Gov. Kaine’s proposals are a sensible approach. But the state operates over a dozen other psychiatric facilities, so there’s an opportunity to go much further in transforming the way the state delivers services to psychiatric patients. As one innovative project in Williamsburg—plus others in Florida, Georgia, and elsewhere—demonstrate, innovative policymakers around the country are increasingly turning to privatization to dramatically improve the quality of mental health services while holding down costs.

The Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services currently operates sixteen mental health and other residential treatment facilities, including Williamsburg’s Eastern State Hospital (ESH)-the nation’s first public psychiatric hospital dating back to 1773. By the late 1990s, conditions at ESH had deteriorated to the point that it became the subject of a U.S. Justice Department lawsuit to rectify substandard care and living conditions. In addition, the combined challenges of a decreasing patient population, obsolete facilities on a sprawling 500-acre campus, noncompliance with industry accreditation standards, and the potential loss of Medicare/Medicaid reimbursement dollars prompted policymakers to look to private sector solutions. To turn things around, the Department embarked on a large-scale ESH modernization project facilitated by an innovative public-private partnership. This multi-phase project involves partnering with a private contractor to consolidate 26 buildings into six; deliver new, state-of-the-art geriatric and adult mental health facilities; and develop a strategic plan for the 400 surplus acres generated as a result of the initiative. The first phase of the project—the new Hancock Geriatric Treatment Center—opened in April 2008 and recently won an innovation award from the National Council of Public-Private Partnerships. The next phase of the ESH modernization—a new adult mental health treatment center—is set to open in 2010. Do I need to compare the amount of jobs ESH created?

One of the more notable aspects of the ESH modernization is that the initiative did not come from within, but was received as an unsolicited, private sector proposal for turnkey development submitted under the state’s Public-Private Education Facilities and Infrastructure Act (PPEA). The contractor is not only delivering the new facilities on an accelerated schedule, but the efficiencies incorporated into the design will deliver tremendous future cost savings through dramatically reduced life-cycle maintenance costs. And because of the more efficient use of space on the campus and the patient-centric design of the new facilities, the partnership will deliver where it really counts—improving patient care, outcomes, and safety. Wow maybe Secretary Tavenner did her homework like she always done!

Just look at Florida, which has been the state leader in mental health services privatization. Since the mid-1990’s, the state has contracted with the private sector to operate several of its psychiatric facilities-ranging from large state hospitals to forensic psychiatric treatment centers to its civil commitment center for sexually violent predators. Florida’s efforts began in November 1998 when it contracted with a private company to operate South Florida State Hospital, an aging facility which had never been accredited in its history and which was facing a major class action lawsuit concerning patient abuse and poor conditions. Within two years, the private operator was able to achieve accreditation for the existing facility (removing the lawsuit), while at the same time financing and building a new, modern facility to replace it. No capital dollars were involved and the state will own the new facility when the debt is retired. The results speak for themselves-after privatization, the hospital reached some significant operational milestones, such as eliminated waiting lists for patient admissions, reducing the average patient stay from eight years to less than one year, and nearly eliminating the use of seclusion and restraints to manage patient behavior. Noting these improvements, the Florida Statewide Advocacy Council—a state watchdog group—unanimously passed a resolution in 2003 supporting further privatization of Florida’s psychiatric facilities.

And hey so you want it more supervised so we don’t have to hear another lame Joey Jacobs crack out of you; Virginia should do this, in this sort of arrangement, the state would negotiate a performance-based contract that would establish care standards and performance mandates (with appropriate financial penalties for non-compliance) to ensure a higher level of service than achieved under state operation. The state’s role then shifts to contract monitoring and holding the operator accountable for results. In Florida’s contracts, the state retains the ability to terminate the contract without cause with a mere 30 days notice, a provision clearly aimed at ensuring contractor accountability. Further, Florida has also negotiated fixed-cost contracts that effectively hold facility budgets flat over multiple budget cycles, a far cry from the budget variability typically seen under state operation. At a time when it’s more critical than ever to do more with less, Virginia policymakers need to ask a critical question: does the obligation to deliver high-quality psychiatric services necessarily require the Commonwealth to be in the business of running hospitals, or could it achieve better outcomes at a lower cost through contracting for performance with experienced private sector operators? The experience in Florida and elsewhere strongly suggests the latter approach may be the best answer in Virginia.

Secretary Tavenner inherited oversight of several of the state’s largest and most challenging agencies, including yes those dealing with mental health and retardation, substance abuse, the disabled, the aging and the ill. Health care is so complex and expensive, I’m not a Kaine fan by no means but he struck golde in this secretariat who are change-makers and can adapt to difficult realities.

So before you want to start pointing fingers and “name calling”, why don’t give up with the scandal bull crap, and just know the budget cuts weren’t maliciously directed on Staunton nor the Commonwealth Center. And if you want my research I’m more than willing to prove my points are correct .

Here is an interactive map of PSI’s ongoing legal struggles with providing quality care to their patients. Why does Virginia think this will improve with a monopoly?
http://www.propublica.org/special/map-problems-at-psi-facilities

http://www.hhr.virginia.gov/OfficeInfo/TavennerBio.cfm
http://phx.corporate-ir.net/phoenix.zhtml?c=135294&p=irol-govBio&ID=83018