By Chris L. Jenkins and Fredrick Kunkle
Washington Post Staff Writers
Monday, January 19, 2009
First in a series of reports that explores the impact of budget cuts being contemplated by elected officials in Maryland and Virginia this session.
For years, when some of Virginia's most troubled children have been struck by serious psychiatric problems, their most likely destination has been the low-rise brick building on a sprawling campus in the Shenandoah Valley that is home to the Commonwealth Center for Children and Adolescents.
"We're the place where kids can come when they can't go anyplace else," said Jeffrey Aaron, forensic coordinator and clinical director of an adolescent unit at the Staunton center.
Now the 48-bed, state-run facility has been identified by Gov. Timothy M. Kaine (D) as a place the state can do without. To help close a $3 billion budget gap, he has ordered the elimination of the center and a 16-bed hospital unit in southwestern Virginia that provides similar care.
The proposal, which has kicked up protests from a broad coalition of mental health experts, advocates and lawmakers, is a stark reminder of all that might be lost as governors and lawmakers in Virginia and Maryland grapple with the agonizing budget choices before them.
Cutting this one line in the Virginia budget would save $7.6 million annually, a small slice of the savings being sought. Cuts will impact spending across the board, including money dedicated for transportation, education, the environment, health care and public safety.
Virginia officials contend that the services the mental health center provides can be better offered at private hospitals that have psychiatric wards for children. Currently, children are sent to the Commonwealth Center when private hospitals won't or can't care for them: when a child is too violent or lacks insurance, for instance. Sometimes, children arrive from juvenile correction facilities for short stays or psychiatric evaluations. Other times, the children are ordered there by a court.
State officials argue that because children stay at the center for short stretches, beds often go unused. With 600 patients, the average occupancy rate in fiscal 2008 was 70 percent. Twenty-two percent of the children admitted last year were from Northern Virginia.
"We think there are ways to serve this population more effectively in the community with existing community resources," said James Reinhard, commissioner for the Department of Mental Health, Mental Retardation and Substance Abuse Services.
He said the state would continue to spend about $2.1 million annually for private hospital care for children without Medicaid or private insurance. More broadly, Reinhard said, the closing enables the state to continue moving those who struggle with mental health and mental disability from publicly-funded institutional care to privately-run facilities.
But the Commonwealth Center and the smaller hospital unit are home to the last public psychiatric beds for children who lack an adequate plan to find similar services elsewhere in the community. And advocates say its elimination would reverse recent gains made by the state to fix its troubled mental health system in the wake of the Virginia Tech massacre almost two years ago, such as increased funding for emergency care and additional therapists.
Advocates said Virginia officials have failed to address a key reality: Many private institutions do not admit and treat seriously troubled children. There are 224 beds available in private facilities across the state, including about 100 in Northern Virginia, for mentally ill adolescents. But many will not accept court referrals because they lack adequate security to care for potentially violent patients. Sen. Mary Margaret Whipple (D-Arlington) said that being able to find places for such children would be a major problem.
Others are concerned that the amount of money allocated for children without insurance won't be sufficient. Reinhard acknowledges these concerns but said he hopes that local mental health agencies will help pick up the slack.
Mental health experts said that the point of the center is to provide services to troubled children that the private sector can't handle. "Every institution has a mission, and the mission of this center is to be a safety net," said Bela Sood, head of pediatric psychiatry at Virginia Commonwealth University, who called the state's solution "a pipe dream."
Others point out that psychiatric services for children in Virginia are woefully underfunded and that the $2 million allocated for the private hospital plan would only exacerbate these problems. In fiscal 2007, 24 percent of the state's mental health clients were children and adolescents, but only 15 percent of the total funds were spent on them, state records show. Meanwhile the needs have increased: The Commonwealth Center's annual census has doubled in five years.
"This is an absolute step back from everything we've accomplished as a state over the last several years," said Mira Signer, executive director of Virginia chapter of the National Alliance for the Mentally Ill.