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Virginia No. 38 in Mental Health America ranking

Richmond Times-Dispatch - 10/26/2016

This is how Virginia ranked among states and the District of Columbia in several categories studied by the nonprofit Mental Health America. A ranking of 1 is the best and 51 is the worst.

Virginia:

Overall ranking: 38

Prevalence of mental illness: 32

Access to care: 38

Youth with severe major depressive episodes: 47

Youth with major depressive episodes who did not receive mental health services: 49

Adults with any mental illness: 16

Adults with any mental illness who did not receive treatment: 10

Source: Mental Health America

Youth who are battling depression in Virginia are among the least likely in the nation to receive treatment for their mental illness, according to a study released recently by a national nonprofit group.

Only one out of four Virginia youth suffering from major depression is treated - a rate that falls below all but two other states, according to Mental Health America's annual rankings of mental health systems across the country.

Virginia's untreated youth was one of the biggest factors that led to a precipitous drop for the state in this year's overall ranking, which was released at a time when lawmakers are meeting to discuss ways to improve the system.

Mental Health America downgraded Virginia to 38th among states in its overall category, which takes into consideration the prevalence of mental illness among residents and their ability to access care. The report is based on 2014 data, the latest available. The commonwealth was ranked 27th in 2011.

"There's no question that Virginia needs to strengthen its community behavioral health system," said Dr. Jack Barber, interim commissioner of the state's Department of Behavioral Health and Developmental Services, which oversees the mental health system. "Whatever the report says, I think it's pretty clear that we have some work to do in Virginia, and we've been talking about this for what feels like most of this calendar year."

The General Assembly'sJoint Subcommittee Studying Mental Health Services in the Commonwealth in the 21st Century meets today at the Capitol to discuss its legislative goals for the next session, which begins in January. Also on the agenda: a review of the investigation into the death of Jamycheal Mitchell, a mentally ill 24-year-old who died last year at Hampton Roads Regional Jail.

Bruce Cruser, executive director of Mental Health America of Virginia, said the state spends only 52 percent of the national average on community-based mental health care.

"No wonder we rank in the bottom quarter of all states in meeting the needs of those with mental health challenges," Cruser said. "Jamycheal Mitchell's tragic death in jail last year illustrates what can happen if we don't change our priorities."

Mitchell, who had been diagnosed with schizophrenia and bipolar disorder, died in August 2015 after losing 46 pounds in 101 days at Hampton Roads Regional Jail.

He was supposed to be transferred to a state mental hospital for treatment, but never made it because his paperwork was stuffed in a drawer by an "overwhelmed" hospital worker.

Several experts said this week that there are significant gaps in Virginia's system and that government officials and the General Assembly are working to close them.

Barber said the state is working on a plan to improve access to care, the quality of the services rendered, the consistency of the services offered in communities across the state, and how performance is measured.

The department can make some of the changes in-house, but many of them will require the General Assembly to allocate extra money for programs.

"We need to be able to reach people sooner, rather than wait until they're in a crisis," Barber said. "It's really just as simple as that."

When lawmakers convene in January, they will be tasked with adopting a budget in the face of a $1.48 billion revenue shortfall. Barber said it's too early to tell whether lawmakers will be willing to dedicate additional resources to mental health services.

Barber said that if the assembly chose to expand Medicaid, $200 million would be available to Virginia to pay for programs that include behavioral health care.

The issue is politically fraught - Gov. Terry McAuliffe has steadfastly supported the expansion of Medicaid, but lawmakers have not - but Barber said there's no doubt that it would bring more money into the state.

"It would be a much lighter lift if the state were to adopt that," Barber said.

Half the people seen by community services boards - often the first facilities to interact with people in mental health crises - have no health care coverage, Barber said. If Medicaid were expanded, that number would be cut in half, he said.

Theresa Nguyen, senior director of policy and programs for Mental Health America, which published the rankings of mental health systems, said states that had agreed to expand Medicaid performed better than states that did not.

Virginia's specific issues hinged on residents' access to care, particularly for young people, Nguyen said.

"Either they don't have health insurance, or there's not sufficient treatment," she said.

Nguyen used to be a therapist in Virginia, and she recalls times when she was unable to locate psychiatrists willing to follow up with her patients, including at least one who had just attempted suicide.

Virginia ranks 40th in workforce availability, according to Mental Health America's study. Nguyen suggests the state focus on workforce development and create incentives to encourage professionals to become therapists, psychologists and psychiatrists.

When patients have little to no access to professionals for continuing care, they wind up back in crisis and back in the mental health system, said Dr. Martin Buxton, chief of psychiatry at CJW Medical Center and medical director at Tucker Pavilion, its psychiatric wing.

"I've talked with people who are overwhelmed because they can't get a doctor's appointment for a week or more than a month," Buxton said.

The community services boards do not have any medication to give them, so they wind up relapsing, he said.

Ann Benner - who for 12 years has worked for VOCAL, a nonprofit for people who have experienced mental illness - said the state has the tools to fix Virginia's system, but finding money to pay for the programs is a challenge.

VOCAL is largely funded by a grant administered by the Department of Behavioral Health and Developmental Services.

"We have an old-fashioned system that is based more on treating people in state hospitals, treating people after they experience a major mental health crisis and have to be hospitalized," Benner said. "The more current way of addressing mental illness is in the community. People can't get well and figure out how to recover and get their lives on track while they're in the hospital."

skleiner@timesdispatch.com

(804) 649-6601Twitter: @sarahkleiner9