Members of the Virginia Legislative Behavioral Health Subcommittee are expressing concern over whether they are “doing enough” to mitigate the Commonwealth’s ongoing workforce shortage at its behavioral health facilities. Virginia state hospitals are resuming Temporary Detention Order (TDO) admissions after they were halted last month due to staffing issues, but stakeholders spent last week’s meeting discussing further behavioral health workforce solutions.
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Committee members first heard an update from Department of Behavioral Health and Developmental Services (DBHDS) Commissioner Alison Land. She said DBHDS was able to reopen the three remaining state hospitals that temporarily halted admissions. However, all five affected hospitals remain on a limited, “one discharge to one admission” basis.
Land said DBHDS used emergency facility funds to hire additional contract staff and to provide first-quarter direct care recruitment and retention bonuses. Land was also “very grateful” for federal funds from the American Rescue Plan Act (ARPA) that would extend the bonuses through June 30, 2022. The recently-passed special session budget brought approximately $45 million in behavioral health workforce bonuses.
State facilities are still seeing an average of two to three resignations per week, according to Land. Along with the ARPA bonuses, Land commended Governor Ralph Northam’s proposed budget item for FY 2023 that would direct $76.9 million to raise salaries for behavioral health workers.
“The salary adjustments and the base budget would really be what’s needed to make a difference — not bonuses but actually, their paycheck and their hourly rate. Compensation will be at a competitive rate, so we’ll be able to do better on recruitment.”
DBHDS is also working on what Land called a “crisis system transformation.” This initiative aims to make evidence-based approaches to care more easily accessible to people in behavioral health crises, and could potentially reduce the overall reliance on 911, law enforcement, and high-cost hospital admissions.
Land outlined additional funding that will support mobile crisis teams and crisis receiving centers. Funds will be distributed within two to three months based on each center’s needs, as well as areas that would directly impact the state hospital census.
Other behavioral health leaders updated the committee on staffing shortages and current response efforts. Jennifer Wicker, Director of Intergovernmental Affairs for the Virginia Hospital and Healthcare Association (VHHA), said private hospitals were “doing our best” to absorb patients after the state hospitals closed. However, some individuals have had to wait hours or days in the emergency department before a bed opened up.
Jennifer Faison, Executive Director of the Virginia Association of Community Service Boards (VACSB), highlighted their staff shortages. According to Faison, there are approximately 2,400 staff vacancies across the state’s 40 CSBs. Faison expressed gratitude for ARPA funding to help address these shortages, but called for long-term funding, rather than the one-time, short-term payments they received.
Faison also called for the legislature to fund community-based services at the same level as state hospitals and workforce training centers. She said VACSB’s top priority is for the legislature to invest $167.5 million in CSB recruitment and retention initiatives.
“The robust community services … [and] traditional outpatient and robust case management and care coordination — that will all work and it will all have this impact, but there’s going to be a period of time where you’re going to have to aggressively support both parts of the system at the same time.”
Mindy Carlin, Executive Director of the Virginia Association of Community-Based Providers, shifted the focus specifically to reimbursement rates. Carlin commended the Department of Medical Assistance Services’ (DMAS) 12.5% reimbursement rate increase for home and community-based services, but asked policy makers to make that increase permanent.
Carlin also advocated for continuing COVID flexibilities, allowing unlicensed clinicians to bill for services as long as they are under supervision of a licensed provider, and ensuring equal funding for both private and public sector providers.
Although Committee Chair Rodney Willett (D – Henrico) did not specify when the subcommittee would meet next, he assured “this will not be the last discussion [on behavioral health].”
View a recording of the full meeting here.