MENTAL HEALTH

     Long before the tragedy of Virginia Tech, informed legislators knew Virginia lagged far behind in mental health services.  Access to help and accountability vary tremendously statewide.  Reluctance and shame still stifle discussion.  Several General Assembly members have significant experience in mental health.  Mine includes 30 hours of college courses focused on the physiology of brain functioning, initiating prison mental health services, and being executive director of a non-profit working with the severe child abuse / neglect and the emotional damage it creates.

     Commissions and legislative committees spent countless hours looking at what Virginia Tech revealed about our mental health system.  In 2008, we changed the commitment standard to respond better to potential danger.  We spelled out oversight responsibility for out-patient tracking and better information sharing.  We added funding for 40 mental health service providers and funded mental health services for veterans, guardsmen, and reservists.

     However, many knew these changes were just a paper exercise unless they were accompanied by significantly increased community staffing.  By 2011, the commitment made in 2008 had been undercut by other budget priorities.  In November 2013, State Senator Deeds was repeatedly stabbed by his 24-year-old son who had been court-ordered to a psychiatric facility … but no bed was found.  His son committed suicide.

     In 2014, a Joint Senate/House Study of Mental Health was established chaired by Senator Deeds.  I am grateful to be a member and pray we can spearhead permanent effective reform.  My long-standing concerns include:

• the people with mental health diagnoses who end up in jail, which is now at least 1/5 of the jail population;
  • Half exhibit severe disorders, such as schizophrenia, bi-polar, major depression, post traumatic stress disorder (PTSD), or an intellectual disability.  Jails are not equipped to provide services or even continue prescribed medication. 
  • Law enforcement is often the first responder to mental crises experienced by people no longer warehoused in psychiatric institutions.  We need significantly expanded Crisis Intervention Training, expanded community mental health staffing for expedited diagnosis, and wide use of personal advanced mental health directives to divert significant numbers into treatment.
• the role and accountability of community services boards and state psychiatric services as well as capacity needs;
• the legal balance of due processes, as well as more appropriate information sharing between mental health professionals, medical personnel, law enforcement, school personnel, and family services.
• the impact of multiple deployments on our military and their families, particularly Guard and Reserve who don’t return to the mutual support network of a military base;
  • The Army reports 27% of non-commissioned officers on their 3rd or 4th deployment had post-traumatic stress disorder or depression compared to only 12% on their 1st deployment.  The suicide rate of recent veterans is 50% higher than similar-aged civilians; it is twice as high among female veterans.
• integrated treatment of multiple disorders in comprehensive reform of all service waivers
  • Mental health services need to be available to those in addiction programs using drugs to deaden the trauma of child abuse, TBI, sexual assault, or PTSD.  Someone receiving technology assistance for a developmental disability might need treatment for depression.

INTELLECTUAL (ID), DEVELOPMENTAL (DD), AND HEAD INJURY DISABILITIES

     In 2018, the General Assembly funded 1,600 priority one waivers – more than in any single budget cycle.  But there were still more than 12,000 people in all three priority levels waiting  This included 2,195 priority one persons who are near or currently in crisis and need services within one year – not the many years the continued long waiting list means they will have to wait.  This is particularly traumatic for older parents who want to be part of getting their adult child settled before they can no longer take care of them.  It is no less serious for the supportive services needed to provide for the safety of ID/DD child who is now a physically strong adult.

     These and a wide range of other examples underscore the need to increase the number of ID/DD waivers and to also deal with strict overtime limits and pay scales in Northern Virginia.  These funding issues are equally important for services to keep people who need Technology Assistance, who are Disabled because of injury, or who are Elderly in the highest functioning and least costly setting.  

TRAINING CENTERS

     While I’m hopeful there’ll be spin offs that better serve the needs of others as well, the DOJ settlement agreement is driving much of what is being done to serve ID/DD individuals.  For example, the settlement requires 4,170 additional ID/DD Medicaid service waivers by 2021.  While federal programs will pay over $900 million, the total cost of providing community services for most of the 6,000 who were in the 5 training centers is estimated to be $2 billion. 

     We must meet the challenge of accurately determining each person’s ability to function in a less restrictive environment, including ongoing oversight of a large number of small programs.  Because there will be many more areas of focus and competing advocacy, I worry that community services will be even more under-funded than the large training centers were. 

     While leaving just one training center open for those who can’t live without highly specialized 24/7 care will bring Virginia in line with the vast majority of states, I support using several small intensive care nursing facilities to supplement the Southeastern Center’s 75 designated beds. This will allow people who live far from almost the furthest corner of Virginia to have more contact with severely disabled family members.  One location under consideration is near Fredericksburg.

ASSISTED LIVING FACILITIES and NURSING HOME STAFFING

       See discussion of these issues under Seniors

MEDICAID EXPANSION

     Virginia was losing $4-$5 million a day in federal funds available to expand Medicaid to 400,000 un-insured people living in poverty – 70% are in working families but earn less than $32,000 for a family of four or $15,302 for one person.  After almost a decade of refusing to expand Medicaid, the defeat of an extra-ordinary number of House members in 2017 sent a strong message and, in 2018, we got the votes to finally expand Medicaid.  The cost of the state match for 90% federal funding will be paid by tax on hospital profits. 

     By October 2019, 9 months after expansion took effect, 325,092 adults had newly enrolled in Medicaid: 1/3 were parents, 60% were women, 45% were under 35, and 21,500 live in Fairfax County.   Nearly two-thirds went without needed medical care in the year before and of those who have received initial services:  33,000 have hypertension, 18,800 have diabetes, and 3,300 have cancer.  

      In its first 9 months, Medicaid expansion also covered 16,100 who are now in substance abuse programs, which used to be paid for solely by the state.  Drug overdose is now the leading cause of death nationwide for people under 50.  When Maryland, West Virginia, and Kentucky expanded Medicaid giving addicts access to outpatient treatment, hospitalizations for substance abuse decreased of 69% – 87%.  In that same period (2013-15), hospitalizations in Virginia increased by 17%. 

      Finally, Medicaid expansion resulted in $1.75 Billion in annual savings through payment for health services that had been borne solely by the state.  These savings are what allowed us to fund mental health ($40 million), increase public school funding ($73 million), and freeze college tuition ($52 million).

WOMEN’S REPRODUCTIVE HEALTH

     I believe reproductive decisions should be made by the woman in consultation with her doctor and when possible with the father.  Basing our criminal laws on the assumption that every fertilized egg will result in a viable birth does not reflect reality.  I support birth control and believe it should be included in insurance coverage and available through prescription from any licensed pharmacist.  Only about 10% of budget of Planned Parenthood clinics is to perform 1st trimester abortions and I strongly support continued public funding to help support all of the other critical health services they provide largely for the lowest income.  The Centers for Disease Control and Prevention (C.D.C.) estimates 92% of abortions are performed in the first trimester.  After the first trimester, most pregnancies ended before viability outside the womb are typically forced by the woman’s dangerously deteriorating health related to diabetes or poor kidney functioning or are related to a miscarriage or gross fetal abnomality.  In the last 2 decades in Virginia, there have been only 2 recorded 3rd trimester.  From the moment of birth, all babies receive the full protection of hospital review protocols that protect all people on life support. 

WHEN LIFE BEGINS

     I believe the very complex decision of when life begins is deeply personal, moral decision.  I will continue to defend that position in all of the challenging and complex ways that it comes before the Virginia General Assembly, including birth control; in vitro fertilization; a women’s right to an abortion under Roe v. Wade; a person’s right to have an advanced medical directive carried out; and stem cell research in the treatment of disease and disabilities. 

CHILDBIRTH

     We’ve known since a 2010 Virginia Health Department report that Black women are 3 times more likely to die than White women from pregnancy-related causes.  A recent C.D.C. report provided a nationwide profile that 42.8 Black women die for every 100,000 live births compared to 13 White women and 11.4 Hispanic women.

    The Brookings Institute found the babies of Black women with advanced college degrees are more likely to die within their first year than babies born to White women who did not complete high school.  Again, we’ve known this in Virginia since a 2008report by the state’s Office of Minority Health and Public Health Policy revealed that  the mortality rate for black infants was twice that of white infants.

     It is my hope that, finally, these disturbing racial differences will be addressed through a robust public dialogue involving the medical community and voices speaking from the Black experience.  Better preventative healthcare through Medicaid expansion for those Black women living in poverty will address only a small part of this serious problem. 

PREJUDICE

      Almost all of the issues discussed above are made more challenging by prejudice.  We are uncomfortable with what we don’t understand, from the genetics and physiology of gender and sexual orientation to the different processing of reality on the autism spectrum disorder.  Most of us don’t understand how impossible the limited choices are faced by low income.  Deep-seated latent prejudice is real and can be deadly.  We turn away and needs go unmet.  Worse yet, needs go unspoken out of fear of being socially shunned, judged, bullied, or attacked. 

     It has been personnally enriching, because I am an elected official, to have my innate lack of broad experience repeatedly challenged and widened.  I truly believe that the Commonwealth – the well being of us all – is strengthened by everyone being enabled to live up to their full potential.