Two States Buck Trend to Put MH Care on Chopping Block

Among the few states to enact major mental health legislation in the 2009 legislative session is West Virginia, which in April approved a statewide increase in expenditures for mental health care. The funding boost is part of a bid to stave off further court interventions on behalf of residents with psychiatric illnesses.

The Mental Health Stabilization Act of 2009 (SB 672) aims to rebuild West Virginia's community-based mental health system by increasing reimbursement rates for a range of publicly funded mental health services provided at community mental health centers.

“The state has been the subject of various court orders as result of the manner in which it dealt with people with mental health needs, and the legislature desires to be proactive and resolve issues surrounding mental illness without the intervention of the courts,” according to the legislation, which was sponsored by state Sen. Jeffrey Kessler (D).

A report by a court-appointed “ombudsman for behavioral health” found that among the public mental health system's problems were serious overcrowding and understaffing at one of the state's two public psychiatric hospitals, Bateman Hospital. The report of the ombudsman, David Sudbeck, led to a West Virginia Supreme Court ruling in January that the ombudsman should conduct evidentiary hearings into conditions at Bateman Hospital and assess whether the state is providing sufficient care for traumatic brain injury and case-management services throughout the public system.

Another recent marker of the decline of the state's mental health system came from the National Alliance on Mental Illness, which downgraded West Virginia's public mental health system from a “D” in 2006 to an“ F” in its recent “Grading the States 2009” report (Psychiatric News, May 1). That report concluded that needed reforms in the state included a redesigned Medicaid plan, increased use of evidence-based practices, and implementation of crisis-intervention, jail-diversion, and former-inmate reentry programs.

The new law is designed to reverse some of these underperformance findings through funding expansions of the state's existing community mental health centers. Increased funding for prevention and treatment should cut current rates of involuntary mental health commitments and incarceration in jails and prisons of people with psychiatric illness, practices that use significant state resources, according to supporters of the measure.

Sidney Lerfald, M.D., president of the West Virginia Psychiatric Association, told Psychiatric News that he hoped the new law would help reduce an overuse of involuntary commitment.

“The [public] system poorly funds early interventions to prevent patients from getting to the point where they require hospitalization, which requires a crisis before someone can get treatment,” Lerfald said.

The scope of the problem in West Virginia is significant. More than 37,000 people who need treatment for mental illness are placed in regional jails each year, advocates of the new law pointed out. They said that the funding burst should begin to return West Virginia to a position of national leadership in mental health as it was when it led national deinstitutionalization efforts in previous decades.

Another statewide effort recently approved by a state legislature was a measure (HB 897) requiring a legislative study of the entire public mental health system in Mississippi. The legislation, advocated by the Mississippi Psychiatric Association (MPA) and signed into law in April, stemmed from growing concerns about poor access to mental health services throughout the state.

The study will assess the availability of treatment for people with mental illness in various parts of the state, identify gaps in the ability to follow a patient from one facility to another, and examine what some describe as the trend of hiring nonpsychiatrists to oversee more functions at Mississippi's mental health facilities. Advocates of the study expect that its recommendations will provide impetus and direction for future legislatures in the state to reform mental health care.

The law mandating this study stemmed from an MPA-sponsored forum for state legislators in December 2008 that sought to educate elected officials on mental health issues and the roles of clinicians, patients, and the state government in the provision of mental health care.

The report and draft legislation to implement its recommendations are both due to the legislature by December 1.

The Mental Health Stabilization Act of 2009 can be accessed at<www.legis.state.wv.us> by searching on the bill number, SB 672. The Mississippi mental health study measure can be accessed at<http://billstatus.ls.state.ms.us> by searching on the bill number, HB 897. ▪