Youngkin: We're transforming behavioral health (copy) (copy) (copy) (copy)
When the Fairfax County church that Gov. Glenn Youngkin and his wife Suzanne helped launch started its mental health outreach mission, he realized two key things that informed his push to fix a broken state behavioral health system.
“We forget that one of the most challenging things to do is to ask for help. And in the world of behavioral health crisis … there's a stigma that comes with everything, and because of that stigma, there is a real hesitancy, if not complete inhibition, to ask for help,” he said in an interview with the Richmond Times-Dispatch.
“And I did see at Holy Trinity when we started our counseling capability, how many people ... were living lives that on the outside looked normal and put together but were struggling mightily and they needed help, and they just needed a place to go,” he said.
On the campaign trail in 2021, he ran into more Virginians who were suffering.
“I saw more examples of failure of our behavioral health system during my year of campaigning than any single other issue daily,” he said.
There were parents who lost a child to suicide, families waiting for years — even more than a decade — to get a Medicaid waiver to pay for supports to help a child with a developmental disability.
There were mothers who could not get an appointment for a therapist for their children for months and months.
Police officers and deputies told him of sitting with Virginians in crisis at hospital emergency rooms, “at wit's end because they were spending 50 and 60 hours sitting with Virginians who were in crisis and they want to help, and there was no answer,” Youngkin said.
“This was not just episodic, it was daily," he said. "We had suicides and young people who were trying to take their lives showing up in emergency rooms and just catastrophe after catastrophe of a system that was failing everybody."
He told people he wanted to fix that if elected, and then he told his transition team to get to work.
'Right Help, Right Now'
The result was that at the end of his first year in office, Youngkin unveiled a sweeping system reform he called “Right Help, Right Now."
So far, that has created:
- A 9-8-8 crisis phone line that offers a gateway to help for more than 37,000 Virginians a month.
- 110 mobile crisis teams that can go to people in a mental health emergency, instead of simply hoping that someone in crisis will find their way to urgently needed help.
- An expansion of the state’s small number of centers that can care for people in crisis for short terms, from 249 slots to 460, with 374 more slots coming online.
Right Help, Right Now has added assertive community treatment teams. These are the clinicians and social workers whose daily visits for people with serious mental illness offer an alternative to a stay in a state hospital.
It’s added school-based mental health programs and 100 beds in small group homes so that when people are ready to leave state hospitals, they have a place to go. That lack was keeping people in hospitals for months, a big reason why the facilities had been overcrowded for years.
Youngkin pushed to add 4,540 new slots for Medicaid waivers, to eliminate the so-called “priority 1” waiting list. These are thousands of people with developmental disabilities who needed support services immediately.
Overdose deaths drop
Right Help, Right Now’s focus on addictions and substance abuse included education and outreach efforts, distribution of overdose-prevention medication and a tripling of peer recovery specialists. These are the people whose lived experience recovering from addiction is one of the most effective ways of helping people stay on track to end addictions.
Overdose deaths are down by nearly 60%.
Right Help, Right Now also addressed money issues. State spending on behavioral health services increased by $1.4 billion, while the state now requires health insurance to cover mobile crisis teams and other crisis stabilization services.
“Where we were, was beyond broken. Failing, failing Virginians. Virginians were dying," Youngkin said. While "everyone had snippets of ideas, if we could only do this program or pass that bill, or if we had that service," he said, "we needed to step back and redesign the whole system."
Even before he took office in January 2022, his transition team started what ended up as a nine-month redesign. During the transition, John Littel, a longtime health insurance executive from Hampton Roads, came by to talk.
“When I met Littel, he told me, and he said it again today, that he had never met anyone in the political environment who had actually campaigned and promised to take on the challenge of a broken behavioral health system. And he told me he wanted to meet me because of that,” Youngkin said.
“And I told him that it was so critical that we fix this, not with a bill or a Band-Aid, but with a total transformation.”
Littel was Youngkin's secretary of Health and Human Resources from January 2022 to July 2024, when he became the governor's chief of staff.
Immediate help
Youngkin said he decided the first challenge was to be able to respond immediately when people need help immediately.
He wanted to ensure that mental health challenges were seen as health challenges, not as crimes, “to take the stigma away so that people could go ask for help."
It meant “simple things, like: 'Folks, we're going to have ... mobile crisis teams, who will get to any Virginian within an hour,' and everybody looked at me like I'm crazy,” Youngkin said.
But now, the state’s 110 teams can get to a person in crisis in an average time of less than 47 minutes.
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“You can get there. You can do this. People were at a loss about why insurance didn't cover any of this. Well, guess what? Private insurance covers it today, because we mandated that they do,” he said.
Youngkin said his team knew they had to expand capacity and access, "because we didn't have anywhere near the capacity we needed. How could we provide same-day response and access when we had no capabilities?"
Expanding the workforce
The governor said his team knew that the health care work force had to grow.
"To say that we had (a) workforce challenge in health care was literally like saying a man in the desert is thirsty. I mean, it was just unbelievable,” he said.
“Fast forward (to) today … there are 20, 30, 40% increases in health care workforce across the most important disciplines — nurse practitioners and doctors and physicians' assistants and registered nurses, and increases in counselors, peer recovery specialists of 200%,” he said.
“It's just changed everything, because you can't treat people without people."
Fixing a 'massive failure'
Transformation meant shedding old ways, Youngkin decided.
“Historically, people were having a crisis moment, and no matter where they were, they were treated as if they needed to go to the hospital … that was the massive failure in that system,” he said.
Right Help, Right Now turned the 9-8-8 call line into a critical access point for getting help.
“We open up a whole new coordinated care system … and it starts with a phone call to 9-8-8,” Youngkin said.
“We're able to really triage the kinds of response that's necessary. Is it a conversation that they can follow up tomorrow? Do we need to dispatch a mobile crisis team? Do we need to dispatch a mobile crisis team and law enforcement? Do we need to invite the person to go find a crisis receiving center near their home?”
A crisis receiving center aims to resolve a crisis within 24 hours, when that’s what’s needed. Sometimes, for instance when a medication change might work, the answer is a longer, weeklong stay at a crisis stabilization unit where staff can monitor and adjust the change.
'We are here to help'
“That continuum allows us to unclog the blockage of everyone being treated as if they have the same problem at the same stage and therefore require the same kind of attention. And it changes everything,” Youngkin said.
That’s the lesson from Holy Trinity Church’s mental health mission about needing a place to go.
There’s still work to do, Youngkin said.
“The physical capacity build continues. The second thing that must continue is the recognition that this is an all-of-the-above approach. We have to continue to recognize the need for comprehensive management support and progress. We can't fall back to the ‘well, my bill is the best bill’" approach, Youngkin said. "We have to continue to have an executive branch that leads this."
“Communication is so important … continuing to tell everyone how important this is,” he added.
“But the flip side of that is also continuing to reduce the stigma. It's important, and we hear you and we see you. And then similarly ... it's really, really important that you ask for help, and we are not judging. We are here to help people.”
Dave Ress (804) 649-6948
