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Sunday, April 14, 2013
The 2013 session of the Virginia General Assembly saw important gains for Virginia’s mental health system.
The final budget included additional money for crisis assessment centers and children’s mental health services, doubled the appropriation for discharge assistance planning and provided new money for increased training and stigma reduction through Mental Health First Aid and suicide prevention training.
But as the “frog in the well” anecdote goes, for every two steps we move forward we fall back one, and so it is with our mental health system.
Currently progressing through the Department of Medical Assistance Services are several proposed changes related to Mental Health Support Services. These services provide a vital link for individuals with mental illness by offering a less institutional environment for them to fully participate in and achieve recovery in their community.
Everyday routines that you and I may take for granted such as scheduling and attending regular doctor’s appointments, taking medications as prescribed and even money management are at the core of what support services workers provide for the individuals they serve. And while the cost benefit can be hard to recognize, there is an incredible one, especially from a public policy perspective.
As individuals attend regular doctor’s appointments and medication compliance increases, they will become healthier and require less medical intervention, often resulting in decreased trips to the emergency room. Another extremely important benefit is decreased incarceration.
The latest report from the State Compensation Board estimated that 25 percent of inmates in the commonwealth have some form of mental illness. However, as support services assist with medication compliance, money management, finding stable housing and teaching coping skills, the likelihood of involvement in the judicial system can be decreased dramatically.
Unfortunately, the proposed changes include reducing the reimbursement rate per hour by almost half and imposing stricter eligibility requirements on diagnosis, age and psychiatric history. While only hypothetical, anyone who has worked in the mental health system can easily see the effect such changes will have on support services.
Many service providers will be unable to continue to offer support services, as it will no longer be cost-effective for public or private providers, and rather than lower the cost of services billed, the proposed rate changes will inevitably result in increased cost of care, as the burden is shifted from support services to the state and private mental health hospital system.
This does not even begin to consider the emotional cost of going through the hospitalization process. And stricter eligibility requirements will inherently create even greater barriers to treatment.
The services provided by this program are essential for individuals with mental illness to be able to recover in their community by providing support in independent living and use of community resources. They represent the type of “upstream” investment in people and the community that has proven to be extremely successful.
While I understand that the department is facing increasing pressure to make changes as a result of exponential growth in spending in Medicaid over the last 25 years, these changes will only shift the spending burden while doing little to help Virginia’s most vulnerable population.
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