WILLIAMSBURG — The new leader of Virginia’s fractured behavioral health system says he’s committed to the path forged by his predecessor and a high-profile political initiative to transform the way the state serves Virginians with mental illness, behavioral disabilities and addictions.
“What we will not do is let up on the gas,” Dr. Hughes Melton, commissioner of behavioral health and developmental services, told a joint legislative subcommittee that met Monday in one of Virginia’s most overcrowded mental hospitals. “Momentum is really, really important.”
Gov. Ralph Northam named Melton as commissioner late last month to succeed Dr. Jack Barber — a psychiatrist with more than 30 years of service at the front line of Virginia’s mental health system — and carry out an emerging plan to relieve pressure on state hospitals by building uniform services in communities across the state and realigning the way those services are provided.
Melton, who had served as deputy health commissioner after a career in private practice in Southwest Virginia, acknowledged concerns expressed by key state legislators about a change in leadership now, as the Joint Subcommittee Studying Mental Health Services in the Commonwealth in the 21st Century enters its last year and a half of work.
He also noted “a crisis in our facilities,” including Eastern State Hospital, where the subcommittee met, as private psychiatric hospitals admit fewer people for temporary detention in psychiatric crises as an unintended consequence of legislation adopted in 2014 in the aftermath of a family tragedy that hit close to home in the General Assembly.
The legislation ensured that state hospitals would provide beds “of last resort” for people posing a danger to themselves or others after the 24-year-old son of the subcommittee’s chairman, Sen. Creigh Deeds, D-Bath, attacked his father and killed himself. It happened just 13 hours after he was released from emergency custody because the regional mental health agency didn’t find a bed in time.
The assembly also created the joint subcommittee for a four-year term that it later extended by two years to deal with the daunting challenges of moving the behavioral health system away from institutions and into communities for treatment.
“We can’t afford to lose ground,” Deeds said after hearing from Melton and Secretary of Health and Human Resources Dan Carey, a former cardiologist and hospital executive in Lynchburg.
Eastern State is one of nine state mental hospitals that are, together, operating at more than 95 percent of their capacity. More than one-third of Eastern State’s nearly 300 patients are there because they have been found not guilty of crimes by reason of insanity, which Deeds sees as a failure of the broader behavioral health system in Virginia to help people before they get into the criminal justice system.
“Those people should have been diverted,” he said.
One of the state’s top priorities is building on the early success of STEP-VA, which the General Assembly adopted last year to expand the availability of essential services in communities across the state.
“The goal here is to create a true system of care across the commonwealth,” Carey said.
But the future of that effort is entwined in the fate of a budget caught in a political showdown between the House of Delegates and Senate over using billions of dollars in federal funding under the Affordable Care Act to expand Virginia’s Medicaid program.
Currently, the state is providing money to ensure “same-day access” of treatment at 18 of Virginia’s 39 community services boards and one behavioral health authority, while preparing to fund services for the remaining boards in the budget that is awaiting action in special session.
The House budget proposal would provide an additional $39.1 million, including more money to help get people out of institutions when they are clinically ready for discharge and primary-care screening under STEP-VA. The Senate plan includes an additional $30 million, including money for two jails with high numbers of inmates suffering from serious mental illness and a new statewide program to provide alternatives for transporting people for temporary detention instead of relying solely on law enforcement.
Sen. Emmett Hanger, R-Augusta, says federal money from Medicaid expansion would help Virginia address some of its most pressing behavioral health challenges, including the institutionalization of people with mental illness in local and regional jails ill-equipped to treating them.
“I believe we’re going to create a pipeline of funding through Medicaid,” said Hanger, co-chairman of the Senate Finance Committee and a key player in impending budget negotiations.
Hanger suggested that the negotiations offer an opportunity to include language in the budget directing the state to explore proposals that stalled in the legislature for lack of funding to require jails and community services boards to contract for behavioral health treatment.
“I think we will talk about that some in [budget] conference,” he said.