- The Washington Times - Tuesday, May 21, 2002

RICHMOND The state is experiencing huge funding shortfalls for medications used by severely mentally ill people treated in community settings, and the deficits could deepen unless the General Assembly puts more money into the program.
A projected shortfall of at least $5.4 million for the fiscal year beginning July 1 and even more for the next fiscal year could leave some people with serious illnesses like schizophrenia with no medicine to control their diseases, said Valerie L. Marsh, executive director of the Virginia chapter of the National Alliance for the Mentally Ill.
Jeff Pittman of South Boston lives and works in the community but says he will have to return to a hospital if he cannot obtain his anti-psychotic medicine from the state's after-care pharmacy.
Without the medication, there would be "a good possibility that the symptoms of my illness would return the delusional thinking, feelings of persecution," said Mr. Pittman, 46.
"You can't take medicine away from people who are on it," said Mary Ann Bergeron, executive director of the Virginia Association of Community Services Boards.
The state's 40 community services boards are responsible for managing treatment of those who have serious mental illnesses but can't afford care.
Miss Bergeron said the projected shortfalls are so great that "you can't manage your way out." Officials will have to seek more money from the 2003 General Assembly, she said.
"We need help," she said. "We're all very, very concerned about it."
Dr. James S. Reinhard, the state's new mental health commissioner, said it is unlikely that people will be cut off from their medicines. "The intention is not to do anything that has an adverse clinical effect," he said in an interview.
The state has covered a similar shortfall this fiscal year by using money from other programs for the mentally ill, but removing funds from one program to cover another can continue for only so long, officials say.
In recent years, Virginia has turned its treatment focus from costly hospitalization in state-run mental institutions to less-expensive community treatment. The patient population in hospitals has dropped more than 50 percent in the past four years. The hospitals also are experiencing deficits in drug funding but more easily manage the problem through payments from Medicaid.
Miss Marsh said shortfalls in drug funding for community treatment centers could mean more people with severe mental illness will wind up in jail for lack of any other place to go.
If they can't get their medicine or get into a hospital, "they will be symptomatic and do things that will get them picked up [by police]," she said.
"Already, without the shortfalls, we are seeing a dramatic increase in the number of people going to jail [instead of getting treatment]."
Miss Marsh predicts the state will try to save money by placing patients on cheaper anti-psychotic medicines that she believes are less effective.
Dr. James Evans, medical director for the state mental health department, said it's reasonable to consider using the least expensive anti-psychotic drugs when starting a patient on medication. But that "doesn't mean the patient will be jeopardized," Dr. Evans said. "These drugs are all equally effective."
The community services boards are working with Dr. Reinhard and others at the state Department of Mental Health, Mental Retardation and Substance Abuse Services to solve what Dr. Reinhard has described in a March 11 memo as "serious problems with the state pharmacy budget." The state sends out about 15,000 refill prescriptions a month.
One reason for the projected shortfalls has been the success in treating people in recent years with newer, yet costlier, anti-psychotic medicines. That in addition to the rising cost of medicine, more discharges from state hospitals and new patients entering the public system produced the projected shortfalls despite funding levels that escaped budget cuts.
Officials have come up with several ideas to deal with the problem, including:
Asking pharmaceutical companies to provide more free drugs under their programs for the indigent ill.
Enrolling in Medicaid all of the indigent mentally ill eligible for the jointly funded federal-state health insurance program.
Using less-expensive generic drugs.

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