Fairfax's Ailing Poor Waiting
Seeing Therapists Takes Months; Housing, Years

By Bill Turque
Washington Post Staff Writer
Friday, March 17, 2006

If you are poor and mentally ill in Fairfax County, it can take you as long as six months to see a therapist. If you need a place in a group home, you could be waiting for years.

Those bleak assessments come from the Fairfax-Falls Church Community Services Board, an agency that operates mental health, mental retardation and substance abuse programs for the county on a $149 million budget.

Driving the prolonged waits for service are staff shortages and caseloads that are growing in volume and in the complexity of the problems patients present, according to agency officials, who delivered their annual report to the Board of Supervisors this week.

"We're in bad shape," John DeFee, director of mental health services, told supervisors.

Long waits for social services are a chronic problem for local governments. While Fairfax enjoys a reputation for efficient delivery of services, aid to those with the most acute needs, such as the homeless and the mentally disabled, has lagged. The sheer size of the county's population -- slightly more than 1 million -- and rapid growth have compounded those challenges.

As of March 1, according to agency records, 173 people were awaiting initial screening by therapists, and they might not see therapists for as long as six months. Once they have received diagnoses, patients can wait again, anywhere from two weeks to two months for placement in adult outpatient programs.

More than 660 people are seeking temporary or permanent spaces in group homes, where a wait for one of the 575 beds can run from eight to 10 months to "literally years," depending on the length of the stay, DeFee said.

"Quite frankly, it depends on whether someone moves out or passes away," he added.

The mentally ill aren't the only county residents struggling for access. Agency waiting lists show 344 adults seeking alcohol or drug treatment. The average wait is described as "variable."

Supervisors expressed dismay about the waiting periods and gave the Community Services Board 90 days to devise a plan to address the issue.

"I shudder to think that someone might have to wait six months for a diagnosis," said Supervisor Penelope A. Gross (D-Mason). Fairfax County provides about 55 percent of the agency's budget; Medicaid pays 22 percent. Advocates have long criticized the state's level of funding, which was 12 percent last year.

Dotti McKee, a Fairfax resident and advocate for the mentally ill whose 36-year-old son is severely mentally disabled, called the county's system "a nightmare." When her son was released from a state mental hospital this year, she was told it would be two years before the county could place him in a group home, she said. In the interim, she has found him rooms in private homes that she said are ill-suited to his needs. Once a month, he sees a county therapist for 30 minutes.

"The help is just not there," McKee said.

Agency officials say they are dealing increasingly with patients whose multiple medical problems and personal circumstances -- combinations of mental illness, substance addiction, poverty and homelessness, for example -- pose special challenges.

More than 83 percent of the 11,000 people who received mental health care last year have annual household incomes below $25,000. Most are either uninsured or underinsured.

Perhaps more vexing have been staffing problems. The agency's outpatient treatment centers in Reston, Alexandria and Annandale have a total of 11 vacancies for psychotherapists, case managers and nurses. Even before the vacancies emerged last year, therapists were oversubscribed, DeFee said, each carrying an average of 50 cases. That workload has expanded.

Although some agency staff members are among the county's highest paid employees (one psychiatrist made $286,886 with overtime in 2003, according to a Washington Post study of area government salaries), DeFee said recruitment and retention are increasingly difficult. Competition from the private sector and other government agencies, as well as the expense of living in Fairfax, are the main obstacles.

Other jurisdictions face similar problems, but to a lesser degree. Loudoun County, which serves about 2,000 mental health patients a year, had 45 adults seeking outpatient care as of March 7. The average wait is 33 days, although some patients have encountered delays of up to three months. Tom Maynard, Loudoun's director of Mental Health, Mental Retardation and Substance Abuse Services, said that the waits have been "a chronic difficulty" but that his agency tries to get everyone evaluated and into treatment within a month.

"It's been a mighty struggle," he said.

Montgomery County, which contracts nearly all of its mental health services to a network of nonprofit organizations, had no immediately available information on waits. However, a November 2004 county report said 140 people were on waiting lists.