When people talk about improving Virginia’s mental health system, they inevitably return to one word: money. Money for treatment centers and hospital beds, money for staff, money for youth programs, money for housing. Money that has been cut significantly in recent years.
The major-party candidates for governor of Virginia agree that mental health systems need more resources. But their approaches differ greatly, based in part on how they view the Medicaid expansion of the new health-care law in Virginia.
Democrat Terry McAuliffe favors a Medicaid expansion wholeheartedly. He says it would provide new health-care coverage for about 400,000 Virginians and would increase money for mental health treatment.
Republican Ken Cuccinelli II opposes a Medicaid expansion completely and says McAuliffe’s estimates of its effect on Virginia are greatly overstated. Cuccinelli wants to increase state funding for mental health, but he would do so by shifting current Medicaid funds from other health-care areas. He also said he would target waste, fraud and abuse and use the savings to bolster options for the mentally ill and the intellectually disabled.
Cuccinelli has been personally involved with the mental health system. As a newly minted lawyer, he began volunteering to represent people with mental illness in civil commitment hearings. As a state legislator and attorney general, he worked to improve the commitment system, both after the 2007 Virginia Tech shootings and after a friend and neighbor, Fairfax County police officer Michael Garbarino, was fatally shot by a mentally ill teenager in 2006.
After the Virginia Tech shootings, in which a mentally ill student from Fairfax killed 32 students and teachers in 2007, the state General Assembly passed reform legislation. The emergency evaluation process improved; the standard for involuntary commitment was eased; mandatory treatment rules were tightened; and community mental health services were better funded.
But Virginia cut its budget for mental health services by 9 percent between 2009 and 2011, according to the National Alliance for Mental Illness. In Fairfax, the most populous jurisdiction in Virginia, the Community Services Board, which handles many cases of mental illness, lost $16 million in funding in the past five years.
Recent high-profile incidents in the District — including the Navy Yard shootings and the police shooting of a woman who appeared to try to breach security at the White House and U.S. Capitol — have cast a spotlight on mental health issues nationwide.
Although Cuccinelli’s platform seeks to cut state funding in many areas, he wrote, he took a different tack in a five-page analysis of the state's mental health system. “We need to actually commit to spending money on mental health reform,” he wrote. “This is an area where I am willing to invest funds to develop a high quality care program.”
McAuliffe estimates that accepting the Medicaid expansion would bring in $21 billion in federal funding and free up $500 million from the state’s general fund over four years.
Cuccinelli says he would rely on tort reform and reductions in the cost of liability insurance — in addition to “waste, fraud and abuse programs” and efforts to redirect Medicaid funding — to free up money for mental health care. He does not have a dollar figure on what such efforts would produce, but his campaign estimated that as much as 10 percent of state health-care spending could be redirected to mental health and intellectual disabilities if waste, fraud and abuse were eliminated.
Cuccinelli also favors revising Medicaid spending to shift more dollars to mental health.
The candidates agree that improving the mental health system will yield savings elsewhere in the state budget by reducing the costs of homelessness and hospitalization. They also agree that more mental health professionals are needed at all levels, from psychiatrists to mental health nurses, to improve the system’s responsiveness. Cuccinelli and McAuliffe support emphasizing and investing in higher-education programs to produce more psychiatrists and mental health nurse practitioners. Cuccinelli also supports streamlining the professional licensing process.
Housing for people with mental illness who do not need full-time care has always been a tough problem for social service agencies, and many homeless people suffer from mental illness. Cuccinelli proposes using “the auxiliary grant,” a little known means of supplementing Social Security payments for those in assisted-living programs or adult foster care. He says he would push to make greater use of the grant and to have the money distributed to individuals, rather than institutions, to be spent as the individuals see fit.
McAuliffe said he supports increased spending on permanent supportive housing, in which residents pay subsidized rent to live in houses or townhouses while stabilizing their lives and becoming established in jobs. The program is promoted by the Virginia Coalition to End Homelessness.
After the shootings at Virginia Tech, the state General Assembly eased the standard for involuntary commitment for mental health reasons, but the number of people committed for treatment did not rise. Cuccinelli wants the standard to be relaxed further, to a finding of “in need of treatment,” instead of demonstrating a “substantial likelihood” of harming the person’s self or others.
McAuliffe said he does not “believe the governor or legislature should be dictating to doctors and patients which types of treatment they should support.”