Use prudence in cutting budget

Pressed between hard places, Gov. Timothy M. Kaine is setting about making choices made of similar texture, saw in hand, as he labors to bridge a $1.5-billion budget gap. Bureaucratic officialdom, a population uncontrolled, declares the flesh is gone and the marrow is next. These are the echoes of constant refrains. Still, the need prevails for precision.

This applies particularly to the category of mental health. Officials at Western State Hospital in Staunton wince at the prospect of paring clinical services and community service boards, a possibility depending on how deeply Kaine slices. The governor earlier this year directed state agencies to provide plans for 5-, 10- and 15-percent cuts, and he is expected next week to unveil a freshly trimmed state budget based on those proposals.

Western State has whittled $4 million from its budget since 2002 and hopes this time as before to avoid layoffs among its 690 workers and subsequent reductions in core services. But “you can only cut administration and support services so far,” said John Beghtol, the facility’s director of community services.
Especially worrisome, Beghtol said, is the potential impact on community service boards. Treatment teams composed of a psychiatrist and case managers operating under the boards’ auspices guide outpatient services in some cases, providing dual benefits, helping people avoid hospitalization and reducing the burden on the larger system.

Don Lewis, the executive director of the Valley Community Services Board covering Waynesboro, Staunton and Augusta County, points out the bottom-line significance: He estimates that the annual cost of outpatient treatment under the services board is about $90,000 per person. If board services are cut, he said, the only alternative in some instances would be to hospitalize patients, at a per-capita cost of $200,000. In addition, Western State, with 260 beds covering this half of the state, already is strained. Cuts now, in other words, might cost more money later.

A function of the community boards perhaps better known in the wake of the Virginia Tech killings is watching for cases potentially on the verge of leading to violence or other dangerous behavior. Kaine signed changes into law that allow community boards greater latitude in involuntarily committing patients. That was not a move we favored – patients have rights, or should – but it underscored the boards’ vital role in ensuring that the mentally ill receive the care they need, for their good and the community’s.

Budgets funded by public money reflect the obesity epidemic we keep hearing about. For all of the ritual wailing that rises as the prelude to final votes, fat still lines public spending, like those love handles that just won’t go away. But prudence, always a valuable commodity, is needed in the category of mental health. Costs hidden, but real, lurk. The governor, who made mental health a small crusade after the massacre at Tech, ought now to demonstrate his recognition of this.