A Comparative Analysis of House and Senate Proposed Budgets for Mental Health: A Closer Look at Key Investments
Posted: - By:Cat Atkinson
THIS BLOG WAS UPDATED ON 3/12/2024 WITH THE CONFERENCE BUDGET ITEMS.
For a visual representation of the 2024 Mental Health Budget Priorities,click here!
At the start of the 2024 legislative session, we were energized by our lawmaker’s’ commitment to improve the state of mental health in Virginia. As the Commonwealth continues to struggle to meet the mental health needs of its citizens, the $500 million investment from Governor Youngkin into the mental health system was welcomed and exciting, especially due to his specific consideration for young people in the “Right Help, Right Now” Youth Mental Health Strategy.
We are navigating a youth mental health crisis and young people have been advocating for improvements to school-based mental health services, workforce, and infrastructure in schools to meet their needs.
It has been encouraging to see many legislators continue to uplift youth mental health priorities through bills and budget amendments;, however, as session nears completion, the lack of youth-centered mental health funding leaves organizations and advocates disappointed with the lack of follow through and prioritization that was originally promised
On Sunday, February 18, the House and Senate released their respective budgets and presented their budget priorities for Fiscal Year 2025 and 2026. Compared to the significant number of youth-centered mental health budget amendments requested by legislators, there was considerable variability in funding for youth mental health between the introduced budget, the floor approved House budget (HB30), the floor approved Senate budget (SB30) and overall.
School-Based Mental Health (SBMH)
was a hot topic item across the aisle, with consideration for the Youth Mental Health Strategy and efforts to increase school mental health staffing ratios, increase access to tele-mental health services in public schools, and ensure the school-based mental health pilot program becomes permanent. Legislators promised young people that they would prioritize school staffing ratios and recognize the importance of equity in mental health through the work of SBMH initiatives. Unfortunately, those promises were nullified upon bills entering the money committees.
The budget is a statement of priorities. Below are some of the mental health items that varied significantly between the House, Senate, and Conference budgets. As we review these discrepancies, we must ask the question: do our legislators truly prioritize our young people’s mental health and well-being?
School-Based Mental Health Integration Program: This grant program supports the Department of Education (DOE) in partnership with the Department of Behavioral Health and Disability Services (DBHDS) to work with school divisions to provide grants and technical assistance to contract with community-based mental health providers to provide mental health services to students within their schools.
Governor’s Introduced Budget (Item 295 FF): Allocates $15 million in FY25 and $15 million in FY26 GF for the School-Based Mental Health Integration Program as described above.
House Budget (Item 295 #7h): Redirects the $15 million in FY25 and $15 million in FY26 GF for DBHDS in collaboration with DOE to provide grants to contract with federally qualified health centers or other healthcare organizations to establish school-based health clinics to serve students, their families, and school staff through the provision of mental health services, primary medical care and other health services in schools.
Senate Budget: Retains the$15 million in FY25 and $15 million in FY26 GF for the School-Based Mental Health Integration Program as described above.
Conference Budget (Item 295 #10c): Accepts the House Budget version.
Access to Tele-mental Health Services: Providing access to tele-mental health services in public schools and public colleges is a priority of Governor Youngkin’s Youth Mental Health Strategy. Telehealth is also a tactic that helps mitigate the significant workforce shortages in Virginia to still meet the needs of young people in the school setting, as local broadband and infrastructure allows.
Governor’s Introduced Budget (Item 117 R): Allocates$7.2 million in FY25 and $7.2 million in FY26 GF for the DOE to contract with a telehealth provider to provide statewide mental health care services to public school students, grades six through twelve.
House Budget (Item 117 #5h): Eliminates the $14.4 million over the biennium to fund the statewide contract to provide tele-mental health services to middle and high school students. However, it still directs the Superintendent of Public Instruction to enter a statewide contract with one or more telehealth providers that school divisions may opt to purchase through local funds.
Senate Budget (Item 117 #1s): Redirects the $14.4 million over the biennium for mental health and telehealth services to other unspecified education initiatives.
Conference Budget (Item 117#1c): Accepts the Senate Budget version
Hire Chief School Mental Health Officer: The Governor sought to establish a new position within the Department of Education who would lead mental health wellness initiatives for educators and K-12 students.
Governor’s Introduced Budget: Allocates $200,000 in FY25 and $200,000 in FY26 to fund the Chief School Mental Health Officer position.
House Budget (Item 117 #5h): Eliminates the $400,000 over the biennium to fund the Chief School Mental Health Officer position.
Senate Budget (Item 117 #2s): Redirects the $400,000 over the biennium for the Chief School Mental Health Officer position to something unspecified.
Conference Budget (Item 123 #1c): Accepts the Senate Budget version.
New School-Based Mental Health Funding Plan: By recommendation of the Behavioral Health Commission, this plan should be developed jointly with DOE, DBHDS, and DMAS with the goal of creating a new program to develop flexible mental health funds to school divisions. The program should provide flexible funding to participating school divisions for maintaining school-based mental health services and supports, technical assistance and evaluation capabilities to build out their mental health programs within the Multi-tiered Systems of Supports framework.
Governor’s Introduced Budget: This language only item was not included in the Governor’s Introduced Budget.
House Budget (Item 117 #1h):Adds a section to Item 117 that directs DOE, DBHDS, and DMAS to develop a new plan and program for delivering flexible mental health funds to school divisions. The language includes provisions on what the plan must include such as a proposed vision and goals for Virginia’s school-based mental health program, action steps to meet those goals, proposed outcome measures, recommendations on appropriate annual funding, proposed funding mechanism to ensure flexibility and consistency and a structure for technical assistance and evaluation capabilities of the program.
Senate Budget: This language only item was not included in the Senate Budget.
Conference Budget (Item 117#2c): Accepts the House Budget version.
SCHEV – Mental Health Initiative: Like the telehealth initiatives for public secondary schools, this initiative directs the State Council of Higher Education for Virginia (SCHEV) to coordinate efforts to pursue a common vendor and statewide vendor to provide mental health services including tele-mental health care, to students at institutes of higher education.
Governor’s Introduced Budget (Item 132 R): Allocates$3 million in FY25 and $3 million in FY26 GF to public institutions of higher education participating in the statewide contract. This specifies that any public institutions of higher education shall be required to match any state funding received with an equivalent amount from nongeneral funds.
House Budget (Item 132 #5h): Eliminates the $6 million over the biennium for this mental health initiative for public institutions of higher education.
Senate Budget (Item 132 #2s): Eliminates the $6 million over the biennium for this mental health initiative for public institutions of higher education
Conference Budget (Item 132 #3c): Accepts both the House and Senate Budget versions.
Crisis Mental Health
has been Governor Youngkin’s signature priority with the “Right Help, Right Now” initiative. However, we must continue to advocate for youth-centered crisis services and programs to address the specific developmental needs of our young people.
Bed Restructuring at the Commonwealth Center for Children and Adolescents (CCCA): Spurred from the 2023 Joint Legislative Audit and Review Commission (JLARC) study and report Virginia’s State Psychiatric Hospitals and the work of the Behavioral Health Commission (BHC), recommendations were made to consider the safety, effectiveness, and overall, performance of the CCCA in caring for and treating young people admitted to the hospital. Persistent operational and performance problems at the CCCA brought forward the recommendation by members of the BHC to consider and develop a plan to 1. close the CCCA and 2. find or develop alternative effective, safe, and therapeutic placements for children and youth who would otherwise be admitted to CCCA.
Governor’s Introduced Budget: This language only item was not included in the Governor’s Introduced Budget.
House Budget (Item 301 #1h): Adds a section to Item 301 that directs DBHDS, in consultation with other relevant state and local agencies, to identify existing and develop new alternative placements that are effective, safe, and therapeutic for young people who would otherwise be admitted to the CCCA, and then develop a report to provide to the Governor and the Chairs of House and Senate Appropriations. The House version specifies that the report shall include types and locations of alternative placements identified, the number and treatment needs of young people who could be admitted, the cost and funding source required for each placement type, and steps that remain to identify enough appropriate alternatives.
Senate Budget (Item 295 #1s): Adds a section to Item 295 that directs DBHDS to work with relevant local and state agencies to review and report on alternative placements. The Senate version does not specify what should be included in the report.
Conference Budget (Item 301 #1c): Accepts the House Budget version.
Flexible Funding for Children’s Psychiatry and Crisis
Governor’s Introduced Budget (Item 297 J): Retains the$12.6 million in FY25 and $12.6 million in FY26 GF to be used for children’s psychiatry and crisis response services for children with mental health and behavioral disorders. The funding would be divided among health planning regions based on current availability of services and used for a variety of mental health related programming, hiring, and training.
House Budget (Item 297 #4h): Increasesthechildren’s mental health funding to $15 million in FY25 and $15 million in FY26 GF and revises the language of section J to encourage flexible use of funds to build service capacity focused on the specialized needs of young people across the crisis services continuum.
Senate Budget (Item 297 #1s): Only revises the language of section J to encourage flexible use of funds to build service capacity focused on specialized needs of children and youth across the crisis services continuum.
Conference Budget (Item 297 #3c): Accepts the House Budget version.
Inflation Adjustment for the Behavioral Health System Reform: System Transformation Excellence and Performance (STEP-VA):
Governor’s Introduced Budget (Item 297 KK):Allocates $4.35 million in FY25 and $4.35 million in FY26 to account for inflation in the cost of implementing and delivering just the first three steps of STEP-VA (same-day access, primary care outpatient screenings and outpatient mental health and substance use services)
House Budget (Item 297 #3h): Increases the funding to $8.9 million in FY25 and $8.9 million in FY26 GF to account for inflation in the cost of implementing and delivering services associated with seven of the nine steps of STEP-VA. Specifically, $1.2 million additionally for outpatient mental health and substance use services and $3.3 million for crisis services, peer services, case management, military and veteran services, psychiatric rehabilitation services, and care coordination services.
Senate Budget (Item 297 #4s): Increases the funding to $7.65 million in FY25 and $7.65 million in FY26 GF to account for inflation in the cost to implement and deliver services associated with the last six steps of STEP-VA. Of this amount, $1.8 million is for crisis services, $401,874 for military veterans, $480,558 for peer services, $181,424 for case management, $150,250 for psychological rehab, and $329,802 for care coordination.
Conference Budget (Item 297#2c): Accepts the House Budget version.
Fund Additional Staff for Crisis Stabilization Units: To ensure that all Crisis Stabilization Units are fully utilizing their bed capacities for those who need care.
Governor’s Introduced Budget: There was no additional funding to support fully staffing crisis stabilization units in the Governor’s Introduced Budget.
House Budget: There was no additional funding to support fully staffing crisis stabilization units in the House budget.
Senate Budget (Item 297 #3s): Allocates$2.5 million in FY25 and $2.5 million in FY26 GF to Community Services Boards to hire additional staff for crisis stabilization units whose bed capacity is not fully utilized due to lack of staff.
Conference Budget (Item 297 #5c): Accepts the Senate Budget version.
Governor’s Introduced Budget: There was no additional funding to support the on-going operations of the Youth Crisis Receiving Center in Prince William County in the Governor’s Introduced Budget.
House Budget: There was no additional funding to support the on-going operations of the Youth Crisis Receiving Center in Prince William County in the House Budget.
Senate Budget (Item 296 #2s): Allocates$2.5 million in FY25 and $2.5 million in FY26 GF to support ongoing operations of the crisis receiving center for youth in Prince William County.
Conference Budget (Item 296 #1c): Accepts the Senate Budget version.
Supporting our Mental Health Workforce
is critical for meeting the needs of young people in the Commonwealth. The Virginia Healthcare Foundation found that 93 of the Commonwealth’s 133 localities are federally designated Mental Health Professional Shortage Areas with 37% or around 2 million Virginian’s living in those shortage areas.
Virginia localities with no or a few behavioral health professionals have poorer outcomes on key behavioral health indicators such as depression, anxiety, substance use, suicidal behaviors than localities with more behavioral health professionals.
The budgets reflect varying priorities in recruitment, support, and retention of our behavioral health workforce.
Behavioral Health Loan Repayment Program: Established in 2021, this Loan Repayment Program was created to help recruit and retain behavioral health (BH) professionals to practice in underserved areas of the Commonwealth and/or provide counseling and treatment to underserved populations. This program will repay a portion of an eligible BH professional’s student loan debt. In return, recipients commit to practicing in Virginia for at least two years at an eligible site.
Governor’s Introduced Budget (Item 271 C): Allocates $8.1 million in FY25 and $8.1 million in FY25 GF to enhance the Behavioral Health Loan Repayment Program (BHLRP). The Governor’s budget includes a provision that ensures $1 million goes to School-Based Mental Health professionals.
House Budget (Item 271 #1h): Eliminates $750,000 in FY25 and $750,000 in FY26 GF from the pool of funding for the BHLRP, bringing the total down to $7.35 million in FY25 and $7.35 million in FY26 GF. The House budget deletes the $1 million provision for School-Based Mental Health professionals and directs $250,000 per FY be provided specifically for eligible mental health professionals outside the licensed group.
Senate Budget (Item 271 #1s): Eliminates$1.5 million in FY25 and $1.5 million in FY26 GF from the pool of funding for the BHLRP, bringing the total funding down to $6.6 million in FY25 and $6.6 million in FY26GF. The Senate budget keeps the provision for SBMH professionals.
Conference Budget (Item 271 #1c): Accepts the House Budget version.
Initiatives to Expand Mental Health Workforce: DBHDS initially requested the introduced funding to support expanding the youth specific mental health workforce through streamlining licensure, improving training and creation of a new mental health certification program for a wellness coach.
Governor’s Introduced Budget: Allocates $595,876 in FY25 and $645,876 in FY26 GF to fund initiatives to expand the mental health workforce by conducting an evaluation of the licensing process, funding a workforce training director, and providing scholarships for behavioral health technicians. The Governor’s budget did not include language specific to youth mental health workforce.
House Budget (Item 295 #5h): Repurposes the funding for initiatives to expand the mental health workforce, however the language does not specify how the funding will be repurposed.
Senate Budget (Item 295 #4s): Redirects the fundingfor initiatives to expand the mental health workforce, however the language does not specify where the funding will be redirected.
Conference Budget (Item 295 #8c): Accepts the House Budget version.
SCHEV – Mental Health Workforce Program: Requested by the State Council of Higher Education, they sought to expand the current mental health workforce pilot program which supports the cost of required supervision for mental health university students seeking licensure. Currently there is funding of $500,000 each year that is divided between institutions of higher education to allocate to students. The request was for additional funding of $500,000 in FY25 and $1 million in FY26 to be able to support 15 mental health candidates completing supervision for licensure every two years.
Governor’s Introduced Budget (Item 132 P): Retains the $500,000 in FY25 and $500,000 in FY26 GF to support the mental health workforce pilot at institutions of higher education.
House Budget (Item 132 #4h): Increases funding to $1 million in FY25 and $1.5 million in FY26 GF to support the mental health workforce pilot at institutions of higher education.
Senate Budget: Retains the $500,000 in FY25 and $500,000 in FY26 GF to support the mental health workforce pilot at institutions of higher education.
Conference Budget: Accepts the Governor’s and Senate Budget versions.
What’s next? We are waiting to see how Governor Youngkin will respond to the Conference Budget. We will continue to advocate for our legislature to prioritize the mental health of our young people in the budget through funding to support SBMH initiatives such as integrating telehealth and community-based providers in schools. We must also improve and expand initiatives to recruit and retain our mental health workforce, such as the Behavioral Health Loan Repayment Program and the Mental Health Workforce Pilot in higher education.
