‘Resources are limited’

Published 10:17 pm Tuesday, December 17, 2013

City, CSB struggle to help in mental health cases

Editor’s note: This is the third in a series of stories on the crisis of mental health treatment for juveniles in Western Tidewater.

Mental health services available in Virginia vary widely based on any number of factors, and not receiving them can have devastating results.

In November, state Sen. Creigh Deeds was stabbed multiple times by his son at the family’s home in Bath County. His 24-year-old son, who later shot and killed himself, had just been released from an emergency custody order without receiving hospital treatment, according to media reports.

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Closer to home, Lauren Samuels, who lives in Suffolk, has had trouble receiving services for her 14-year-old son, who she says has caused her physical harm. And Emily Richards’ son, of Virginia Beach, just turned 18 and finally is starting to be able to get help. (The names of both women and their sons have been changed to protect their and their sons’ identities.)

Obtaining mental health services in Virginia, especially for juveniles, can be an expensive, complex and bureaucratic process fraught with every kind of roadblock imaginable.

“The resources are definitely limited, and they’re hard to access sometimes,” said Rachel Lewis, Comprehensive Services Act coordinator for the city of Suffolk. “Parents don’t always know how to access them.”

Lewis manages the Family Assessment and Planning Teams for Suffolk, Franklin and Isle of Wight County. Those teams work with families and make recommendations to their respective Community Policy and Management Teams, which make the funding decisions.

Most families that make it to that point have severe cases and haven’t been able to get treatment through private insurance or other means, Lewis said.

Although the state’s budget for the Department of Behavioral Health and Developmental Services has risen 32 percent since 2007, localities have borne the brunt of unfunded mandates.

Suffolk received $1.3 million from the state to spend on juvenile mental health treatment in Fiscal Year 2013 but received only $812,000 — almost a 38-percent decrease — from the state in the current year.

And where there’s government money, there’s also red tape.

“The state is getting more regulatory,” Lewis said. “There used to be a lot of flexibility.” The state does regular audits and demands repayment with local money for anything that doesn’t meet its approval.

Brandon Rodgers, child and family services supervisor for the Western Tidewater Community Services Board, said services available vary based on the age and diagnosis of the child, where they live and even what kind of insurance they have.

Rodgers said a juvenile has to be diagnosed with a serious mental illness or labeled as seriously emotionally disturbed to receive services from the community services board.

For those up to age 7, the bar is a little lower — they must have a risk factor for being seriously emotionally disturbed, which can include coming from a low-income family, having developmental delays or having parents who were substance abusers.

A number of levels of treatment are available, Rodgers said. Outpatient counseling is considered the least intense, and intensive in-home therapy is on the most intense side of the scale.

Rodgers said treatment focuses on keeping children in the home if possible.

“What we know about kids and families is they do better if you don’t separate them,” he said.

Suffolk has financial incentives to keep children in their homes, too — the city must match state money at a rate of 18 percent for in-home services but has to pony up 45 percent for out-of-home treatment, Lewis said.

The level of treatment available to a juvenile also depends on insurance, an inequality that Rodgers sees as the No. 1 problem in the treatment of juveniles.

“Coverage is not always the same, no matter what insurance you’re looking at,” he said. “It sometimes can restrict the options.”

Families eligible for Medicaid or Virginia’s FAMIS insurance for needy children have access to the broadest array of services, he said.

Rural community service boards, as in Suffolk and Deeds’ Bath County, also struggle to keep qualified professionals on staff.

The Western Tidewater board has worked to fix that problem lately by starting a program that shares electronic access to two psychiatrists who work in Virginia Beach. Other recent additions, including a Crisis Intervention Team and Crisis Stabilization Team, aim to improve the immediate response to mental health crises for children and adults.

When a bed is needed for a juvenile, finding one can be tough, Rodgers said. Bon Secours Maryview Medical Center in Portsmouth offers the closest one to Suffolk. But it’s not just about finding a bed, but the right bed.

“It depends a lot on what the issues are,” Rodgers said. “You have to have the right room makeup.”

Lewis said the state has been aware of the bed availability issue for years.

“It’s a common problem,” she said, also noting that families often protest that the child gets sent right back to them once they are released. Most of the time, acute care is meant to stabilize the patient — just like hospitalization for a physical illness — and then they are sent home.

Hospitalization can occur after the magistrate issues an emergency custody order during a crisis. Western Tidewater Community Services Board Director Demetrios Peratsakis said an evaluation takes place by a licensed mental health professional, and a recommendation is made that can include referring them to counseling up to hospitalization.

The process of finding a hospital able and willing to take the patient at the time involves a multitude of factors, Peratsakis said, which can include things as mundane as the hospital’s current staffing level.

“We’ll continue to call until we find a willing facility, which means we start playing beat the clock,” Peratsakis said. “The times when they cannot find an available bed are really not very common.”

He said releasing people from custody when they should be in the hospital is “not the best solution, but there are times when it has been the only solution.”

“It isn’t as simple as people want to make it,” he added.

Coming Thursday: The hidden costs and how lawmakers and government agencies are working to fix the issues.