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Fifteen years later, much work remains

DBHDS Commissioner Debra Ferguson, Guest Columnist for the Richmond Times-Dispatch 

June 20, 2014

Fifteen years ago this month, a U.S. Supreme Court case was decided that would fundamentally change the course of treatment and services for people with disabilities, specifically those with intellectual and/or mental health disabilities. The 1999 Olmstead case upheld the civil rights of people with disabilities to live in communities instead of institutions in compliance with the Americans with Disabilities Act. It also required that states serve people with disabilities in the most integrated settings appropriate to meet their needs, consistent with their choice. This ruling applies to both individuals with intellectual disabilities, as Virginia is undergoing a careful downsizing of its institutions (called training centers), and to those with mental illnesses, who should have immediate access to the mental health services they need, when they need them.

Institutional living can no longer be the only choice. Community integration means that people live in their own communities, surrounded by friends and family, with opportunities to learn and work and be a part of life in their neighborhoods. Virginia’s community services system must be designed to facilitate, support and preserve this life for people.

As I begin my tenure as Commissioner of Virginia’s Department of Behavioral Health and Developmental Services, the 15th anniversary of the Olmstead decision provides a rich opportunity to examine our system of care in the commonwealth and to identify ways to strengthen and improve it.

Virginia’s system for people with mental illness, substance-use disorders and developmental disabilities is undergoing significant and needed changes. It is a time of intense monitoring as Virginia implements the terms of a settlement agreement following the U.S. Department of Justice conclusion that Virginia failed to provide services to individuals with developmental disabilities in the most integrated setting appropriate to their needs. It is a time of scrutiny. The mental health system must improve its access, timeliness, and quality of services. The inevitable changes are also an opportunity to look unflinchingly and non-defensively at our system and commit to strengthening and improving it.

Our primary responsibility is to provide a safety net of services that ensures access, quality services and the appropriate clinical response, especially in times of crisis. To start, we are working in several key areas:

(1) Improving access to care. There is tremendous demand for services, but they are inconsistently available across Virginia. We must ensure that people have access to the mental health services they need, and we must continue to increase Medicaid waiver slots so people with developmental disabilities can get services in their communities. A staggering 8,500 Virginians with developmental disabilities are now on waiting lists for services.

(2) Investing more in programs that work. For example, Mental Health First Aid is a program that teaches family members, health care and school employees and others how to respond to an escalating mental-health crisis. Crisis intervention teams produce positive outcomes by diverting people in mental-health crises from jail and instead providing much needed mental-health services. Supportive employment and supported housing programs for people with behavioral health disorders and developmental disabilities facilitate stability and self-sufficiency in the community.

(3) Closing the coverage gap. Expanding Medicaid coverage to more than 400,000 uninsured Virginians would provide access to clearly needed mental health and substance abuse services.

(4) Funding and developing programs for improved substance abuse services. Opioid abuse and overdoses are increasing, often with fatal consequences.

(5) Using technology, such as telepsychiatry, to increase access to care in under-served areas. Those included, particularly, the southwestern and rural portions of the commonwealth.

(6) Strengthening partnerships with key system stakeholders. Effective collaboration among community services boards, law enforcement, the court system, primary health care providers, landlords, and advocates, as well as with the persons served and their family members, helps to ensure the best outcomes for Virginians.

(7) Developing, supporting and expanding peer support activities. The aim is to improve the care we provide and promote our values of recovery, resiliency and self-determination.

On the anniversary of this important ruling, it is important to remind ourselves that Olmstead is fundamentally about improving the lives of the people we serve. Regardless of whether there is a mental illness, substance use disorder, and/or a developmental disability, a life in the community is our enduring goal.