Category Archives: Mental illness and substance abuse

State Mental Health Plan Too large, Complex to Succeed?

by James C. Sherlock

I really want Virginia’s mental health program to work. It looks like a major struggle, however.

I will recommend a major change: state control of the Community Services Boards (CSB)s.  I think that will be necessary for the plan to have any chance of succeeding.

I have just finished reading a draft 409-page report to the federal government that describes planned efforts to expand and improve the state’s mental health care system. It has been developed by the Virginia Department of Behavioral Health and Developmental Services (DBHDS) for the signature of the Secretary of Health and Human resources.

Three things jump off the pages — all of the hard things are to happen going forward, the complexity of the program will be enormous and the state will not have enough control to make it happen.

Continue reading

Can’t Anybody Here Play This Game? Virginia’s 211 – Service or Crapshoot?

by James C. Sherlock

Sometimes the government of Virginia just makes you want to scream, cry, stay under the covers, whatever.

Navigating government and private social services agencies when you need help is hard, even more so a crisis. But it is way harder in Virginia than it needs to be.

To streamline the navigation process, the Federal Communications Commission in 2000 created 211, a number reserved for helplines that offer information or referrals to health and social support programs.

Given a layup, Virginia has clanged the ball off the bottom of the rim. Continue reading

Virginia’s Continuing Mental Health Crisis

Credit: Adobe clipart

by James C. Sherlock

I like government at every level to address only things it must. Then I want it to be world class in efficiency and effectiveness. It has been clear since the ’60’s that I am destined to be repeatedly frustrated on both counts.

We come to an old issue in Virginia, the shortage of appropriate treatment options for the mentally ill. The COVID-driven increase in mental illness has brought this issue back front and center.

Why is the Commonwealth so reliably awful when it comes to strategy, management and funding of state health programs? Even under federal court orders in the case of mental health?

Some of that is incompetence, but some is lack of interest — investigations and funding — by our governors and General Assemblies of both parties.

Most of us discovered the shortage in severe mental illness capacity in 2013 when Sen. Creigh Deeds’ son killed himself and injured his father. That incident that was preventable if there had been a psychiatric bed available.

That was not the first time the Commonwealth knew about it. There was that pesky federal investigation and court order. Continue reading

The Accelerating Scale of the Legislate-Regulate-Spend-and-Repeat Cycle Has Broken Government

by James C. Sherlock

Virginians – the state and individual citizens – have received over $81 billion in COVID-related federal funding. That comes to $9,507 for every man, woman and child in the Commonwealth.  Big money. 

That was Virginia’s share of $5.3 trillion in federal spending just on the pandemic (so far). A trillion dollars is a million million dollars. A thousand billion dollars.

For comparison, GDP was about $21 trillion in 2020  It is projected to total just short of $23 trillion this year.  The national debt is $29 trillion and growing. A little over $86,000 for every American. That figure does not include the $5 trillion in additional spending pending in the Congress.

Every day we spend $1 billion on interest with interest on the 10-year treasuries at 1.18% today. The Congressional budget office predicts 3.6% before 2027. Do the math. That is $3 billion a day — well over a trillion dollars a year — in interest. 

Relax. If you thought I was about to launch off on a discussion of drunken sailors, writing checks that our grandkids will have to make good, and the fact that inflation will drive interest payments ever upward, be reassured I am not.

This is about the demonstrated inability of many government agencies at every level to regulate, administer, oversee, spend and repeat with anything approaching efficiency or effectiveness.  Continue reading

COVID and Labor Shortages Are Aggravating Virginia’s Mental Health Crisis

Despite rising incidence of mental illness and substance abuse, admissions to hospitals in Virginia has trended lower in recent years. Something is broken. Source: Virginia Hospital and Healthcare Association

by James A. Bacon

The story made big headlines earlier this month when the Northam administration announced that five of the Commonwealth’s eight mental health institutions have stopped taking new patients. Two things are happening to make a chronically bad situation worse. First, the number of patients referred to state hospitals through Temporary Detention Orders (TDOs) has soared — from 3.7 patients per day in FY 2013 to 18 per day currently, or a 392% increase. Second, the hospitals are suffering staff shortages, in part due to the COVID-19 epidemic but also because “the level of dangerousness is unprecedented,” according to a letter from the Virginia Department of Behaviorial Health and Development Services to partners and providers.

“There have been 63 serious injuries of staff and patients since July 1 and we are currently experiencing 4.5 incidents/injuries per day across the state facilities,” the letter stated. Employees are quitting. One facility, the Commonwealth Center for Children & Adolescents, can safely operate only 18 of its 48 beds.

Similar supply-and-demand issues are spilling into the private hospital sector. Private psychiatric hospitals, which provide acute short-term care, are experiencing a similar imbalance between demand for psychiatric facilities and a labor shortage. Continue reading

Northam Administration Neglects Virginia’s Mentally Ill

by Kerry Dougherty

You would think that with a medical doctor occupying Virginia’s Governor’s Mansion, Virginia would have topped the nation in COVID testing and COVID-19 vaccine rollouts and would be setting the standard for care for the mentally ill.

You would be wrong on all counts.

At the risk of plowing old fields, Virginia was close to dead last in both COVID categories for months. Shoot, even former Gov. George Allen was forced to cross our Southern border — along with hordes of other Virginians — to get a vaccine in North Carolina back in February when the commonwealth’s vaccine program was a convoluted mess. Continue reading

Psst! We Have Some Beds for You

by Dick Hall-Sizemore

Something just does not seem right about this.

The Richmond Times-Dispatch reports today that the state has temporarily halted admissions to its mental health hospitals. In addition to being overcrowded, on Friday, Central State Hospital in Petersburg had more patients than beds, the hospitals have lost a significant number of staff and are struggling to replace them after COVID outbreaks in the hospitals.

But, wait! The private sector is coming to the rescue! The Virginia Hospital and Healthcare Association has announced that a private health system (unidentified) will make available 58 unused mental health beds (40 for adolescents and 18 for adults) to the state. Oh, yes, and, in exchange for $8.5 million in federal American Rescue Plan Act funding to pay for staff for those beds.

I could understand the state contracting with the private sector on a per diem basis to take in these patients. But, a $8.5 million payment up front seems a bit brassy. The state would be better off using that $8.5 million to pay recruitment and retention bonuses to bolster the staff in its own facilities.

Time to Take the Fentanyl Scourge Seriously

Funeral service for Jayla McBroom, victim of a fentanyl overdose. Photo credit: Washington Post

by James A. Bacon

Drug dealers are lacing opioids, marijuana and cocaine with  fentanyl in the Washington area, reports The Washington Post. The city medical examiner identified the super-addictive and often deadly drug in 95% of the 85 overdose deaths through March this year. Law enforcement authorities are seeing similar increases in fentanyl overdoses in Arlington and Alexandria as well.

Writes the Post:

Emily Bentley, Alexandria’s opioid response coordinator, attributes the recent spike to dealers lacing substances with the cheaper, more addictive fentanyl. She noted that unsuspecting marijuana users may be taking drugs laced with the synthetic opioid, broadening the types of drug users who could be impacted.

Society has not yet come to grips with the fentanyl scourge. If we thought crack cocaine was bad in the 1980s, fentanyl is worse. Fentanyl is cheap, like crack, but it is even more addictive — reportedly 50 times more potent than heroin. Dealers have discovered they can create a market for their product by mixing it with other drugs. Thousands of Americans are dying. Continue reading

COVID’s Latest Victims: Those Afraid to Return to the World

by Kerry Dougherty

If there’s one thing we can all agree upon it’s that mental health services are woefully inadequate in Virginia.

Our jails are filled with mental patients. So are our homeless shelters. Our state hospitals are so packed that they usually don’t have any beds available.

So, given the limited resources available, am I the only one wondering why mental health resources are being spent to help people who are afraid to come out from under their beds now that the COVID emergency is over? Continue reading

Virginia Nets $80 Million for Opioid Treatment

by James A. Bacon

Virginia’s Opioid Abatement Authority will get an $80 million shot in the arm (so to speak) from the resolution of a lawsuit pursued by Virginia Attorney General Mark Herring and his peers in 14 other states. The bankruptcy-court settlement with the Sackler family and its company Purdue Pharma requires payment of $4.3 billion nationally for prevention, treatment and recovery efforts across the country.

Additionally, Purdue and the Sacklers are required make public more than 30 million documents, including attorney-client privileged communications about the original FDA approval of OxyContin and tactics to promote opioids.

“No dollar amount will ever bring back the Virginians we have lost to the opioid crisis or repair the families that have to live with the devastating effects of losing a loved one, but this settlement is an important step in our ongoing efforts to combat the opioid crisis,” said Herring in a press release. Continue reading

As COVID Recedes, Focus on the Other Epidemic

by James A. Bacon

From the Fauquier Times: According to Virginia Department of Health data, the number of Virginians who died from drug overdoses in 2020 increased 41% the previous to to 2,297. Local officials attributed the surge to the COVID-19 lockdown. “The pandemic has had a devastating impact,” said Jan Brown, executive director of SpiritWorks Foundation Center for the Soul, which operates a recovery center in Warrenton. “We’ve seen more people relapsing. We’ve seen more deaths because of the isolation. People are using alone. Help can’t get to them in time.”

Then there’s this factoid from Carol Bova’s series in Bacon’s Rebellion about the Ballad Health merger: 30% of Wise County babies are born addicted.

More than 11,000 Virginians have died with COVID. By any other yardstick of comparison, an increase in the number of opioid deaths last year, 670, would be considered a calamity. Overshadowed by COVID, the leap in opioid deaths attracted little notice. COVID is fast receding. Will opioid addiction retreat as well? Continue reading

Mentally Ill in Jails, Part 3: Costs, Legislative Initiatives, and a Modest Proposal

By Dick Hall-Sizemore

(Note: This is the third, and final, post in a series examining the issue of mentally ill people being held in jails. Earlier posts can be found here and here.)

Costs. In comments to the previous installments, several readers brought up the issue of the cost of providing services for the mentally ill in jails, as well as the comparable costs of mental health services and the costs of incarceration. This is a tricky subject.

There will be costs. Programs to divert the mentally ill from jail or to provide treatment services while in jail will cost money. There is no getting around that.  How much it will cost will depend on the scope of the diversion and treatment efforts. A second question is who bears, or should bear, those costs.

Incarceration vs. treatment. Is it cheaper to treat the mentally ill than to hold them in jail? Probably not. Many advocates for diversion and treatment point to the daily cost per offender in jail. In FY 2019, the latest year for which data is available, the operating cost per inmate for all jails was $91.97 per day. The daily cost per individual jail varied from $270.55 (Fairfax County) to $48.69 (Piedmont Regional Jail). Continue reading

Bacon Bits: Jerry Reed Tribute Edition

When you’re hot you’re hot. How hot is the data center industry in Northern Virginia? It’s so hot that vacant land in parts of Prince William County is nearing $1 million per acre. “They are just building like crazy,” said Tim Leclerc, Prince William County’s assistant finance director, as reported by the Prince William Times. “We’ve seen land purchases on a per acre basis up in the Loudoun County area that are approaching $2 million. We’ve seen them approaching $1 million here.” The surge in real estate assessments in parts of the country where the data-center use is allowed by right is “being driven principally by developers and speculators who are scooping up land as fast as they can because they know data centers are willing to pay just about any amount for it,” he said.

When you’re not you’re not. Virginia’s eight public mental hospitals for adults are operating at 96% capacity, prompting them to delay admissions and straining the ability of law enforcement officers to maintain custody in psychiatric crisis, reports the Richmond Times-Dispatch. The COVID-19 epidemic has triggered an exodus of employees from state hospitals, which are “overwhelmed” and operating at only 60% to 75% full staffing. The staff shortage has spillover effects. Sheriffs deputies have to stay with patients for hours or days at a time before beds become available.

You can explain it all down at city hall. The State Board of Elections voted Tuesday to ask the Richmond Commonwealth Attorney to look into accusations that City of Richmond electoral officials violated state law in the November 2020 election. Republican election watchers said Democrats improperly opened sealed envelopes on election night and completed the vote count at a board member’s home a few days later. Denying wrongdoing, Democratic Party officials have counter-charged that Republicans were unhappy with a decision to replace former Richmond Registrar Kirk Showalter, who had run-ins with Democrat officials during her 25-year tenure. Claiming a lack of resources to investigate the conflicting claims, the electoral board asked Commonwealth’s Attorney Colette McEachin to get to the bottom of the dispute, reports the Virginia Mercury.

Jerry Reed composed the funniest lyrics of the past half century (maybe ever). When You’re Hot You’re Hot was a classic.

Mentally Ill in Jail, Part 2 — State and Local Efforts to Address the Issue

by Dick Hall-Sizemore

(Note:  This is the second installment of a discussion on mentally ill people in Virginia’s jails. Part 1 of this series set out the scope of the problem.)

Although senior policymakers are aware of the large number of mentally ill people in jails and acknowledge the seriousness of the problem, the state has taken only tentative steps to address the issue. Furthermore, the approach has been somewhat disjointed, primarily because of the involvement of agencies from different disciplines. Mental health, local community corrections (jails), and the courts all have a role to play  And, as is typical with government agencies, each goes off in its own direction, with little coordination among them. No one at the state level has stepped up to provide coordination and sufficient funding to support a statewide policy.

Diversion. The Department of Behavioral Health and Developmental Services (DBHDS) has come the closest to providing leadership at the state level. Beginning in 2007, the agency’s Office of Forensic Services has supported programs that attempt to divert individuals diagnosed with serious mental illnesses away from the criminal justice system and connect them with treatment as soon as possible. As of 2017, the agency provided grant funds totaling approximately $2.5 million annually to 14 community services boards to support the diversion efforts. In FY 2017, these programs screened 4,505 individuals and enrolled 1,102 for services. Continue reading

Mentally Ill in Jails, Part 1–The Scope of the Problem

By Dick Hall-Sizemore

(Note:   This was not intended to be a long post, but, during its development, it grew like Topsy.  Being painfully aware of my tendency to be wordy and the limitations of a blog regarding long essays, I have broken the post into three parts or installments.  The first examines the extent of the problem; the second looks at what the state and local and regional jails are doing about it, and the third discusses recently-enacted legislation that represents a positive step forward.)

In meeting after meeting over the previous years, the most common lament of sheriffs has been the number of mentally ill people in their jails.  They point out that their facilities were not designed to house the mentally ill, their officers have not been trained to deal with the mentally ill, and they have not been adequately funded to provide treatment to these inmates.  In short, the mentally ill do not belong in jails.

The numbers bear out the sheriffs’ concerns.  In June, 2018 (the latest date for which data is available), there were at least 7,852 people known or suspected to be mentally ill housed in the Commonwealth’s local and regional jails.  That was almost 20 percent of the total number of inmates housed in jails that month.  Of the total number of female inmates (6,946), more than a third (2,395) were deemed mentally ill.  More than 16 percent of the male inmates were reported as mentally ill. Continue reading