Aid to Poor Improving, but Caseloads Still High

By Bill Turque
Washington Post Staff Writer
Sunday, November 19, 2006

The Fairfax County agency that operates mental health programs says it has eliminated a waiting list of low-income adults seeking treatment, but warns that the improvement could be short-lived if heavy therapist caseloads are not reduced.

The Fairfax-Falls Church Community Services Board reported this year that as of June 1, 314 people faced waits of up to six months for initial mental health screenings -- nearly double the 173 awaiting service March 1.

In an Oct. 31 memo to County Executive Anthony H. Griffin, the Community Services Board's executive director, James A. Thur, said recently filled staff vacancies, several newly created positions and rehiring of retirees enabled the agency to wipe out the backlog.

According to the memo, adults and children with psychiatric emergencies can now expect immediate responses from clinicians. Those with non-emergency conditions will be seen within 16 days -- higher than the nationally accepted standard of two to 10 days, but an improvement from last June.

"Excellent progress has been made on the wait for services compared with June 2006," Thur wrote.

Supervisor Penelope A. Gross (D-Mason), vice chair of the Board of Supervisor's human services committee, said the Community Services Board's report was "a step in the right direction," but that she wants to be assured that recent progress is more than a temporary gain.

"My skeptical side says we need to see more of a sustained effort," Gross said.

Thur said the recent gains are at risk if clinical caseloads are not reduced. Community Services Board clinicians each carry 40 to 58 patients, far above the national standard of 25.

"Caseloads are growing to unacceptable levels, and this must be addressed in order to maintain the progress that has been made," Thur said.

The agency plans to ask for more money to hire additional clinicians next year.

Heavy caseloads are one of several vexing issues facing the board. The Washington Post reported last week that 19 severely mentally ill people whose families sought treatment were released from involuntary confinement because there were not enough independent psychologists to perform examinations. When the Community Services Board began using its own psychologists and social workers for the evaluations, a panel of Fairfax justices ruled that the organization was not sufficiently independent, because they could ultimately be involved in the patients' future treatment. The justices ordered the patients released.

The agency's difficulties prompted supervisors this year to empanel a commission to investigate mental health services in the county. The Josiah H. Beeman Commission, named after the late Community Services Board chairman, is expected to deliver an interim report in the middle of next year.

Mental health, mental retardation and substance abuse treatment in Virginia is provided through a network of community boards. Fairfax County underwrites about 55 percent of the Community Services Board's $137 million annual budget, with Medicaid and the state providing the rest.

The county's growing population and changes in the health-care industry have strained the Community Services Board's ability to serve those in need. More than 83 percent of the 11,000 Fairfax residents who received mental health care in 2005 had household incomes below $25,000 a year. Most were uninsured or underinsured.

Because most nonprofit mental health service providers don't provide medication and don't accept Medicaid patients, Thur said, demand for the Community Services Board's assistance will continue to grow.

"The [board] is finding itself as the default provider of mental health and substance abuse services for a growing number of uninsured and underinsured persons," he said.

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