At best, half of Central Virginians who need public mental health care might not get it, according to a study by a University of Virginia economics professor. At worst, nearly nine in 10 might not get care.
UVa’s Steven Stern estimates that 9,634 to 38,022 people in the region annually fall beyond the reach of the Region Ten Community Services Board, which served an average of 4,813 people a year from 2008 to 2010.
Region Ten is among 40 community services boards across Virginia that form the state’s public mental health safety net, which has been under scrutiny since last fall, when state Sen. R. Creigh Deeds’ son attacked him and then killed himself.
A former Region Ten board member, Stern began the study six years ago to arm the organization with information needed when seeking state money.
“I was hoping this would encourage policy makers and CSB’s to try to determine demand for their services and use that to determine how much money to allocate to mental health services,” he said. “It is clear that there is a large shortage of services for those in need.”
The national journal Health Services and Outcomes Research Methodology published the study Thursday.
State lawmakers this week convened a four-year study aimed at remaking Virginia’s public mental health system. Deeds, D-Bath County, the commission chairman, called the results of Stern’s study “disturbing,” but he said he was “not surprised.”
“We will have to tackle the funding issue, and I am confident that the commission’s work will address it,” Deeds said. “There are other issues that have to be addressed first, in my view; I’m not sure this is a problem you can solve just by throwing money at it.”
Lawmakers passed omnibus mental health legislation this year targeting gaps in Virginia’s crisis response system unveiled by the case of Deeds’ son, Austin C. “Gus” Deeds, 24, whose attack on his father and subsequent suicide Nov. 19 made national headlines.
Thirteen hours earlier, Gus Deeds was released from an emergency custody order mandating mental evaluation. A community services board clinician was unable to find him an available psychiatric bed so he could undergo further treatment.
State officials were warned of the practice — known as ‘streeting’ in mental health circles — more than two years before Deeds’ death.
“There was still ‘streeting’ going on in April! “ Deeds wrote. “The real time [psychiatric] bed registry is not real time. Those aren’t the biggest issues, but after the scrutiny of this past winter, the lack of urgency is disturbing.”
Community services boards have not reported cases like Deeds’ since the soft launch of new civil commitment laws June 16.
Even beginning to assess the true need for mental health services is complicated, Stern said, because experts have not resolved how to gauge that need.
Stern’s estimates of the number of people missing out on help range widely because his study is based on the results of national surveys with varying interpretations of how to define mental illness. As a result, the economics professor had to base his numbers on previous surveys with both a narrow and wide focus of who might suffer from a mental health problem.
“There’s a lot of disagreement among psychologists and psychiatrists about how to measure mental health … and to measure prevalence,” he said.
While the region’s low-income population faces a shortage of available help, the study also shows there’s an abundance of services in the area for the more affluent segment of the population.”
“For those who can afford it,” Stern said, “we don’t have a shortage of supply, that’s for sure.”
Deeds has said his son’s case illustrates that the public mental health system does not work for those who do have resources and support, let alone those without.
Local waiting lists for mental health care can be dangerously long for people without insurance, said Sue Hess, a registered nurse who helps connect people with health services through her position at the Charlottesville affiliate of Mental Health America.
Hess, who once managed psychiatric units at the UVa Medical Center, said her clients regularly report waiting six months for an appointment.
“It’s very easy to get frustrated,” she said, “especially if you don’t have good insurance or good community connections to start with.”
At Region Ten, Hess said, insured and uninsured patients go on different waiting lists.
“Everyone has limited resources to work with,” she said.
Region Ten Executive Director Robert Johnson, who was unavailable for comment Thursday, said Friday that the agency does not currently have a waiting list and does not keep separate waiting lists for insured and uninsured patients.
"Historically there have been times when individuals have had to wait days or weeks for services due to demand outstripping our agency’s capacity to provide care," he said in a statement. "Last year, we were able to provide services to a record 6,700 individuals, far above the average ... of 4,813 noted in Dr. Stern’s excellent research article.
"That being said, it is a constant challenge to provide treatment upon demand and our goal is a fully funded system that has no one waiting any period of time for needed care."
Hess said weekly walk-in clinics at Region Ten and The Women’s Initiative, a Charlottesville-based nonprofit where people pay on a sliding scale, help shore up gaps. The area is resource-rich compared to outlying counties and other parts of Deeds’ district, she said.
Deeds said he would like to see Stern’s study replicated across the state.
“We have much work to do, but I’m confident we can build the best system of care here,” he said.
Factors other than limited resources, such as denial about illness or fear of being stigmatized also may help explain why the need Stern identified eclipsed the care delivered, Hess said.
“I think we should be doing better,” she said.