Category Archives: Mental illness and substance abuse

Littel Pick as Health Secretary Signals Youngkin’s Approach to Healthcare Reform

John Littel

by James A. Bacon

Governor-elect Glenn Youngkin has appointed a new Secretary of Health & Human Resources to lead the fight against the COVID-19 epidemic and also to pursue long-term  reforms in mental health and healthcare.

Youngkin’s pick, John Littel, is a Virginia Beach resident and recent president of Magellan of Virginia and chief external affairs officer for parent company Magellan Health. Magellan of Virginia provides behavioral health services to Virginia Medicaid and FAMIS enrollees.

“The COVID-19 pandemic has had devastating impacts on Virginians across the Commonwealth, and John will play a pivotal role in overseeing our efforts in protecting Virginians’ lives and livelihoods,” said Youngkin in a press release.

“Starting on Day One, John’s experience will be an asset as we fix our broken mental and behavioral health system, ensure Virginians have access to affordable, free-market healthcare options, and reform our healthcare safety net to save taxpayer dollars and improve healthcare outcomes,” he added. Continue reading

Chronic Complainers Notch Big Win Against Landlords

by James A. Bacon

Whether you agree or disagree with Attorney General Mark Herring’s position on the case, a dispute between an unnamed individual with mental health issues and her Manassas landlords, Gia and Ernest Hairston, makes a fascinating case study. In a press release, Herring touts the outcome — the landlords paying the tenant $60,000 in compensation — as a victory for the disabled. Based upon upon the facts provided in the press release, it looks more like a victory for chronic complainers.

Here are the facts as contained in a Herring press release issued today. The tenant rented a condominium unit from the Hairstons in the summer of 2018. She told Mr. Hairston that she lived with a mental health condition that was currently under control. After moving in, she complained about the air conditioning system on very hot days and made requests for other repairs.

Mr. Hairston became frustrated by the maintenance requests, telling her that “any adult” would know better and that she was being “difficult” and “a problem.” He said the maintenance concerns were “all in her head.” To document the necessity for the repair requests, the tenant asked that any time the Hairstons came to the unit that her therapist or caseworker be present. After agreeing initially, Mr. Hairston then terminated her lease, giving her 90 days to move. Continue reading

To Get Respect, Show Respect

Khalah Sabbakhan, after her encounter with Richmond police. Photo credit: Daniel Sangjib Min, Richmond Times-Dispatch

by Dick Hall-Sizemore

There are frequent posts on this blog citing the low morale of police officers and officers quitting or retiring as a result. (For one example, see the post from earlier today.) However, for some reason, those posts often fail to report on the continued bad behavior of police.

Early last month, a 45-year old Black woman encountered two white police officers questioning a woman who appeared to be homeless near the Sauer Center in Richmond. (In order to keep the people involved in this incident straight in my narrative, I will refer to the woman being questioned as homeless, although it is not certain that was her status.) The subsequent actions were recorded by the Black woman involved and another eyewitness who started recording after she heard the first woman pleading for help. Continue reading

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