West Virginia mental health care in crisis

The intro to a long story by Paul Darst at The State Journal:

Twenty years ago, West Virginia was considered a national leader in providing mental health services.

But those who work in that field now look upon those days with a degree of nostalgia.

"We were one of the national leaders in the mid-'80s and early '90s," said John Russell, executive director of the West Virginia Behavioral Health Care Providers Association. "Then we had a steady stream of slow erosion."

Today, West Virginia is in what state lawmakers have termed a state of crisis when it comes to mental health care.

The lack of community-based mental health programs has led to overcrowding at the state's two mental health hospitals. The overcrowding is so severe that William R. Sharpe Jr. Hospital in Weston and Mildred Mitchell-Bateman Hospital in Huntington routinely have to pay private hospitals to house patients in need of care. Other West Virginians in need of help go without treatment.

There was no one thing that led West Virginia into its current situation, said Dave Sanders of the West Virginia Mental Health Care Consumers Association.

"We believe there has been a huge lack of community-based service in West Virginia since 2000-2001," he said. "There was no one cut that did it. It's been a death of a thousand cuts."

About 20 years ago, the state was known as a national leader in deinstitutionalizing behavioral health care patients, according to information from the state Behavioral Health Care Providers Association. The state had a 95 percent success rate in moving patients out of its nine psychiatric hospitals and into community-based programs.

During that time, the state's psychiatric hospital population decreased from 5,410 to 224 by 1994, according to the data.

But the past 15 years have been a different story, according to the association. During that time, behavioral health care providers' reimbursement rates have been stagnant. And the state has made several cuts along the way.

Medicaid reimbursement to providers declined 28 percent -- $34 million -- between 1997 and 1999, the association reported. Medicaid cut another 36 percent -- $41 million -- in 2000. Clinic-based services, rehabilitation services and case-management services were hardest hit by those cuts. All are important funding sources for nonprofit behavioral health care centers.

The cuts continued in 2002, when the state reduced its behavioral health care funding by $27 million, according to the association. In 2005, the Legislature cut another $115 million in Medicaid spending because of a budget shortfall.

To add insult to injury, providers receive no annual inflationary rate adjustment. From 1993 to 2008, the rate of inflation was more than 50 percent, the association reported.

As a result, at least five West Virginia behavioral health care providers filed bankruptcy, and many others have ended their treatment programs in recent years.