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Statewide mental health worker shortage forces docket to pause new referrals

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Region Ten Community Services Board

Therapeutic staff issues at Region Ten Community Services Board has forced the suspension of the area court system’s mental health diversionary docket.

Local officials and the Region Ten Community Services Board are scrambling for solutions after a shortage of mental health workers forced the Albemarle-Charlottesville Behavioral Health Docket to pause admissions.

Started in 2015, Behavioral Health Docket — also sometimes referred to as the therapeutic docket or mental health docket — has become a successful tool for local courts to divert people from jail in favor of treatment.

In mid-November, however, the docket stopped accepting new clients due to staffing issues at Region Ten, causing significant impact on the program.

Jim Hingeley, Albemarle County commonwealth’s attorney, said prosecutors and mental health partners have cobbled together a process to work with those already in the program.

“We can come up with alternatives but in no way are they as effective as the therapeutic docket,” Hingeley said. “I guess you could say we have a big box of Band-Aids and we’ve started putting Band-Aids on problems that need more than just bandages.”

The alternatives actually existed before the docket was created and do not offer the same supports, said Nina-Alice Antony, senior assistant commonwealth’s attorney for Charlottesville.

“The reason we really wanted the therapy docket from the beginning was that it provides a level of judicial oversight and community that is unlike any other experience you’ll have in the justice system,” Antony said. “It takes someone’s case out of an adversarial system and puts them into an alternative docket that’s more of a collaborative community of people trying to get them where they need to be.”

Liz Murtagh, head of the Charlottesville-Albemarle Public Defender’s Office, said staff shortages at Region Ten are a huge issue for her clients, with some waiting more than a month for treatment.

“If you have someone in crisis or who has a substance abuse problem and they need to be seen immediately, they still don’t get seen immediately,” she said. “If you’re trying to meet the needs of someone who’s in a crisis — they’ve been arrested, they need assistance and we’re trying to resolve the case — if that treatment or evaluation piece doesn’t happen, it slows everything down.”

Since the pause in new referrals began, current participants have continued to receive treatment. Those already approved to be assessed for docket eligibility have continued on through the process.

The docket currently has 16 active participants, four inactive participants and seven pending entries, with an additional two scheduled to be entered Wednesday.

The therapeutic docket is voluntary, but it begins with a referral from one of numerous sources, including jail officials, OAR, police, defense attorneys, prosecutors or a mental health professional at Region Ten.

The docket is currently overseen by Albemarle County General District Court Judge Matt Quatrara.

The docket is for those for whom a serious mental illness played a significant part in the crime committed. It is only open to those charged with misdemeanor offenses. Defendants are not eligible if they committed a felony or have a significant history of violent or sexual offenses.

Region Ten has continued its commitment, allocating other resources to attempt to support participants. Those include a peer support specialist, an intern to work with participants and a new clinician.

Region Ten is among several community service boards that assist with the local courts’ diversionary and treatment dockets. Like many mental healthcare providers across the nation, it has been experiencing a workforce crisis for years.

In the wake of the COVID-19 pandemic and the increased need for mental health services, the crisis has only been exacerbated, said Joanna Jennings, community relations coordinator for Region Ten.

She said the community service board has had to temporarily pause additional referrals “to maintain safety for current clients.” That includes clients participating in the Mental Health Docket.

Jennings said unprecedented gaps in staffing combine with increased risk for staff and clients, increased complexity of cases and compassion fatigue to create stress and burnout among caregivers.

The burnout leads to some staff members leaving their positions for other jobs, more pay elsewhere, or to stay at home.

There are currently 2,400 open positions for community service boards across Virginia, said Jennings. The current average vacancy rate across the state is 15% but Region Ten’s vacancy rate is nearly 40% in some of the most essential programs.

Jennings said staff is wooed away by offerings from Virginia state hospitals that provide bonuses for recruitment and retention as well as state general funds directed at the Department for Behavioral Health and Developmental Services. Those funds are slated to bring that department’s salaries up to 75% of the national average.

“This approach creates inequity that has a significant negative impact on [a community board’s ability] to hire,” Jennings said. “We are currently asking that every new dollar invested in Virginia’s psychiatric hospital system that a new dollar is also invested in community-based care.”

The Virginia Association of Community Services Boards is currently advocating for a $167.5 million investment in recruitment and retention programs, according to Region Ten. The proposal includes a path to licensure by paying for clinical supervision hours, and funding for loan repayments and scholarships.

Katie Moore, the probation program manager for the mental health docket, said the Behavior Health Docket’s advisory board recently was awarded a U.S. Department of Justice grant. The approximately $500,000 grant will be used to provide additional staff to support the docket, including one at Region Ten, one at OAR and one at Partner for Mental Health.

“We were fortunate to receive federal grant funding that will help to expand capacity and we have applied for an increase in local funding from both the city and county,” Moore said. “Typically, we have received tremendous support for the program from both the city council and county board of supervisors. While we are faced with this current challenge, the support and resolve for the docket is strong and we look forward to expansion of these services in our community.”

Although the federal grant provides a path forward, it is a temporary solution to a complicated issue, said several docket advocates.

“The money is certainly welcome, but it doesn’t change the fact that, on a basic level some positions OAR and Region Ten have been advertised for more than a year and no one wants the jobs because the pay is too low for work that requires a master’s degree,” Antony said.

“We’re all very excited about the possibilities the grant opens up but we still have fundamental issues with getting more funding across the board to these organizations so that they can recruit and retain the staff they need to run at full capacity,” Antony said.

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