By Randy Ihara, South Riding, Vice President, Friends of Loudoun Mental Health
Virginia has struggled for years to address the prevalence of mental illness among its population. According to the National Alliance on Mental Illness, 1.1 to 1.5 million Virginians suffer from mental illness and as many as 300,000 have a serious mental illness. Yet Virginia’s mental health system has the capacity to provide services to only 19 percent of adults who live with serious mental illness.
Loudoun County has not been without its own struggles providing mental health services. After years of insufficient funding for mental health and other related services, the county’s proposed fiscal year 2018 budget for the Department of Mental Health Services, Substance Abuse and Disability Services at first glance apparently represents a continuation of the trend of budget increases that began in 2007. The FY18 request is about $37.5 million, an almost 7 percent increase over the department’s FY16 actual spending level and more than double the 2010 budget in terms of current dollars. One would, therefore, expect adequate delivery of services to the Loudoun residents who, because of their income levels, are heavily dependent on county mental health services because private care is beyond their means.
However, when adjusted to account for the growth in the county’s population (which increased 36 percent since 2010), the proposed FY18 budget for mental health services, stated on a per capita basis, is $95.40, 15 percent less than 2016’s actual spending level ($112.50). It’s 3 percent less than 2007 ($98.90), the first year the mental health budget increased on a per capita basis followed by several years of increases until 2017. In fact, on that basis, the 2018 request is 19 percent lower than 2017, because of an increase in the county’s population estimated to be about 24 percent.
The proposed budget for personnel—critical resources for service delivery (stated in terms of FTEs)—is almost 6 percent higher. But a closer look suggests that the FY18 personnel budget request shows essentially no growth. The department notes that budget resources will be applied to reducing existing intake, access and service delivery constraints. Long-standing issues of access to, and delivery of, services and delivery arising from relentless increases in caseloads are noted throughout the budget documentation.
In FY16, the department provided mental health services to more than 4,300 Loudoun County residents. With that caseload, for example, the average waitlist to receive outpatient services for adults and youth needing critical behavioral and mental health therapy has been 36 people per month for the past three fiscal years. The average wait for intake alone has been 30.2 days, and as long as 151 days. Such delays in access to care have “a high potential for worsening conditions and increased use of mental health emergency services, or higher levels of institutional care.” In other words, in human terms, the consequence of such delays is the further deterioration of the client’s condition, requiring reliance on more expensive treatment options.
In 2016, more than half of the 817 clients waiting for substance abuse outpatient treatment experienced wait times of more than 15 days for access to care and up to 111 days for services. The FY18 budget requests funds to “address workload capacity issues related to growth in enrollment.” In 2016, 777 children received services, but the department estimates it will provide services to 900 children in 2017, a 15.8 percent year-over-year increase, a harbinger of future demand.
If, in 2016, the department experienced waitlists of two weeks or more for access to services, as well as delays in service delivery, the outlook for improving access to, and delivery of, services is not encouraging. Projections of continued annual growth in county population implies marginal increases in caseloads. The challenge of maintaining service delivery at current levels in the face of growing caseloads and limited growth in the availability of key resources—including qualified professionals commensurate with the need—may prove to be chronic, as may be the case in some service areas, and insurmountable.
There are, and will be, current and future costs borne by local taxpayers and individuals. The costs incurred in the Sisyphean struggle with mental illness are largely hidden and are borne directly by those with mental illness and their families in terms of lost income, medical bills and quality of life due to chronic pain and suffering.
The public, i.e., county taxpayers, pay the social costs, for example, in subsidies to low-income residents for housing, food, etc. These costs include the public expenditures for jail maintenance, where it’s estimated that one in four inmates suffers from a mental illness and 13 percent have a serious mental illness. (In fact, Virginia jails house more of the mentally ill than its hospitals.). Other costs include law enforcement and court costs. More than 60 percent of jail maintenance expenses are paid by local taxes, at a rate of more than $200 per day per inmate.
On a county-wide basis, the social cost of mental illness is measured in terms of the share of county tax revenues allocated to the financing of the DMHSADS annual budget, which understates the local costs, since not all residents in need of service are treated. More importantly, the share of local taxes funding the department’s budget declined from 70.4 percent in 2016 to 66 percent in FY18, made possible by a 32 percent increase in the allocation of state funds over the period.