Introduction

• Governor James S. Gilmore, III’s priorities for the publicly funded system of mental health, mental retardation, and substance abuse services are predicated on two primary qualitative outcomes:
• Improvement in the quality of care, conditions and consumer protections at Virginia’s mental health and mental retardation facilities.
• Strengthen community-based resources for the care and treatment of individuals and families coping with mental disabilities and substance abuse addition.

• Principle Four of the Hammond Commission’s Interim Report on Community Services and In-Patient Care states:

• Study after study has supported the principle of community-based care as a priority, with state facility-based care designed for specialized psychiatric treatment. These studies include:
• Virginia Mental Health Study Commission (3/65)
• Hirst Commission: First Report (1/70)
• Hirst Commission: Second Report (11/72)
• Bagley Commission (1980)
• Emick Commission (1986)
• Hall/Gartlan Commission (HJR 240 Report: 1998)

• We all know that significant advances in medical psychiatric treatment, especially in the area of psychopharmacology, linked to community-based psychosocial rehabilitation, assertive community treatment methods, residential supports, advanced crisis services, and human rights, has allowed almost all persons with mental illness to effectively reside in the community.
• Access and availability of these services are essential for the effective treatment of mental illness in the community.

• We also know that the majority of consumers and families prefer qualitative and accessible community-based services instead of state hospitalization.

• Additionally, the public demands the effective and efficient use of their tax dollars; cost and sustainability are critical in linking the needs of the mentally disabled with the support of the general public.

• The most significant opportunity and challenge we face is to work together to modernize an antiquated system of care that has focused on dependence and illness and refocus the system and the public’s resources on independence, recovery, and the removal of stigma.

• 15 State Facilities

9 Psychiatric Hospitals

5 Mental Retardation Training Centers

1 Skilled Nursing Facilities

• 3356 Total Acres
• 427 buildings
• 131 buildings occupied
• 46 buildings scheduled for demolition pending availability of capital outlay funding
• 36 buildings currently declared as surplus
• Six year capital plan for all state facilities is $233,564,774

• Eastern State Hospital

• 573 acres
• 29 buildings
• 9 occupied buildings (8 patient treatment; 1 administration)
• 2 buildings scheduled for demolition
• 5 buildings currently declared surplus
• 4 buildings scheduled for capital renovations pending availability of capital outlay.

• Admissions History: Mental Health Facilities
• FY 84 - 9880 admissions
• FY 89 - 9513 admissions (3.7% reduction/367 less admissions)
• FY 94 - 8958 admissions (5.8 % reduction/555 less admissions)
• FY 98 - 7431 admissions (17% reduction/1527 less admissions)
• FY 99 - 6212 admissions (16.4% reduction/1219 less admissions)
• FY 2000 - 3685 projected admissions (40.7% projected reduction/2527 less admissions projected; 1227 actual admissions: 7/1/99 - 10/31/99)
• FY 84 - FY 2000: 6195 less admissions annually; 62.7% reduction in adult admissions; 3.9% annual average rate of reduction
• FY 98 - FY 2000: 3746 less admissions; 50.4% reduction in adult admissions; 16.8% annual average rate of reduction

• State Psychiatric Facility Costs
• The total cost of state psychiatric facilities in FY 84 was $108,647,490; (Average Daily Census: 3576)
• The total cost of state psychiatric facilities in FY 2000 is $257,679,445; (Average Daily Census: 1819, year to date)

• The Development of a Commonwealth Trust Fund
• Gubernatorial Leadership
• General Assembly Cooperation
• Participatory Process
• Leverages currently unused or underutilized assets to provide a stable, dedicated source of funds for the purpose of investment in the transition (bridge) from facility-based services to community-based services.
• Once a state facility transition plan was completed, state general fund savings from the base budget would be returned to the trust fund to replenish the base.
• Protects the base funding of the involved state facilities for direct transfer into community-based services.

• Increases flexibility in creating community-based clinical services with community-services boards and public-private partnerships.
• Provides a financially sound platform to provide supportive alternatives and assistance to state employees.
• Provides a financially sound platform to achieve savings and reinvestment in the publicly funded system.
• Visionary as a method to provide support for appropriate transition from facility-based care to community-based care into the future and over time.
• Provides for safety and protection of current services to consumers in that transition decisions will not be implemented if the trust fund resources are not available.
• Integrates market-based principles into the publicly funded system with significant control over individual facility and system-wide decision-making.
• Fund to be managed by publicly elected officials, thereby increasing accountability.

• Protects the assets in the system for continued use on behalf of the mentally disabled citizens of Virginia.
• Responsible stewardship of state assets on behalf of consumers and the general public.
• Conservative and common sense approach to the financing of the modernization of clinical treatment based on science, best practice, and consumer/family preference.

• The Re-Structuring of Eastern State Hospital

• Based on best practice, quality and protected services, and decentralized delivery.

• Significant participatory community-based planning has already taken place in the greater Williamsburg area.

• Strategic Location
• Develop a Transition Plan Leadership Group comprised of community leaders, local government, consumer and family advocates, state employee representatives, and other interested stakeholders to assist with the development of the implementation plan and process.

• Eastern State Hospital and its employees have provided significantly improved services to consumers, however, the facility continues to provide services that could be delivered in the community at less cost and closer to home.

• Preliminary Recommendations: Eastern State Hospital provides clinical services to three distinct populations:

• Acute Care Psychiatric Services (90 Beds): these services would be targeted for transition to community-based hospitalization or alternative community services through the community services board system, private providers, and competitive bidding at the regional/local level.

• Geriatric Services (260 Beds): these services would be targeted for provision by a newly developed public/private partnership model connecting current or newly developed nursing home services with additional augmentation for specialized behavior management and supervision, as well as specialized mental health and psychopharmacological treatment on an individual basis.

• The majority of geriatric consumers may not require legal commitment to a state psychiatric facility if community-based alternatives existed, thereby losing their constitutional liberty.
• Opportunity to develop specialized psycho-geriatric nursing home service as a component of an integrated long-term care policy.
• Significant unused capacity at other state geriatric facilities for those who may continue to need state facility level care.

• Long-Term Care/Extended Rehabilitation Services (231 Beds): these services would be targeted for continued provision through state support.

• DMHMRSAS would continue to require between 175 and 225 long-term care beds for the Greater Tidewater Region.
• There is ample private sector underutilized hospital space available in the region.
• Opportunity for significant public/private partnership models of delivery, such as private provision of the actual facility and state-run or contractor provided services.
• Do not recommend building a new state capitalized facility.
• Continued concentration on psychosocial rehabilitation, behavior management and multi-disciplinary treatment planning.

• Principles of Consumer/Family Involvement

• Each individual would be treated as an individual; treatment would continue to be delivered through the development and implementation of a multi-disciplinary Individual Treatment Plan.
• The home community and family linkages of each consumer must be taken under consideration in any transition plan.
• Transitional treatment plans will be individually reviewed by an independent panel consisting of a psychiatrist, nurse, psychologist, and social worker. This will be structured to include consumer/family and Eastern State Hospital clinical staff participation.
• The issue of morbidity of geriatric consumers, or any consumer, will be medically managed.
• The Human Rights system will be involved with every individual throughout the transition phase.

• State Employee Consideration at Eastern State Hospital

• Approximately 400 employees reside in Williamsburg.
• Approximately 450 employees reside in Newport News, Hampton, Chesapeake, Norfolk, and Virginia Beach.
• Approximately 270 employees reside throughout the cities and counties surrounding Williamsburg, including Richmond.
• DMHMRSAS would support transition, training, re-training, and redeployment services for all state employees.
• DMHMRSAS would establish incentives to retain essential state facility employees until the end of the transition plan on campus.
• A 225 bed long-term care psychiatric facility, be it state or private sector operated, would require at least 45% of all current ESH employees, or 505 employees.
• The development of a public/private partnership for psychogeriatric specialized nursing home services will require significant new jobs in the private sector.
• DMHMRSAS would support preference for current state employees in any competitive bidding process, based on how and market conditions.
• Specialized severance packages would be recommended for funding for any current state employee who ultimately lost state employment, either voluntarily, or involuntarily, through this plan.
• DMHMRSAS would support a full-time EAP professional on campus throughout the transition planning process.
• Memorialization of the historical significance of Eastern State Hospital and the thousands of employees who have served the needs of its consumers should be a consideration in any sale of property.

• The FY 2000 base budget of Eastern State Hospital is $58,284,945.

In summary, the Commonwealth of Virginia is truly at the crossroads of modernization of the publicly funded system of mental health, mental retardation, and substance abuse services. The Trust Fund approach is fundamentally sound, prudent, and protects the interests of consumers and families and the general public in a values-based approach. The issues involved have been discussed for decades. The pathway for consumer treatment is clear. On behalf of DMHMRSAS, I urge positive consideration of this proposal.

Thank you.