What Are 32 Lives Worth? What’s The True Cost Of Not Helping Them?


(3-20-17) The mother spoke clearly and with a sense of urgency and fear in her voice.

“Our son has late occurring Schizoaffective disorder which began to be evident seven years ago. He is now 46.

Before he became ill, he graduated from Clemson University and worked in a responsible position. Since 2010, our son has been through a list of events that include being incarcerated, 90 days of rehab, hospitalization twice and consistently suffering from the side effects of his medications. 

However, he has worked hard to become stable and after two years of treatment, he became stable. This was most notable during the presidential election as he remained focused on the candidates, asked questions and actually voted.”

Her voice was followed by a letter from another concerned parent.

We have a 34 year-old son, Mariano, who was diagnosed with schizophrenia in 2006. As you can imagine this has brought a lot of suffering, especially to him. He has been under the care and supervision of very competent doctors. But, medical care is only a portion for his wellness. Family and community support are also indispensable to establish a purpose in my son’s life and in the lives of individuals like him.

He is now in a program that offered and still offers him the possibility to relearn and retrain the skills and behaviors that the illness took away. His improvement is shown week to week. And that improvement doesn’t occur only because of the medications, it also comes because of the dedication and knowledge of the counselors helping him… Thanks to their almost individualized attention- there are 4 to 6 clients per group- my son has improved significantly. He realizes he is setting goals that can be attained, even though they will take time, but he is learning to veer all of his energy towards his own betterment.

Why, both women asked, is the county about to close down a program that is helping their sons’ recover from the terrible spiral of debilitating mental disorders? Why is there no money? Why is this particular program that has proven to be effective being terminated?

These mothers are demanding answers from elected officials in Fairfax County, Virginia, where I live, but these same questions are being asked across the nation at budget times because of a lack of public funds for mental health and substance abuse care.

This is not a new dilemma. It is as old as mental illness itself and it is about to get worse. Those who are the sickest of the sick often are in treatment programs that are the most expensive because they require more intensive services. This often makes them the first to be cut because there are fewer parents and patients impacted — meaning it is politically easier to ignore them. Often, it is these people who end up caught in a vicious cycle of streets, jails and/or prisons.

The service in Fairfax that faces elimination is called the Community Readiness and Support Program better known as CRSP.

CRSP has a ratio of counselor to clients or 1 to 3 or 4. In order to save funds, the Falls Church-Fairfax Community Services Board (CSB), which oversees mental health and substance abuse issues, has proposed sending the 32 clients receiving services through CRSP into a similar but not as intense program. That will save approximately $373,303 by cutting four staff position.

The CSB argues the 32 clients can be absorbed by the Psychosocial Rehabilitation Services, Inc. (PRS) program run by a private contractor without additional cost. PRS has a ratio of one worker for 20-25 clients. Much of its focus is on preparing clients for jobs, but the complaining parents claim PRS clients are not as sick as their sons and daughters who need more specialized care.

The PRS does not have a nurse on staff.  In the past, several CRSP clients who were moved to PRS programs have not done well.

“They had to return to CRSP when their mental health deteriorated. There are clients at CRSP who cannot be serviced by PRS. One client is deaf and the other one is on oxygen. What will happen to these clients and others like them in the future when there is no CRSP to take care of them?… As one client stated, ‘Before CRSP, I was constantly being hospitalized. Since my years in CRSP, I have not been hospitalized even once…Two residents…who were PRS clients were sent to CRSP because they have medical and mental disabilities that PRS could not service.”

The parents have been lobbying the Fairfax County Board of Supervisors which oversee the country’s spending to continue funding the CRSP program. In a meeting with Board of Supervisor John Foust, the parents noted that studies done in 2006 and 2011 both concluded that moving the CRSP clients to PRS program “would not be cost effective…We have had no guarantee from PRS that they will take all the CRSP clients and change their large group setting to accommodate the CRSP client needs. Finally, PRS has continued to return clients to CRSP because they were not able to service these clients.”

The CRSP backers argue there has not been a cost-analysis done that will show shifting the CRSP clients to PRS services actually will save money. In fact, they insist shifting CRSP clients could put the community at greater risk and ultimately cost more money because of additional hospitalizations and possible arrests.

The cost of jailing someone in Fairfax is $50,000 per year. Those with severe mental illnesses  traditionally cost two to three times more than others when incarcerated in jails. The cost of a night in a hospital is more than $1,200 per night. Remember Million Dollar Murray? His untreated mental illness cost a million dollars a year in other services. The Perryman Group in Texas found that for every dollar spent on mental health care, the state saved seven dollars.

The CRSP backers told me:

“Supervisor Foust quickly zeroed in on exactly our concern.  How is it possible that moving CRSP clients to PRS will not lead to additional costs?  Foust is very familiar with PRS and questions CSB’s statement about cost savings.  He seemed to agree with us that it is disconcerting that CRSP is being closed without a cost analysis… I am more and more convinced we must save CRSP.  It gives hope to those who have lost all hope.  They are the forgotten ones.”

The parents of CRSP clients have been meeting individually with the county supervisors. That’s how democracies work.

They will be speaking to the full CSB board meeting March 22 at 5 pm at the Merrifield Center located at 8221 Willow Oaks Corp. Drive, Fairfax, VA level 3 Room 409A and they will appeal to the full Board of Supervisors April 4th during a budget meeting, at 12000 Government Center Parkway, Fairfax, VA 22035. They asking others to attend and call 703-324-3151 to speak against closing the CRSP program.

But they face an uphill battle.

CSB Executive Director Tisha Deeghan has met with the parents and is sympathetic to their cause. She and her assistant Daryl Washington did not become mental health professionals to turn away people who are sick and require care.

But they have been given a budget and the county and the state legislature have set priorities.

Diversion First, a program that I personally have been fighting in favor of for years to get Fairfax to implement is one of them. Unfortunately, it only became a priority after Natasha McKenna, a young mother with schizophrenia died after being repeatedly stunned with a taser in our local jail. Programs that divert individuals from jails into community treatment have proven to save money.

But they cost money to implement and the money they save doesn’t necessarily flow back into Deeghan’s budget.

The state also has ordered the county to set aside funds to stem our growing opioid crisis that is expanding the pool of county residents who didn’t previously need services.

Next comes supportive housing. It is estimated that 30,000 individuals living in Fairfax County need supportive housing and many have mental health and substance abuse issues. How can anyone get better if they are living on the streets or incarcerated?

Also, Deeghan’s department has new, legally mandated responsibilities to implement a system of services for people with developmental disabilities, traditionally funded through Medicaid waivers.

Fairfax voters rejected a meals tax that the Fairfax Board of Supervisors said was needed to fund additional community services. Other budget starving groups are demanding funds. Teachers are fleeing because they haven’t gotten raises and their salaries are falling below other counties. Roads need repairs. The police need money too.

Virginia refused to become a Medicaid expansion state and that cost it millions in potential federal  funds that could have helped insure individuals with mental disorders. More cuts will be coming under the Trump administration’s plans to scale back services.

And no one likes tax increases.

So what happens to the 32 severely ill sons and daughters who can be helped, who can recover, who can lead promising lives and ideally get jobs and pay taxes?

A friend once told me: “Whenever we put dollars above helping people in our communities to live with a certain amount of human dignity, I believe we lose something of our own humanity.

If one of those 32 individuals in the CRSP program were your son or daughter, how would you feel?

Do not even the “forgotten” deserve our mercy?

About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.