MHAV Public Policy Positions

Introduction

Mental Health America of Virginia (MHAV) is a non partisan, non profit working to ensure that all people in Virginia achieve optimal mental wellness. MHAV and its affiliates have adopted the following policy priorities.

Please contact MHAV with questions or comments at 804-257-5591 or mhav.org.

1. ACCESS TO CARE

Background: The underfunded and fragmented nature of Virginia's mental health system continues to adversely impact access to care as follows.

• Lacks a continuum of services including options in the least restrictive environment.
• Limits access to providers from the full range of mental health disciplines, including peer providers.
• Fails to provide real choice of individual providers.
• Fails to provide full access to culturally competent services.
• Services that are predicated on where someone lives rather than on their assessed needs.
• Lack of provider accountability for the implementation of clear published standards. for access and wait times for emergency care, urgent and routine appointments
• Lack of integrated policies within and between key Virginia Departments to work on issues of social inclusion.
• Lack of an action plan in specific incremental steps with clear timetables to work on stigma, discrimination and prejudice.
• Absence of a public health approach and population based interventions.

Proposals

• Due to the absence of a full range of mental health services, there should be no further reduction in the beds available for mental health stabilization.
• Promote growth of trauma- informed services and crisis management supports including in-home crisis stabilization in addition to crisis stabilization units.
• Promote growth of workforce development and training to ensure a full range of providers from all the mental health disciplines.
• Develop a range of services for older people experiencing mental illness.
• Provide access to high quality, affordable and personalized preventative, early-identification and treatment services in both rural and urban settings.
• Develop a public health approach and population based interventions.
• Encourage the development of pilot programs that seek to bring together primary health care and mental health services in order to deliver integrated care.
• Ensure that mental health and substance be a core component of any health care benefits package and that there is parity in coverage of those conditions compared to medical and surgical benefits.
• Parity, integration, prevention and quality should be included in any health care reform legislation both state or national. (see MHAV's statement on federal health care reform)

2. CHILD ADOLESCENT SERVICES

Background: The serious shortcomings of child and adolescent mental health services are well documented and include the following.

• A fragmented system that focuses on periods when things have gone wrong rather than on early support and the promotion of preventive programs.
• A shortage of child and adolescent psychiatrists, psychologists and specialist counselors leading to very limited access to care.
• Limited community based and state services coupled to a shortage of locally available crisis stabilization and in-patient beds results in children with serious disorders being denied appropriate wraparound, crisis or inpatient treatments (only 1 in 5 children with serious emotional disorders receive care).
• An absence of programs to both prevent poor mental health and to promote the mental well being of families.
• Other systems are inappropriately left to provide mental health care, notably the juvenile justice system.
• An absence of programs to both prevent poor mental health and to promote the mental well being of families.

Proposals

• Increase funding and evidence based service capacity including wraparound services, crisis stabilization and inpatient beds.
• Increase efforts to improve the availability of mental health training for all people. working with children and young people. Further efforts to increase the numbers of specialist Child and Adolescent clinicians.
• Increase opportunities for parent education, support and treatment.
• Develop an action plan to create accessible specialist information for children, young people and their families about mental health and about available services. Utilize the "experts by experiences" in promoting the message that recovery is for everyone.
• Encourage mental health screening as part of routine health care.

3. Criminal Justice Background: The Commonwealth of Virginia should have a criminal justice system that understands and responds appropriately to individuals with mental illness.

• 17.9% of the total population of jails in 2007 had a diagnosable mental illness.
• Virginia jails house more people with mental illness per day than do all the state hospitals.
• In 2007, 3,091 inmates had co-occurring mental illness and substance abuse. About
• "45% of children in delinquency detention centers suffer from mental illness". *
• Families often have to seek judicial assistance to get access to mental health services e.g. relinquishing custody.
• "Too many people with mental health problems are not getting the help they need when they need it to prevent crisis or ameliorate them before they spiral out of control".*

* Professor Richard Bonnie

Proposal

• Develop and implement mental health and substance abuse training for personnel within the judicial system.
• Provide mental health treatment services for incarcerated individuals throughout their involvement in the criminal justice system.
• Initiate restoration of Medicaid/Medicare eligibility prior to an individual's discharge from a criminal justice facility.
• Provide for continuity upon and individuals release into the community.
• Use of restraints should be at the discretion of the transporting law enforcement officer.
• Continue to monitor the qualifications of individuals eligible to serve as independent evaluators or magistrates.

4. MEDICAID

Background

• Virginia is ranked 48th for per capita Medicaid spending and 50th for federal grants received for programs such as Medicaid.
• The low rates of Medicaid reimbursements limit the number of clinicians who are willing to accept Medicaid.
• Medicaid is not used to enable capacity building of mental health services.

Proposals

• Enhance eligibility standards for Medicaid to at least 100% of poverty guidance to both increase the Medicaid federal dollars spent in Virginia and ensure that low income citizens begin to qualify for coverage.
• Continue access to appropriate and timely medications based on individual need and focus on practice that improve consumer health and contains cost
• Increase provider accessibility to the Medicaid system, including timely and reasonable reimbursement rates.
• Develop Medicaid incentive programs that enable providers to work collaboratively to improve the physical health of persons with serious mental illness whose life expectance is 25 years less than the general population average citizen.

5. PSYCHIATRIC ADVANCE DIRECTIVES

Proposals

MHAV gratefully acknowledges the effort of the Virginia General Assembly for enacting advance directive legislation in the 2009 session. As a result of that legislation MHAV proposes that implementation of the advance directive law is monitored to ensure the following.

• Individuals can freely choose the most important elements of the directive for themselves including: what types of treatment will be covered, what events or determinations will trigger implementation, and whether or not and under what circumstances the directive will be revocable.
• The decision to agree or not to agree in advance to treatments or to authorize someone else to do so on one's behalf is accompanied by appropriate safeguards to ensure that the decision is fully informed and free from coercion.
• Mental health providers comply with a valid psychiatric advance directive unless to do so would result in serious and imminent physical harm to the individual or others.
• Individuals have the right to release HIPAA protected information to their designated health care proxies and in their psychiatric advance directives.
• The DBHDS be required to promote education, training and research towards the successful creation and implementation of psychiatric advance directive programs. Further, the DBHDS be required to promote the development of community dialogues of consumers, family members, friends, advocates, healthcare providers and other professionals to work together in promoting psychiatric advanced directives.