacancy rate, he said.
Last year, about $100 million for behavioral health, including $37 million in CSB pay increases, was cut out of the final budget in compromises made to achieve the governor’s tax cut, Deeds said.
He questioned if the scope of the plan was sacrificed to pay for part of his proposed tax cut.
“He says we’re going into a recession, so their idea maybe of a big, bold plan has to be looked at in that context,” Deeds said. “They want to do other things so this plan doesn’t appear as bold as maybe they would want it to be.”
Deeds said he hopes Youngkin’s plan is the floor of what the legislature will spend on bolstering public behavioral health services.
“I will work like the devil for more,” he said.