Mental health facilities are bracing themselves for closure with a $6.6 million budget cut from the state legislature looming in the distance.
Two facilities that are facing possible closings are the Commonwealth Center for Children and Adolescents located in Staunton, Va., and the Southwestern Virginia Mental Health Institute's adolescent ward in Marion, Va.
Both of the facilities provide state-funded treatment for children and adolescents in southwestern and western Virginia. The CCCA provides treatment for children between the ages of three and 17, with 48 beds in the facility and an average stay of 19 days.
SWMHI houses 16 beds in its adolescent unit, serving children between the ages of 13 and 17. The average length of stay at this facility is 10 days or less.
"Budget cuts have a tremendous effect on us," said Don Roe, director of clinical services at CCCA. "There are only 64 beds total in Virginia's public sector for metal health. It's really shocking how low that number is considering that our facility alone served over 600 children last year."
The proposed plan from Virginia Gov. Tim Kaine calls for closing the two facilities, but would provide $2.1 million for children without insurance to be redirected into private institutions throughout the state.
The directors of both of the facilities see flaws in this plan, however.
"There is a major difference between the children that we treat and those accepted by the private sector," Roe said. "Most of the kids have problems that the private institutions will not admit them for. Most of them will end up in detention centers, not receiving care."
In terms of the SWMHI, the problem is the operating budget in general.
"All of the state mental health institutes and training centers in Virginia have a pretty low operating budget," said Cynthia McClaskey, director of SWMHI. "We don't have a lot of extras that we can cut, because most of our budget goes to patient care, patient illnesses and staff. We just don't have that much fat in our budget that we can cut and still stay operational."
McClaskey went on to say that Kaine could not rightly take 15 percent off the top of all of the state's mental health facility budgets, as this would ensure that none of them would be able to remain operational.
It is because of this lack of flexibility in the budgets of each institution that Kaine has proposed to close two facilities. The state legislature, however, has proposed alternate plans that call for either the closing of only SWMHI while allowing for CCCA to remain open, or slicing the operating budget of both facilities. This would call for CCCA and SWMHI to reduce their bed counts to 24 and six, respectively.
"The governor had come up with a plan that would allow for private facilities to offer the same kind of services that the adolescents get here," McClaskey said. "Of course, our biggest concern is that the private facilities have had that opportunity all along."
One of the biggest problems with the shift from public to private care is the obvious cost; about half of the children in these facilities are not covered by insurance, McClaskey said. The private sector is able to choose who it wants to work with, usually excluding children with behavioral problems, histories of violence, legal charges or histories of substance abuse.
"It's just puzzling to me," Roe said. "Looking at the larger picture, it's just not the best thing for these kids. It's difficult to think about what's going to happen to these kids."
The state institutions that are already in place allow children seeking mental health treatment to remain in their communities and close to family, if they have any.
"In our region, the closest private facility that takes adolescents is in Salem," McClaskey said. "For somebody in Lee County to go to Salem -- that's a four-hour drive in some cases. It's the Department of Mental Health's goal to have folks treated in their communities and closer to home. But with these new plans, it's been hard to work on strong plans to be able to do that right."
The center in Staunton is facing the same problem.
"We don't have many state institutions nearby to send our patients to," Roe said. "And we're still facing problems with admittance into private facilities."
Some of the strongest advocates against the new plans to close facilities and cut funding are arguing that there is no safety net in place for the more than 800 children helped annually to ensure that treatment will be available.
A major concern for these advocates are the obvious pitfalls of the mental health system in Virginia that have already allowed some cases to fall through the cracks.
Chris Flynn, director of the Cook Counseling Center, also weighed in on the need for more focus on the status of the state's mental health infrastructure.
"I can't imagine why they would be cutting back on the number of beds when the original numbers are so low," Flynn said. "When students come to us and need to be hospitalized, we do need to look at whether they could have been helped earlier."
Flynn went on to say that there has always been a chronic need in Virginia for more treatment options for mental health. Even though many students who come into Virginia Tech currently have health insurance, with the current economic crisis and job losses, students are slowly losing coverage. The lack of insurance may keep them out of private institutions.
"I am really pleased that the focus of everyone has been on the wellbeing of the children and the adolescents of the commonwealth, and we understand that there are difficult budget decisions that have to be made," McClaskey said. "But I think we want to be known as a commonwealth that takes care of the most vulnerable people."