Author Archives: Cat Atkinson

  1. Youth Mental Health, Well-Being, and Healing Must Continue to Be a Priority: 2024 Budget Recap

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    For previous blogs on Mental Health during the 2024 legislative session, click here and here.

    Intro/Desired Outcomes:

    The 2024 Legislative Session began with excitement and energy surrounding the continued improvement of the mental health system and continuum in Virginia. The governor proposed significant investments in the mental health of the Commonwealth with a particular focus on young folks in the creation of the Youth Mental Health Strategy. This investment plan focused on the expansion of school-based mental health (SBMH) services, tele-mental health services in schools, and limiting the overuse of social media by young people, especially in schools.

    The Behavioral Health Commission (BHC) was charged with bringing forward legislation and budget items that would improve our crisis system for young people by overseeing the reform of the one youth mental health hospital, the Commonwealth Center for Children and Adolescents (CCCA), funding Recovery High Schools for students recovering from substance addiction, and allocating state dollars for youth specific Crisis Receiving Centers and Crisis Stabilization Units.

    The BHC additionally brought forward budget items to develop a comprehensive school-based mental health system through the continued funding of the School-Based Mental Health (SBMH) Integration Pilot and concurrently, look at how to sustainably and flexibly fund SBMH services through collaboration with the Department of Behavioral Health and Developmental Services (DBHDS), the Department of Education (DOE), and the Department of Medical Assistance Services (DMAS).

    Overall, there was a commitment by the Governor and lawmakers to prioritize youth mental health during the session and rightfully so as we continue to contend with a youth mental health crisis both in Virginia and nationally. Virginia has been 48th in the nation for youth access to mental health services, and young people are continuing to speak out about the lack of services and support in their communities and in their schools. In 2021, the Virginia Youth Survey identified that 38% of surveyed Virginia high school students stated they felt sad or hopeless almost every day for 2 weeks or more, and 21% of respondents seriously considered attempting suicide and self-harmed.

    We are particularly struck by national data provided by the AAKOMA Project that highlighted the specific needs of youth and young adults of color. In 2022, they identified that at least half of youth and young adults of color  in their research reported experiencing moderate to severe depression or anxiety. Some specifics: 53.3% of Black youth in the study experience moderate or severe depressive symptoms, 26.9% of Multiracial youth responded that they cut or self-harmed themselves in some way, 58.9% of Latino/e youth in the study experienced mild to severe anxiety, and 83.3% of Latino/e Nonbinary and Transgender youth experienced moderate to severe anxiety.

    Disaggregated data, such as the numbers above, highlight that not all needs are the same nor are they going to be addressed by one miracle solution. The reality is that we need to take a multi-faceted, multi-systematic, and community-driven approach to addressing the mental health crisis at hand. Practitioners and professionals know what is going well and what is not going well in practice and young people and their families know what they need, what will support their healing and what will not; it is the duty of folks in power to listen, learn, implement, listen again, change, and relearn.

    Much of our time during the 2024 session was spent rebuilding knowledge around youth-centered mental health priorities, solidifying youth mental health legislative champions, and building bridges for impacted folks to be a part of the decision-making process around mental health policy and budget items. Here is where we landed in terms of funding for youth mental health.

    Final Outcomes:

    School-Based Mental Health:

    • New School-Based Mental Health Funding Plan: Language Only. Directs the Department of Education (DOE), the Department of Behavioral Health and Developmental Services (DBHDS), and the Department of Medical Assistance Services (DMAS) to develop a plan for creating a new program to deliver flexible mental health funding to school divisions.
      • Specifies that funding will be used to maintain school-based mental health services and supports, provide technical assistance to bill for Medicaid, and conduct evaluation  capabilities built into programming.
    • School-Based Health Centers: $30 million across the biennium will be utilized to provide grants to local school divisions to contract with a Federally Qualified Health Center or other healthcare organizations, to build out school-based health centers in local schools. These centers will provide mental health, dental, and physical health services and serve students, families, community members and school staff.
      • This funding is redirected from the School-Based Mental Health Integration Pilot that was used to provide grants to school divisions to contract with community-based providers and develop school-based mental health programming.
    • Recovery High Schools: Recovery High Schools are year-round high schools that are open to any student residing in the defined region who is in the early stages of substance use disorder or dependency. These schools provide academic, emotional, and social support to aid students’ progress toward graduation and recovery.
      • Chesterfield (Item 295 KK and Item 124 MM): $1.4 million across the biennium to support the already established school.
      • Loudoun County: $500,000 in FY25, $250,000 in FY26 to establish a school.
      • Hampton Roads: $500,000 in FY25, $250,000 in FY26 to establish a school.
    • Access to Tele-mental Health Services: $14.4 million across the biennium was not included in the final budget. This funding would have been used for mental health and telehealth services in public schools.
    • SCHEV – Mental Health Initiative: $6 million across the biennium was not included in the final budget. This funding would have been used for the State Council of Higher Education to coordinate efforts to pursue a common and statewide vendor to provide mental health services including tele-mental health care to students at institutions of higher education.

    Crisis Mental Health:

    • Fund Mobile Crisis Teams (Item 296 U): $10 million in FY25 allocated to fund the establishment of additional mobile crisis teams in underserved areas of the state.
    • RHRN Crisis Services: $64.8 million in FY25 and $42.5 million in FY26 provided to expand and modernize the comprehensive crisis services system (such as developing more crisis receiving centers and crisis stabilization units, pharmacy improvements, and enhancing established sites).
    • Increase Funding for 988 Crisis Line (Item 295 DD): $4.34 million across the biennium ($1.14 million increase across the biennium)
    • Inflation Adjustments for STEP-VA (Item 297 KK): $122.9 million in FY25 and $125.7 million in FY26 (a $17.7 million across the biennium increase in funding).
      • $27.8 million in FY25 and $27.8 million in FY26 ($2.2 million increase across the biennium) provided for outpatient mental health and substance use services.
      • $28.7 million in FY25 and $28.7 million in FY26 ($3.6 million increase across the biennium) provided for crisis services for individuals with mental health or substance use disorders.
      • $4.2 million in FY25 and $4.2 million in FY26 ($804,000 increase across the biennium) provided for military and veterans services.
      • $5.8 million in FY25 and $5.8 million in FY26 ($961,000 increase across the biennium) provided for peer support and family services.
      • $3.9 million in FY25 and $3.9 million in FY26 ($300,000 increase across the biennium) provided for psychiatric rehabilitation services.
      • $6.8 million in FY25 and $6.8 million in FY26 ($659,600 increase across the biennium) provided for care coordination services.
      • $4.3 million in FY25 and $4.3 million in FY26 ($363,850 increase across the biennium) provided for STEP-VA-specific case management services.
    • Funding for Additional Staff for Crisis Stabilization Units: $5 million across the biennium provided for the CSB’s to hire additional staff for crisis stabilization units whose bed capacity is not fully utilized due to lack of staff.
    • Flexible Funding for Children’s Psychiatry and Crisis Response: $27.6 million across the biennium ($2.4 million increase across the biennium) and language change that ensured the flexible use of the funding for children’s psychiatry and crisis response services.
    • Bed Restructuring at CCCA: Language Only. Directs DBHDS to identify existing and develop new alternative placements for children and youth who would otherwise be admitted to Commonwealth Center for Children and Adolescents (CCCA). Findings will be reported to the Governor and Chairs of the Appropriations Committees by November of 2024.
      • The Governor introduced Amendment 218 to the Capital Outlay section, C-48 that would allocate $500,000 in FY25 to begin preplanning for a child and young adult psychiatric treatment facility, however this did not make it to the final budget.
    • Expand Crisis Intervention Trained (CIT) Workforce: $5.2 million across the biennium provided to DBHDS to contract with the Virginia Crisis Intervention Team Coalition to facilitate the expansion of de-escalation training and skilled knowledge of behavioral health laws and regulations for first responders and law enforcement.
    • Crisis Co-Responder Programs (Item 297): $3.43 million in FY25, $3.3 million in FY26 provided to support the ongoing costs of seven crisis co-responder programs established during the 2024 Fiscal Year.
      • Crisis Co-Responder Programs are aligned with the Marcus Alert law that requires 911 and 988 crisis call centers, law enforcement and local behavioral health agencies to work together to improve responses to individuals experiencing a mental health crisis.
    • Alt. Transportation/Alt. Custody for TDO/involuntary commitment: $29 million across the biennium.
    • Salary Alignment at State Facilities: $20.8 million across the biennium.
    • Fund Comprehensive Psychiatric Emergency Programs (CPEP): $10 million in FY25 was not included in the final budget. This funding would have been used to develop and support comprehensive psychiatric emergency programs or similar models of psychiatric care in emergency departments. These programs provide specifically mental and behavioral health emergency/crisis services in the emergency departments of hospitals and would be in partnership with the region’s Community Services Board or Behavioral Health Authority.

    Workforce:

    • 20 Additional Psychiatric Residencies (Item 288 UU): $2 million GF, $2 million NGF across the biennium used for supplemental payments to fund 20 graduate psychiatric residents who begin their residencies in July of 2024.
    • Mental Health Treatment Centers, Clinical Training Sites (Item 301 F): $741,889 in FY25, $711,989 in FY26 provided to establish and support formal partnerships between academic institutions and three state-operated facilities to serve as clinical training sites for licensed mental health professionals, medical residents, nurses, nurse practitioners, and physician assistants.
    • Boost 200 Expansion (Item 295 AA): $1.15 million across the biennium provided for DBHDS to contract with the Virginia Health Care Foundation to pay for costs of supervisory hours needed for students working toward their social work or counseling licensure.
    • VMAP (Item 296 G): $29.6 million across the biennium ($7.96 million increase across the biennium) provided to DBHDS to contract with Virginia Mental Health Access Program to develop integrated mental health services for children.
    • Behavioral Health Loan Repayment Program (Item 271 C): $14.7 million across the biennium ($10 million increase across the biennium) provided for the Behavioral Health Loan Repayment Program.
      • Eligible practitioners: psychiatrists, licensed clinical psychologists, licensed clinical social workers, licensed professional counselors, child and adolescent psychiatrists, child and adolescent psychiatry Fellows, psychiatric physician assistants, psychiatric pharmacists, psychiatric registered nurses, and psychiatric nurse practitioners.
    • Initiatives to Expand Mental Health Workforce: $595,876 in FY25, $645,876 in FY26 were not included in the final budget. This funding would have been used to expand the mental health workforce by conducting an evaluation of the licensing process, funding a workforce training director and providing scholarships to behavioral health technicians.

    The Way Forward:

    The mental health budget outcomes of the 2024 General Assembly Session include some great investments in crisis services and support for mental health professional licensees and residents as well as great losses of significant funding for school-based mental health initiatives that would prioritize prevention services over reactive crisis services. While we need both crisis and prevention services concurrently, it is important that we continue to uplift preventative measures to addressing the youth mental health crisis through advocating for and prioritizing services such as school-based mental health, restorative practices, and early intervention.

    According to youth.gov, mental health prevention is defined as “intervening to minimize mental health problems by addressing determinants of mental health issues before a specific mental health problem has been identified in the individual, group, or population of focus with the ultimate goal of reducing the number of future mental health problems in the population.”

    We must take a holistic approach to prevention by still supporting efforts to improve access for young people to receive treatment when symptoms arise and crises occur. Concurrently, we must prioritize getting ahead of the symptoms and crises by supporting young people and their families earlier in life through things like social-emotional skills, coping strategies, and destigmatizing mental health. Furthermore, we must always be working to dismantle the root causes of mental health challenges and mental illness by addressing the social determinants of mental health such as economic insecurity, housing insecurity, and community violence.

    More specifically, the mental health workforce shortage continues to be a concern and we are listening.

    We continue to hear concern, nationally and in the state, that the mental health professional workforce shortage is at the forefront of our inability to meet the youth mental health crisis and address prevention across systems. This is a serious challenge and one that we can prioritize; chipping away at some of the weaker pieces of our mental health system to build it back stronger for young people across the continuum.

    Our mental health workforce is waning as caseloads are high, administrative work is burdensome and time-consuming, and practitioners are not being paid for the significant and impactful work they provide to their clients. Up until this point, Virginia’s efforts have focused on workforce recruitment partnerships with key organizations like the Virginia Health Care Foundation (VHCF) that developed the Boost 200 program and the Virginia Mental Health Access Program (VMAP) that worked with healthcare professionals to integrate mental health services for children. Additional markers of progress include state investments in residencies, establishing clinical training sites, and incentivizing higher education in mental health through loan repayments and programming. These initiatives address recruitment challenges by breaking down barriers to becoming a licensed mental health professional across various areas of specialty including social work, psychiatry, psychology and nursing.

    The questions that remain are 1. why are there high turnover rates in the field and 2. what systemwide improvements need to be made to support the existing workforce.

    In 2023, the Virginia Health Workforce Development Authority (VHWDA) released a report that assessed the current state of primary care, nursing and behavioral health workforce in Virginia. They looked holistically at both recruitment and retention and highlighted infrastructural issues associated with working in the mental health field, such as low pay, stressful work environment and administrative burdens taking providers away from their direct services. Closing data collection gaps around vacancies and turnover as well as pipeline data assessing school to licensing to practicing and beyond were recommended by the authority and we are glad that the BHC and the Joint Commission on Healthcare (JCHC) are both going to be conducting studies around the health workforce and will be releasing recommendations in September and December. We are eager to see what they will find and policy solutions they will consider  bringing to the 2025 General Assembly Session.

    By assessing the workplace environment for our mental health professionals, offering solutions to the infrastructural challenges of retention, addressing the Medicaid reimbursement inequities, thinking creatively about how we can build culturally rooted and healing-centered practices into our systems, and continuing to fund recruitment initiatives, Virginia will be taking the right steps to meeting the multi-tiered, multi-faceted mental health needs of our young people. That is prevention.

    Voices’ will continue to uplift the priorities of those most impacted by these recommendations and policy decisions and provide opportunities to support folks who are interested in advocating and sharing their stories with legislators to enact change. Please connect with Cat Atkinson, cat@vakids.com for more information related to youth mental health or mental health workforce and connect with Sophia Booker, sophia@vakids.org for advocacy opportunities and training.

    Glossary:

    • Conference Budget: Appropriations of state revenue agreed to by the budget conferees from the House and Senate and passed by the General Assembly. The conference budget is sent to the governor for approval.
    • Governor’s Budget Actions
      • Veto: Action by which the Governor refuses to sign legislation, including the budget, passed by the General Assembly. A 2/3 vote of each body is required to override a veto.
      • Amendment: A proposed change that inserts and/or strikes language from the legislation or budget.
      • Sign: Action by which the Governor signs the legislation, including the budget, and it becomes law. Effective dates are July 1, unless otherwise specified through an emergency clause.
    • Final Budget: Appropriations of state revenue agreed to by the General Assembly and Governor.
    • General Fund (GF): The predominant fund for financing state government programs. The primary sources of revenue for the General Fund are the personal income tax, sales tax, and corporation taxes.
    • Non-General Fund (NGF): All sources of revenue other than the General Fund. For example: federal appropriations, grants, and contracts.
    • Biennium (FY25-FY26): A two-year period used by the state for financial and budget purposes. It includes two fiscal years, running from July 1 in an even-numbered year to June 30 of the next even-numbered year.
    • Fiscal Year (FY): A fiscal year is a 12-month accounting period. The fiscal year for Virginia state government begins July 1 and ends June 30. For example, FY25 is from July 1, 2024-June 30, 2025 and FY26 is from July 1, 2025 – June 30, 2026.

  2. Toward Wellness: The Status of School-Based Mental Health Initiatives in Virginia Report

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    Virginia is 48th in the nation for youth access to mental health services, and young people are continuing to speak out about the lack of services and support in their communities and in their schools. In 2021, the Virginia Youth Survey identified that 38% of surveyed Virginia high school students stated they felt sad or hopeless almost every day for 2 weeks or more, and 21% of respondents seriously considered attempting suicide and self-harmed.

    Nationally, in 2022, the AAKOMA Project identified that at least half of Youth and Young Adults of Color in their research reported experiencing moderate to severe depression or anxiety. Some specifics: 53.3% of Black youth in the study experience moderate or severe depressive symptoms, 26.9% of Multiracial youth responded that they cut or self-harmed themselves in some way, 58.9% of Latino/e youth in the study experienced mild to severe anxiety, and 83.3% of Latino/e Nonbinary and Transgender youth experienced moderate to severe anxiety.

    Behind these statistics are real young people suffering from systems that do not meet their needs. As the Commonwealth continues to reckon with the realities of the youth mental health crisis, attempting to find a clear solution to a multi-faceted issue is challenging. However, the reality that Virginia’s young people deserve systems that support their mental health and well-being has not changed.

    One possible solution to address the youth mental health crisis, paired with continued state efforts to support our mental health workforce and address the shortage, is school-based mental health (SBMH) services and programming. SBMH services are preventative in nature and seek to shift the prioritization of healing before a crisis occurs.

    Toward Wellness: The Status of School-Based Mental Health Initiatives in Virginia is a comprehensive report that examines the state of mental health services in Virginia’s K-12 public schools. Authored by Cat Atkinson, Policy Analyst, this report:

    1. Answers critical questions about what SBMH is and how these services can be funded,
    2. Provides context on the status of SBMH initiatives in the state of Virginia,
    3. Shares insights from the 2024 legislative session and current outcomes regarding SBMH, and
    4. offers considerations and recommendations for community members, legislators, and state agencies on how we can build out a statewide SBMH system that will center and meet the needs of Virginia’s young people.

    SBMH programs are an opportunity to advance equity in mental health care, overcome the many barriers young people face to receiving services, and be intentional about addressing the unique needs of young people within each unique local community.

    We hope this provides insight into the world of preventative mental health services, spurs conversations and energy toward improving Virginia’s youth mental health system, and informs how we as individuals, communities, organizations, and leaders can create a Virginia that centers healing.

    Read the full report below or download here.

    Download here.

    We’re thrilled to announce a webinar series to coincide with the release of our school-based mental health report. Our first session will be on May 30th at 1 PM, featuring a discussion with our CEO Rachael Deane and Policy Analyst Cat Atkinson, who will delve into the report’s key findings. Register to join us using this link.

     

  3. A Comparative Analysis of House and Senate Proposed Budgets for Mental Health: A Closer Look at Key Investments

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    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): Increases the children’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 FY26 GF.  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 funding for 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. 

  4. Prioritizing Youth Mental Health during the 2024 Legislative Session

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    The 2024 Legislative Session started with significant energy being poured into the Commonwealth’s mental health continuum. We are grateful for Governor Youngkin’s commitment to investing $500 million into our mental health system and are encouraged by his focus on young people in the Right Help, Right Now, Youth Mental Health Strategy; legislators have been following suit by uplifting youth mental health priorities across mental health systems.  

    The Commonwealth has continued to reckon with the realities of the youth mental health crisis, attempting to find a clear solution to a multi-faceted issue. Crisis services attempt to treat the symptoms of an unhealed system impacting our young people. Young people continue to remind us that this mental health crisis is not new, nor was it caused solely by the COVID-19 pandemic. The U.S. Surgeon General’s 2021 Advisory on Protecting Youth Mental Health highlights that youth mental health symptoms and suicide rates have been increasing for at least a decade. Young advocates and data emphasize factors such as increased substance use, academic pressure, and structural injustices such as racism, gun violence, and income inequality, all as contributing to the current state of youth mental health. 

    Paired with the continued workforce shortage, noting that 93 of the Commonwealth’s 133 localities are federally designated mental health workforce shortage areas and the lack of intentionality toward equally prioritizing preventative services, Virginia has unfortunately earned their ranking of 48th in Youth Mental Health Access in the country.  

    The 2024 Legislative Session brings new investments in mental health prevention services via school-based mental health, crisis services, and workforce development, support and incentivization programs. The outlined budget items and amendments below are promising as we work toward improving accessibility for young people and families to receive the care they need and deserve, regardless of their identity, socioeconomic status, or locality. 

    School-Based Mental Health 

    School-based mental health (SBMH) services prioritize the mental health and well-being of students within a school setting by providing easy access to mental health services, promoting healing and destigmatization, and supporting lifelong health and wellness. SBMH programs are an opportunity to advance mental health equity, overcome the many known barriers young people face to receiving services, and be intentional about addressing the unique needs of young people within each unique local community. 

    Voices has been following the development and expansion of the SBMH Integration Pilot and prioritizing funding that continues to address the unique needs of each division and locality. 

    Budget amendments: 

    • Item 124 #4s (Sen. Craig) | VDOE | Language Only 
      • Language added to transfer the SBMH Integration Pilot funding from DBHDS to DOE. 
    • Item 295 #3s (Sen. Deeds) | Item 295 #10h (Del. Watts) | DBHDS  
      • Item 295 #3s: FY25: $7.5 million, FY26: $7.5 million 
      • Item 295 #10h: Language Only 
      • Adds funding to the school-based mental health pilots to support the development of performance measures for participating schools and the pilot overall. This is a Behavioral Health Commission (BHC) recommendation. 
    • Item 288 #6h (Del. Rasoul) | DMAS | FY25: $868,732, FY26: $868,732 
      • Requires DMAS and DOE to revise their interagency agreement on the amount of administrative funding DOE will receive to help school divisions bill Medicaid for allowable services, including mental health services. 
    • Item 118 #3s (Sen Deeds) | Item 117 #1h (Del. Rasoul) | VDOE | Language Only 
      • Directs VDOE, DBHDS, and DMAS to work collaboratively on a plan for creating a new program that will deliver flexible mental health funds to school divisions. This is a BHC recommendation. 
    • Item 124 #37h (Del. Carr) | VDOE | FY25: $25 million, FY26: $25 million  
      • Funding to local school divisions via competitive grants that serve communities with high incidences of community violence to contract for community-based mental health services for students from public or private community-based providers or to fund the hiring of additional specialized support staff to meet student needs.   
    • Item 124 #50s (Sen. Deeds) | Item 125 #2h (Del. Rasoul) | VDOE  
      • Item 124 #50s: FY25: $30 million  
      • Item #32h: FY25: $20 million 
      • Provides one-time funding to school divisions to maintain school-based mental health services established using one-time pandemic relief funding. This is a BHC recommendation. 
    • Item 125 #18s (Sen VanValkenburg) | Item 125 #6h (Del. Hernandez) | Item 125 #42h (Del. McClure) | VDOE | FY25: $57 million, FY26: $57 million 
      • Provides the state share of funding for four specialized support staff per 1,000 students in public schools. These specialized staff include school social workers, school psychologists, school nurses, and others. In conjunction with SB127 and HB386. 
    • Item 125 #16s (Sen VanValkenburg) | Item 125 #12h (Del. Feggans) | VDOE | FY25: $62.7 million, FY26: $63.2 million 
      • Provides the state share of funding for one school counselor for every 250 students in public schools, a decreased ratio from 1:325. In conjunction with SB127 and HB181. 
    • Item 117 #19h (Del. Srinivasan) | VDOE | FY25: $50,000, FY26: $50,000 
      • Funding to support implementation and provision of mental health teletherapy for students in public schools, as developed through the model MOU that will be enacted between a school board and the tele-mental health provider. In conjunction with HB919. 
    • Item 117 #24h (Del. Price) | VDOE | FY25: $50,000, FY26: $50,000 
      • Funding to support the development of age-appropriate mental health curricula for ages K-12 as a part of physical health education in public schools. In conjunction with HB603. 
    • Item 117 #25h (Del. Henson) | VDOE | FY25: $50,000, FY: $50,000 
      • Funding to update the requirements of mental health awareness training for public school teachers to include how to address the needs of youth who are at a high risk of experiencing mental health challenges. In conjunction with HB224. 

    Youth Crisis Mental Health 

    Currently, there are only three Residential Crisis Stabilization Units (RCSUs) for youth across the state—St. Joseph’s Villa, Mt. Rogers and Western Tidewater. St. Joseph’s Villa is also building out the first 23-hour crisis receiving center (CRCs) specific to youth, scheduled to start operating in the spring of 2024. There are also budget amendments below supporting the development of an additional youth unit within the Prince William County CRC.  

    These efforts are positive and are also inadequate; 2024 budget investments will continue to build out components of the crisis services system, however, it is important to keep a focus on crisis infrastructure specific to children and youth services.  

    Budget amendments: 

    • Item 124 #53h (Del. Srinivasan) | Item 124 #6s (Sen. Perry) VDOE | FY25: $1 million, FY26: $1 million 
      • Funding to establish and maintain a recovery high school in Loudon County (Superintendent Region 4). In conjunction with HB696. 
    • Item 295 #17h (Del. Tata) | DBHDS | FY25: $500,000 NGF
      • Funding from the Opioid Abatement Authority Fund to establish a recovery high school in Hampton Roads (Superintendent Region 2). In conjunction with HB696. 
    • Item 295 #2s (Sen. Deeds) | Item 301 #1h (Del. Hope) | DBHDS | Language Only 
      • Provides language directing DBHDS to work with relevant local and state agencies to review and report on alternative placements for children and youth who otherwise would be placed at the Commonwealth Center for Children and Adolescents (CCCA). This is a JLARC recommendation to the BHC. 
    • Item 296 #5s (Sen. Deeds) | Item 297 #1h (Del. Rasoul) | DBHDS | FY25: $3.3 million, FY26: $3.3 million 
      • Funding provided to account for inflation costs for implementing and delivering services associated with STEP-VA. There is no explicit language in the budget guaranteeing that any of this funding will be used for young people. 
    • Item 296 #9s (Sen. McPike) | Item 296 #16h (Del. Sewell) | DBHDS | FY25: $2.3 million, FY26: $2.3 million  
      • Funding to support the build-out of a Crisis Receiving Center (CRC) in Prince William County. Item 296 #9s states that this CRC will serve youth only while Item 296 #16h states this CRC will serve adults and adolescents. 
    • Item 296 #20h (Del Rasoul) | DBHDS | FY25: $33 million, FY26: $2.6 million  
      • Funding is redirected from Item 296 #19h (Del. Rasoul) to fully staff existing crisis centers. There is no explicit language in the budget guaranteeing that any of this funding will be used for young people. 
    • Item 297 #1s (Sen. Deeds) | Item 297 #5h (Del. Rasoul) | DBHDS | Language Only 
      • Provides language changes that will ensure flexible use of funds for children’s crisis services. This is a Voices’ requested budget amendment. 
    • Item 296 #4h (Del. Rasoul) | DBHDS | FY25: $5 million, FY26: $5 million 
      • Establishes a program to provide funding to private psychiatric hospitals that agree to increase the percentage of involuntary inpatient admissions they accept and to demonstrate the need for funding to safely admit such patients. This is a JLARC recommendation to the BHC. 
    • Item 288 #13s (Sen. Locke) | Item 288 #51h (Del. Askew) | DMAS | FY25: $2.7 million GF / $2.7 million NGF, FY26: $2.7 million GF / $2.7 million NGF 
    • Item 288 #6s (Sen. Deeds) | DMAS | FY25: $11 million GF / $12.5 million NGF, FY26: $22.2 million GF / $25 million NGF) 
      • Increase rates by 10% for Medicaid-funded, community-based mental and behavioral health services, which includes Comprehensive Crisis Services and much more.  

    Mental Health Workforce 

    Voices’ priority is to attract and retain a culturally diverse behavioral health workforce that is representative of our young people and well-supported by Virginia’s behavioral health system. 

    The Virginia Health Workforce Development Authority identified interventions that should be prioritized in recruiting and retaining our behavioral health workforce, including ensuring adequate Medicaid reimbursement rates, increased residency slots and funding for psychiatry, promotion of team-based or collaborative care, removal of excessive supervised training hours and expenses to supervision, and student loan forgiveness/repayment.  

    Governor Youngkin and state legislators are taking the workforce shortage seriously by investing in programs and facilities that shift our system to train, support, and pay our mental health workers the compensation they deserve. 

    Budget amendments: 

    • Item 297 #1h (Del. Clark) | VDH | $1 million, $1 million 
      • Funding will be used to create a loan repayment program for people that have worked in the Commonwealth as mental health professionals for at least five years (bill amended to two years). In conjunction with HB37. 
    • Item 132 #2s (Sen. VanValkenburg) | Item 132 #19h (Del. Sickles) | SCHEV  
      • Item 132 #9s: FY25: $500,000, FY26: $1 million 
      • The funding for Item 132 #9s supports the costs of required supervision for graduates of Master of Social Work and Master of Counseling programs seeking licensure. 
      • Item 132 #20h: Language Only 
      • Item 132 #20h requests the addition of private, nonprofit institutions that offer the Master of Social Work degree with access to this Mental Health Pilot program to assist in growing the state’s pool of qualified mental health workers. 
    • Item 132 #9s (Sen. VanValkenburg) | Item 132 #20h (Del. Sickles) | SCHEV | Language Only 
      • Edits language to specify that funding shall be allocated to public and private not-for-profit institutions of higher education participating in the statewide contract to improve the mental health workforce pilot. 

    View Voices’ Bill Tracker to keep up with Mental Health bills that we are supporting and monitoring: https://vakids.org/our-news/blog/voices-for-virginias-children-2024-legislative-agenda