Budget battle over mental health reform

Lawmakers in Richmond are deep in budget negotiations and will soon decide which parts of the mental health-care system will receive a funding boost. The House and Senate proposals have a number of differences, and what emerges will likely be a mash-up of the two. Here is a short summary of the major proposals in play:

Bed registry: That an online registry of state psychiatric beds is only starting in 2014 is somewhat baffling. It was in the works before the death of Austin “Gus” Deeds, son of Sen. R. Creigh Deeds (D-Bath), that galvanized reform efforts this year, but wasn’t ready in November to help local mental health workers find him a psychiatric bed in time. It finally went live Monday, state officials announced Tuesday morning. Both the House and Senate have budgeted the same amount of money to support the registry, roughly $234,000 over the next two years.

Therapeutic “Drop off” Centers: These are secure facilities scattered throughout the state where people can be evaluated. They free up law enforcement, who are required to stay with a person getting a psychiatric evaluation under an emergency custody order. The Senate would devote $5.4 million to fund additional centers over the next two years, on top of the governor’s proposal. The House would devote $2.7 million.

Program of Assertive Community Treatment Team: In addition to the governor’s proposal, the House has proposed creating more of these intensive case work and service teams that have been shown to help keep the mentally ill out of hospitals and prisons. In addition to what the governor has proposed, the House has budgeted an extra $1.9 million over two years; the Senate has not put in more funds.

Permanent supportive housing: The Senate wants to increase the number of permanent housing spots for mentally ill adults by 100, and has allocated roughly $2.44 million toward that end. The House has not.

Children’s mental health: The Senate wants to put an additional $1.5 million over two years toward expanding access to mental health care for children through child psychiatry and crisis response services. The House bill has no parallel proposal.

Discharge assistance planning: The Senate has proposed increasing money to this program to help place 50 to 60 of the most difficult to discharge patients in state hospitals back into the community, thus freeing up much-needed hospital beds. It has allocated $2.25 million over two years. The House has not proposed any additional funding for this.

Bed of last resort: On top of what the governor has proposed, the House wants to spend $8 million over two years on more beds for people being treated under a court-issued Temporary Detention Order. The Senate has proposed $4 million to help state facilities to act as a “bed of last resort” when a willing hospital can’t be found before the legally allotted time limit runs out.

Annys Shin has been a staff writer at the Washington Post since 2004.

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Emma Brown · March 4, 2014