“I will work every day to ensure my fellow Virginians facing behavioral and substance abuse disorders receive the care they deserve. I will work to prevent addiction, provide intervention and welcome those seeking recovery with open arms.” – Ed Gillespie
Hundreds of thousands of Virginians are dealing with a serious mental illness. Many more a dealing with some sort of mental behavioral, or emotional disorder. Virginia communities are being torn apart by addiction. Thousands are dealing with mental illness and addiction from behind bars in Virginia’s jails and prisons. These are real problems for our Commonwealth that demand real solutions.
In order to be able to address these issues, the Commonwealth must have response, care and treatment system that is organized and coordinated. To date, the Commonwealth has been unable to meet that challenge. Rather, the legislature, governor, cabinet, agencies, nonprofits and private sector have proposed different ways to address the mental health issues facing Virginia and not a unified solution. This has created decision paralysis at all levels, resulting in many Virginians not receiving the care they need at the most appropriate place and time.
Virginians struggling with mental health issues, addiction or who are in recovery do not neatly fit into secretariat or agency organizational charts. Any Virginian who has needed mental health or substance use disorder treatment or intervention, knows the system – or lack thereof – is not working for all Virginians.
Our mental and behavioral healthcare safety net is inadequate, falling far short of what our most vulnerable citizens deserve. The challenge for Virginia’s next governor will be to strengthen our mental and behavioral health services and address the crisis of drug addiction that is sweeping across every community in every region of our great Commonwealth. Virginia cannot wait for the Federal Government or other states to solve this crisis. We should set the standard for other states to follow.
As governor, Ed Gillespie will work with Republicans and Democrats in the General Assembly to implement a comprehensive plan to ensure alignment across all agency and partner organizations.
Either way you look at it: from serving individuals and families or ensuring the best use of taxpayer dollars, the overwhelming research compels us to focus on intervention, before crisis occurs. Crisis is destructive to families and individuals. Crisis costs more and takes longer to stabilize. Virginia’s behavioral health system must ensure Virginians have access to high quality care when they first need it. To accomplish this, we must develop and fund community based systems of care to help our fellow citizens before they fall into crisis.
There are many dedicated and caring professionals working tirelessly on all ends of behavioral health. In order to serve them and our fellow Virginians who find themselves working through the complex web of behavioral health and addiction treatment, we must take action to de-silo our structures and move toward solution oriented systems.
As governor, Ed will work to improve our behavioral health system to ensure individuals receive the care they need. He will work with healthcare and law enforcement experts to develop a comprehensive solution that addresses all facets of the addiction crisis, including prevention, intervention, treatment and recovery. If we do this right, we can save lives and improve treatment options and outcomes. Doing so will result in a healthier and stronger Commonwealth, which will ultimately save taxpayer dollars over the long term. We must proactively pursue reform and realignment of our behavioral health care system rather than continue waiting for the next crisis to serve as a catalyst for change.
Virginia is facing a crisis. Ed believes five key principles should guide Virginia’s efforts to combat this epidemic:
Principle 1: Addiction is a disease – not a moral failing
Addiction affects nerve function and brain chemistry. Scientific evidence clearly indicates that long-lasting brain changes are responsible for the distortions of cognitive and emotional functioning that characterize addiction, including the strong compulsion to continue drug use. Addiction acutely modifies mood, memory, perception, and emotional states that can persist long after the individual stops using them.
Principle 2: Focus on Intervention
Too often, our behavioral health system as a whole seems to lurch from one crisis to the next. We must work together to provide care and treatment at the first signs of problems, for the individual and the system as a whole, rather than wait for the next crisis to dictate our response. Likewise, our criminal justice system should not be one of Virginia’s leading treatment centers. We must continue to improve our ability to divert nonviolent offenders suffering from mental health or addiction into treatment rather than jail. Often addicts enter the criminal justice system not through a possession charge, but through a crime committed to feed their addiction. It will require an investment of time and resources in community-based services to solve this problem.
Principle 3: We cannot arrest our way out of the current epidemic of addiction
The emerging consensus from health practitioners and law enforcement leaders is a shared belief that addiction is clearly a public health issue more than a criminal justice problem. Law enforcement representatives are searching for creative alternatives to divert the afflicted to needed treatment in lieu of incarceration because the prison system is not the appropriate venue to treat those who struggle with addiction. Already stretched law enforcement, judicial resources and overcrowded jails cannot become a substitute for meaningful treatment. Managing an increasing population suffering from addiction under such an approach is not sustainable.
Principle 4: Recognize multiple pathways to recovery
Moving forward, strategies to combat addiction must address stigma, administrative barriers and state capacity to provide wider access to treatment and counseling.
Principle 5: Help must be immediate
When someone facing addiction is in crisis and asks for help, we must respond immediately. For those facing addiction, one week can mean the difference between entering recovery or continuing a harmful addiction.
With these principles in mind, Ed will work to make the following policy changes:
Despite considerable public awareness of the nation’s prescription opioid and heroin addiction epidemic, over a thousand Virginians died last year due to prescription opioid and heroin overdoses, a significant increase over the previous year. In fact, there are now more deaths associated with drug overdoses than car accidents.
The opioid addiction epidemic has two pathway drivers – non-medical use (abuse) and medical use (overuse) of prescription opioid drugs. Access to prescription opioids and illegal drugs is readily available in communities, schools, workplaces and in home medicine cabinets, making them available for medical overuse or abuse. Strategies that fail to address non-medical use and medical overuse will be incomplete.
The General Assembly and the current Administration have enacted numerous measures to combat this epidemic. But, we can all agree, much more needs to be done.
To combat the opioid epidemic in our schools, Ed will:
The Centers for Disease Control developed in March 2016 voluntary opioid prescribing guidelines for chronic pain. Upon issuance of these prescribing guidelines, the CDC declared, “Overprescribing opioids—largely for chronic pain—is a key driver of America’s drug overdose epidemic. The guideline will give physicians and patients the information they need to make more informed decisions about treatment.” More needs to be done to widen the use of prescribing guidelines, especially beyond chronic pain treatment into prescribing for acute pain conditions.
Virginia utilizes a Prescription Monitoring Program (PMP), which is an electronic database to track prescribing and dispensing of controlled substances, meant to be used by prescribers, pharmacies, and other law enforcement and health officials. Some states have responded to the overdose epidemic with enhanced policies around PMP use that can help prevent overprescribing, abuse, and diversion and to inform prescribers of their opioid prescribing patterns. Virginia should strengthen its PMP reporting to better identify those who may be abusing opioids and physicians who may be overprescribing.
During its 2015 legislative session, the General Assembly passed a Safe Reporting law, which encourages those present at an overdose event to make a call to emergency or law enforcement personnel. Virginia’s law still subjects those present and making a call for assistance to potential arrest for a variety of specified infractions.
According to the recent US Surgeon General’s report on the nation’s opioid addiction epidemic, only one in ten people suffering from Substance Use Disorder receive meaningful treatment. Clinical data supports the use of evidence-based treatment involving a number of medications that demonstrate higher recovery rates from opioid addiction than traditional abstinence-only approaches.
CONNECT MENTAL HEALTH AND PHYSICAL HEALTH
For far too long behavioral health has been isolated from physical health – in treatment and through state government silos. We must do more to ensure that mental health is connected to the whole of Virginia’s health care system.
PROVIDE REGIONAL BEST PRACTICES WHILE MAINTAINING LOCAL CONTROL OF CSBS
We also must take action to reform our systems approach to behavioral health. Our Community Service Boards (CSBs) have done what has been asked of them, but often that has meant doing more with less. This results in a system that does not provide care equally or with the same high standards from one region of the Commonwealth to the next. In some cases we see points of pride and success, and in other cases we see inconsistent service and care. It is important to note that CSBs are in this situation through no fault of their own. Pursuing consistent high quality care while retaining the flexibility that comes with local control is central to Ed’s plan.
SET LONG-TERM STRATEGY FOR MANAGED CARE
Virginia currently operates two Medicaid managed care programs. Virginia Medicaid Managed Care, known as the Medallion program, is now Medallion 3.0. The next iteration of the Medallion managed care program will be Medallion 4.0, which will be implemented in 2018. The second is Commonwealth Coordinated Care Plus known as “CCC Plus,” is a statewide Medicaid managed long-term services program being implemented over the next several months. Once CCC Plus and Medallion 4.0 are successfully implemented, Virginia should explore improving alignment between the Medallion program and CCC Plus to ensure greater efficiency for the benefit of all Virginians, including those in need of services along the behavioral health continuum.
ENSURE MONEY FOLLOWS THE PERSON IN BEHAVIORAL HEALTH
In order for our behavioral health system to provide a true continuum of care, we must ensure our incentives are properly aligned. To date, we have disincentivized primary care physicians from helping those with behavioral health problems from seeking care. We must create a system where dollars follow the patient. Virginia has successfully implemented the “Money Follows the Person” concept to ensure appropriate services are available for those transitioning from an institutional setting to a community setting for care. We need to expand this concept to allow state and federal funds to follow individuals in the community who are seeking mental health or substance use disorder treatment.
Virginians in need of mental health or substance use disorder treatment do not fit neatly in one Secretariat. Accordingly, Ed will continue to roll out policy ideas to address these important issues over the coming weeks. In addition, Virginia’s behavioral health system touches many different Virginians across secretariats and Ed will roll out policy ideas specific to these populations in the weeks ahead.