Children’s mental health declared a state of emergency.
During the COVID-19 pandemic, more than 25% of high school students nationally reported worsened emotional and cognitive health; and more than 20% of parents with children ages 5-12 reported their children experienced worsened mental or emotional health. Reports of increased isolation, loneliness and anxiety were related to increased mental health concerns.
Towards the end of 2021 the US Surgeon General and AAP, Children’s Hospital Association and Academy of Adolescent and Child Psychiatry declared a state of emergency in children’s mental health. In early 2021, U.S. emergency department visits for suspected suicide attempts soared by nearly 51 percent among girls 12 to 17 and increased by nearly 4 percent among adolescent boys, compared to the same time period in early 2019.
Voices and our partners are working to reduce the stigma associated with mental health as mental health is as important as physical health and make the case for transformation of our children’s behavioral health system in Virginia. We are advocating for increased access and improved coordination of quality mental health services for all children in Virginia, regardless of where they live or at what point they seek mental health services.
Mental health issues are common in children of all ages; with 50 percent of all lifetime cases of mental illness beginning by age 14. In Virginia, children’s mental health disorders are prevalent, with one in five children experiencing symptoms of mental health disorders. While mental health conditions affect many children in Virginia, access and treatment options remain limited.
Voices and our partners are working to bring attention to these issues and to the need for transformation of our children’s behavioral health system in Virginia. We are advocating for increased access and improved coordination of quality mental health services for all children in Virginia, regardless of where they live or what system identifies their needs.
2022 Mental Health Legislative Priorities:
Offering mental health support for children should be normalized whenever and wherever the need arises — with a health care provider, at child care, school, and within the community. Better access for children to receive care from diverse and qualified professionals is needed. Services should be culturally appropriate as it relates to language access, workforce diversity, and other identities children and youth may embrace including religion, race and ethnicity, and gender identity. This requires opportunities to eliminate barriers and to increase incentives and supports to get qualified professionals in the behavioral health and mental health workforce pipeline.
Mental Health Priorities
- Attract a diverse workforce by offering incentives to enter the behavioral health field, achieve licensure, and receive appropriate compensation.
- Increase community-based funding for mental health initiatives, such as additional resources for comprehensive services at Community Services Boards and enhanced Medicaid reimbursement rates at public and private providers.
- Connect schools and mental health providers by encouraging collaboration among systems and between clinical providers and schools to offer more intensive, Tier 2 & Tier 3 supports.
- Provide resources in state government and state agency leadership to work across systems to address children’s mental health and to maximize Medicaid funding.
Bills We Are Monitoring:
Disorderly conduct and incident reporting – Voices has continually opposed policy changes that result in criminalizing student behavior and lead to referrals to law enforcement. Often those circumstances could be better addressed by providing mental health supports to students.
Disorderly conduct in public places HB89 | Walker – This is one of a series of bills that would reverse progress on disrupting the school to prison pipeline by reintroducing “disorderly conduct” as an activity that can be referred to law enforcement when taking place on school grounds for a high school age student.
Status: Reported from the House of Delegates (52-48) and referred to the Senate where it was left in committee.
School principals and incident reporting | HB4 | Wyatt | & SB36 | Norment – This is one of a series of bills that would reverse progress on disrupting the school to prison pipeline by reintroducing incidents that must be referred to law enforcement officers. House Democrats have reached a bipartisan compromise on this legislation. Read more here. In the Senate, similar legislation was heard in the Education and Health Public Education subcommittee and recommended tabling.
Status: Both bills reported during the regular session with some bipartisan support. Governor Youngkin proposed two amendments with the House and Senate both accepting the amend to exclude students with a disability from being reported to law enforcement.
Budget Amendments We Support:
School-based mental health integration pilot | (McClellan 331#5s/Price 311#3h) | This amendment provides $10 million each year from the Department of Behavioral and Developmental Services (DBHDS) to local school divisions to contract for community-based mental health services for students from public or private community-based providers.
The final budget includes $2.5 million in FY23 for the school-based mental health pilot.
Recovery high school pilot | (Coyner 136#6h/Morrissey 136 #14s): In 2020, the General Assembly approved a bill to begin a recovery high school pilot in Chesterfield County, but put the funding on hold. This amendment provides the funding to jumpstart the pilot as a year-round high school for students residing in Region 1 in the early stages of substance use recovery. This bill provides $864,000 the first year and $890,000 the second year to begin the program.
The final budget included $864,000 the first year and $500,000 the second year for the pilot that will begin enrolling fall of 2022.
Remove barriers to licensure for the mental health workforce (Barker 144 #4s/Deeds 304#5s /Davis- 304#39h): Governor Northam’s proposed budget provides $3 million in one‐time funds for a contract with the Virginia Health Care Foundation to pay for the costs of supervisory hours needed for licensure for individuals seeking advanced degrees in social work or counseling. Senator Barker adds an additional $1 million for this effort. Additional amendments from Senator Deeds and Delegate Davis adds 10 new psychiatry residency slots to allow more providers to enter that specialty.
The final budget includes funding for the workforce initiative, now called Boost200 and currently accepting applications for participation. The final budget includes funding for 10 new psychiatry residency slots.
Support funding for VMAP: The Virginia Mental Health Access Program (VMAP) has developed a strong, efficient, and effective model of behavioral health and health integration. Proposed increases will expand training efforts beyond primary care into emergency departments and provide additional expertise to support young children and their families. The proposed budget includes an additional $2.3 million each year to expand the reach of the program.
The final budget includes an additional $882,000 each year but the program plans to move forward with expansion plans.
Enhance funding for existing services by continuing to support the expansion of STEP-VA and improve Medicaid reimbursement rates for behavioral health services to provide accessible services. Both the public and private mental health providers can serve more children and youth with improved Medicaid reimbursement rates for clinical mental health services.
The final budget includes increased funding for STEP- VA as well as Medicaid reimbursement rate increases for home and community-based services, peer and family recovery specialists and psychiatric residential treatment facilities.
Study of school-based mental health services (McClellan 33#2s /Brewer 33#1s) by creating a task force of the Behavioral Health Commission to assess current approaches developed at the local level and recommend how the state can support and sustain approaches by maximizing federal funding and integrated with existing public and private community-based services. The task force should make recommendations for how the state can develop and support more integrated student mental health supports. Similar approaches proposed by Senator Dunnavant to study school-based mental health services and proposals to study school-based health services from Senator Favola, Delegate Robinson and Delegate Bennett-Parker could be incorporated with this approach.
The final budget asks the Behavioral Health Commission to study resources and recommendations to improve school-based mental health and to produce a report to the General Assembly by fall 2023.
In recent years, we’ve accomplished the following:
- Collaborated with partners to improve integration of children’s mental health services in primary care by establishing a pediatric mental health access program in Virginia. In 2019, $1.23 Million per year to build out state-wide capacity for the Virginia Mental Health Access program (VMAP). By the FY22, $5.45 million per year has been allocated to build out state-wide capacity for the Virginia Mental Health Access program (VMAP).
- Led efforts to secure $7 million in 2018 to establish a statewide alternative transportation model for children and adults under a Temporary Detention Order (TDO) and in need of transportation to an inpatient psychiatric hospital.
- Secured millions of dollars in new state funding for child psychiatry and crisis response services in communities across Virginia.
- Advocated to keep the Commonwealth Center for Children and Adolescents (CCCA) open when proposed for closure. CCCA is the only state-run inpatient psychiatric hospital for children in Virginia and, as such, serves as the safety net for kids.
2021 Mental Health Policy Agenda
Policy Implications for Virginia’s Early Childhood Mental Health Work, 2017: A brief on Virginia’s infant and early childhood mental health policy work in 2017.
Voices and its advocacy leaders have been involved in the work of the following task forces, commissions, or committees:
In 2014, Senate Joint Resolution 47 established a joint subcommittee to study the delivery of mental health services, including laws governing the provision of mental health services and the system of emergency, short-term, forensic, and long-term mental health services in the commonwealth. Chaired by Sen. Creigh Deeds, the subcommittee is divided into three workgroups: Continuum of Care, Crisis Intervention, and Special Populations. In 2015, the Special Populations workgroup focused on the delivery of children’s mental health services. All meetings are open to the public. Meeting agendas and materials can be found here.
Established in 1992, the Joint Commission on Health Care studies and makes recommendations on all areas of health care (including behavioral health care) provision, regulation, insurance, liability licensing, and delivery of services. In 2014 and 2015, the JCHC studied and made recommendations on the following behavioral health care topics related to children’s mental health:
- Minor Consent Requirement for Voluntary Inpatient Psychiatric Treatment
- Allowing Certain Minors to Receive Inpatient Mental Health Treatment Without Parental Consent
- Impact of Childhood Trauma on Health
All meetings are open to the public and held at the General Assembly Building. Meeting materials are posted as they become available.
Virginia Association of Community Services Board-Public Policy Committee & Children and Family Services Council
The VACSB represents the 40 CSB/BHAs at the state level for matters of public policy involving legislation, regulation, and funding for the Virginia public mental health system. The campaign works with VACSB to advocate for funding and public policy solutions that will improve our mental health system for children.