Twenty years ago, West Virginia was considered a national leader in providing mental health services.
But those who work in that field now look upon those days with a degree of nostalgia.
“We were one of the national leaders in the mid-’80s and early ‘90s,” said John Russell, executive director of the West Virginia Behavioral Health Care Providers Association. “Then we had a steady stream of slow erosion.”
Today, West Virginia is in what state lawmakers have termed a state of crisis when it comes to mental health care.
The lack of community-based mental health programs has led to overcrowding at the state’s two mental health hospitals. The overcrowding is so severe that William R. Sharpe Jr. Hospital in Weston and Mildred Mitchell-Bateman Hospital in Huntington routinely have to pay private hospitals to house patients in need of care. Other West Virginians in need of help go without treatment.
Long Road to Ruin
There was no one thing that led West Virginia into its current situation, said Dave Sanders of the West Virginia Mental Health Care Consumers Association.
“We believe there has been a huge lack of community-based service in West Virginia since 2000-2001,” he said. “There was no one cut that did it. It’s been a death of a thousand cuts.”
About 20 years ago, the state was known as a national leader in deinstitutionalizing behavioral health care patients, according to information from the state Behavioral Health Care Providers Association. The state had a 95 percent success rate in moving patients out of its nine psychiatric hospitals and into community-based programs.
During that time, the state’s psychiatric hospital population decreased from 5,410 to 224 by 1994, according to the data.
But the past 15 years have been a different story, according to the association. During that time, behavioral health care providers’ reimbursement rates have been stagnant. And the state has made several cuts along the way.
Medicaid reimbursement to providers declined 28 percent — $34 million — between 1997 and 1999, the association reported. Medicaid cut another 36 percent — $41 million — in 2000. Clinic-based services, rehabilitation services and case-management services were hardest hit by those cuts. All are important funding sources for nonprofit behavioral health care centers.
The cuts continued in 2002, when the state reduced its behavioral health care funding by $27 million, according to the association. In 2005, the Legislature cut another $115 million in Medicaid spending because of a budget shortfall.
To add insult to injury, providers receive no annual inflationary rate adjustment. From 1993 to 2008, the rate of inflation was more than 50 percent, the association reported.
As a result, at least five West Virginia behavioral health care providers filed bankruptcy, and many others have ended their treatment programs in recent years.
Cutting community-based programs has led to a host of problems, said Stephanie Belford, clinical director for The Prestera Center for Mental Health Services.
“Funding has been an issue,” she said. “The past 15 years, (before) last year, there was no increase in Medicaid reimbursement rates. ... As other costs increase, (community-based) services that were once available have been cut.”
Among the hardest hit community-based programs was targeted case management, Belford said.
“The state really cut back on (funding),” she said. “And the regulations have made it so difficult to provide that service.”
Targeted case management, which would allow those with mental health problems to receive help while living at home, once was widely used in West Virginia, Belford said. Sometimes that service can be as simple as making sure patients have been taking their medication. Other times, targeted case management can be more complex.
“The state was paying a lot of money for that service,” she said.
But the state cut its level of funding for targeted case management over the years, Belford said.
Another area hard hit by budget cuts is housing assistance programs, she said. As a result of those cuts, the number of homeless people with mental illness in West Virginia increased by more than three times between 2001 and 2004, according to data from the state Behavioral Health Care Providers Association.
Another impact of cutting funding for services is that suicides have increased in West Virginia, Belford said. West Virginia now ranks fifth in the nation for suicides.
The result is that more and more people with mental health problems are going to the state’s two psychiatric hospitals, Sanders said.
“The state hospitals are 15 to 20 percent over census each day,” he said.
Sharpe Hospital has 150 beds available, while Bateman has 90, according to the West Virginia Department of Health and Human Resources. An increasing number of the beds in both facilities are occupied by forensic cases: those forced into the hospitals by the court system, Belford said
“That takes up a lot of bed spaces,” she said. “Also, there are a lot more patients with developmental disabilities and mental retardation. More patients are staying for long periods of time.”
Adding to the problem, the recidivism rate is high, Sanders said.
And the problem could be getting worse, according to the Behavioral Health Care Providers Association. The number of mental hygiene petitions for involuntary commitments filed in the state rose 60 percent from 2000 to 2006. The drug overdose rate in the state increased five and one-half times from 1999 to 2004.
The problem, however, is putting a strain on more than just the mental health industry in West Virginia, Belford said. It also is straining the law enforcement and court systems. Involuntarily committing a person takes court action. And those with addiction problems often make more work for the police, she said.
Hospitals also have been affected, according to the data. More than 1 million emergency room visits each year involve mental health or substance abuse.
Because of the increasing demand for the 240 state beds, the two hospitals regularly send patients to private facilities for care, Sanders said. The so-called “diversion beds” cost the state a lot of money each year.
It costs the state $700 per day to treat one patient housed at Sharpe and Bateman, he said. That cost jumps to $1,200 per day for one patient to stay in a diversion bed.
According to the DHHR, the state spent about $17.5 million for diversion beds during the past two years. That is more money that it would cost to keep them in a state hospital, Sanders said. A cheaper and better option that would work for most of those with mental health problems would be treating them through community-based programs.
Despite the high cost, state officials announced earlier this month that they intend to set up 100 more beds at public and private psychiatric hospitals. John Bianconi, commissioner for the Bureau of Behavioral Health and Health Facilities, told legislators earlier this year that the state plans to add 70 beds at Sharpe and Bateman by 2010. Bianconi was unavailable for an interview by press time April 29.
The state also intends to have at least 38 beds at a new private psychiatric hospital that Beckley Appalachian Regional Healthcare Hospital plans to build. Those would be additional diversion beds.
The money spent on the diversion beds would be better spent on other programs that are more effective and allow patients to continue being productive members of society, Belford said.
“That money could be used to increase community-based services,” she said. “... It’s a lot cheaper to have community-based services than it is to have people in crisis who need to go to a hospital.”
Treating patients through community-based mental health services is far more cost effective, Sanders said. It costs about $8,000 per year to do so. The cost to treat those patients in a state hospital could run 10 times that amount.
And treating patients through community-based programs makes more than just financial sense, Sanders said.
“It’s something the consumers want,” he said. “They don’t want to be hospitalized.”
Twenty years ago, West Virginia was considered a national leader in providing mental health services.
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