Four Keys To Successful Mental Health Programs


Why do some communities have better mental health services than others? In a recent Op Ed published in The Washington Post,   I took my home state of Virginia to task because our outgoing governor appointed yet another task force to study mental health — the 16th in recent years. In that opinion piece, I describe the four “secrets” to success that I have found during my travels.

How does your community fare when it comes to these four earmarks?

Va. doesn’t need another mental health task

By Pete Earley, The Washington Post

Virginians should be embarrassed and angry that a newly appointed state mental health task force convened Tuesday in Richmond. It is the 16th task force asked to investigate the state’s mental health system.

Are Virginia legislators so dense that they need yet another expert panel to tell them what’s wrong?

Four major studies, from 1997 through 2000, in Virginia each identified the same problems and made similar recommendations. Yet the system remains a mess. Why?

Outgoing governor Robert F. McDonnell (R) appointed the newest panel after the November stabbing of state Sen. Creigh Deeds (D-Bath) by his son, Austin, who then killed himself. A local mental health official said afterward that Austin had not been treated because no psychiatric hospital bed was available locally.

That may have shocked the governor, but it wasn’t a surprise to those of us with family members who need mental health care. Virginia’s inspector general warned in a  May 2011 report that 200 people were turned away from hospitals during one 12-month period because of a lack of beds, even though the patients were considered a danger to themselves or others. The practice had become so widespread hospital officials coined a term for it: “streeting.”

The mental health task force that I served on issued its findings after the Virginia Tech shootings in 2007 that left 33 people dead, including the shooter, who had been deemed dangerous but hadn’t received treatment. Our recommendations led to sweeping legal changes and an additional $42 million in mental health funding spread over a two-year period. Problem solved. Or so we thought.

Since 2006, I’ve visited more than a hundred treatment programs in 48 states and three countries, and I’ve found that the problems in Virginia and nationally are not the result of ignorance. Mental health professionals know how to help most people with serious disorders. Four things are missing in Virginia. Unfortunately, it’s unlikely the new task force will focus on any of them.

●Virginia is missing a leader powerful enough to force state and local agencies to work as a team…Mental health services in Virginia are managed by 40 Community Services Boards (CSBs), and that patchwork is often blamed for problems with the system. While cumbersome, the boards are not the problem. Regardless of how a CSB is operated, it cannot require police chiefs to implement specialized training for their officers or demand that a judge create a mental health court, even though both have proved to reduce violent incidents, save tax dollars and help the mentally ill get treatment.

Virginians must stop thinking that mental health is solely a problem for the CSBs and state Department of Behavioral Health and Developmental Services. Mental health cuts a wide swath. Housing, veterans’ assistance, drug and alcohol services, transportation and employment all play a role in helping someone recover. Sadly, so does law enforcement and the judiciary. It takes leadership to bring these divergent agencies together.

●Good treatment requires adequate financing. After the Virginia Tech shootings, the legislature approved the $42 million in new money, but within three years had instituted across-the-board budget cuts that reduced mental health spending to below what was being spent before the shootings. Successful mental health programs are often costly to launch but ultimately save tax dollars, as much as $22 saved for each $1 spent, according to a Texas study carried out by the Perryman Group. Few politicians want to invest in programs that offer far-off results, but that’s where we should be putting our tax dollars, not in quick, one-time fixes.

●Virginians must look at the big picture. After the Virginia Tech shootings, our task force lowered the criteria for involuntarily committing someone into a hospital. While a positive step, this has proved ineffective because there are not enough hospital beds. Meanwhile, 80 people in state hospitals are ready to go home but can’t leave because there is no affordable housing in their communities. It costs $590 per day to keep those patients in a hospital. It would cost $120 per day for them to live in a community setting. You can’t fix one tire and expect a car to run if the other three are flat.

●Mental health must be an ongoing priority. While Virginia’s Department of Behavioral Health and Development Services “may pay lip service to serious mental illness,” a top legislator told me, “check that department’s priorities and you’ll find its best-funded programs are aimed at helping the intellectually disabled. Not mental illness.” Why? Because many parents of children with intellectual disabilities are well organized and are used to fighting for their children. They call their local representative, show up at town meetings and vote. Parents with mentally ill kids in jail, homeless or in hospitals often are ashamed to speak out and demand improvements. The only time anyone cares about mental illness is after a tragedy.

We don’t need another task force. We need a leader with enough clout to bring everyone to the table, get them the money they need to do their jobs and direct them to create a true system, not a fractured one being held together by Band-Aids that we apply each time there’s a tragedy.

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.