Many Not Sick Enough for Services

Funding Has Fallen for Those With Non-Severe Disorders

Funding for services for mentally ill people such as Seung Hui Cho has decreased nearly 10 percent in Virginia since 2000, eroding key programs for thousands of people with non-severe mental disorders, documents and interviews show.

For a decade, Virginia officials have increased state resources for the complicated needs of the severely mentally ill and patients recently discharged from state-run mental hospitals.

But that has come at a price. Money for people with less serious disorders, who live in the community but need mental health treatment, has been reduced after adjusting for inflation. These people are not eligible for Medicaid, the government health care program for the poor and disabled, because they make too much money or have too many resources, and they often aren't covered by private insurance.

In a handful of jurisdictions, almost exclusively in Northern Virginia and Hampton Roads, officials have tried to make up for inadequate state resources with local money. But in most cases, agencies have eliminated or reduced dozens of services, including outpatient treatment, leaving many to deal with their illnesses any way they can.

It is unclear how many people are affected by decreased funding because the state has no way of tracking those who seek services but don't receive them. But as Virginia officials sort out the future of the mental health system after last year's deadly shootings at Virginia Tech, one of the persistent challenges is how to allocate money for the vast and varied issues that confront the state's 118,700 mentally ill residents who receive community services.

Cho's rampage at Virginia Tech in April has heightened long-standing concerns among lawmakers, state officials and advocates that the system has funding holes and other problems that must be addressed. Now, for the first time in a decade, state officials have begun to address the shortfall for this population by appropriating money specifically for these kinds of outpatient programs.

Gov. Timothy M. Kaine (D) has included $42 million in the state's budget, including funds to expand the number of caseworkers and psychiatrists who can address people's mental health issues in their beginning stages.

State lawmakers have included budget amendments to add even more money. Those amendments will be considered today as lawmakers craft the budget. But because of the erosion of programs this decade, the state is still a long way from filling all the gaps in services for this group.

"The bottom line is that in most places, there's very often nothing available unless you're at rock bottom, coming out of a state hospital, or you show up and are basically a danger to someone else," said Byron Stith, a mental health outreach coordinator in Richmond who serves as a member of the state Supreme Court's Commission on Mental Health Law Reform.

Even as the General Assembly begins to modify the state code to address the gaps in the system exposed after Cho killed 32 people and himself, the major issue will be how to increase access to services. Until then, many argue, the system will continue to fail.

"Everything revolves around adequate funding . . . there's really no way around it," said Mira Signer, the Virginia director of the National Alliance for Mental Illness. "We have to find a way of helping prevent people from reaching a point of crisis, but we can't lose sight of those people who are most seriously at risk so that they don't become worse."

The overall impact of the change in priority over the past several years has been a drastic shift in who gets services in Virginia.