All hope is not lost

When it comes to rationalizing the burden of drug addiction in Virginia, Niles Comer prefers to play it straight. 

“I don’t even talk to people about morality, I talk about numbers,” said Comer, the director of the Roanoke Valley Collective Response to the Opioid and Addiction Crisis (RVCR), an organization working to find new and effective strategies to combat addiction across the valley. Since the beginning of the pandemic, the number of Americans addicted to drugs has increased from 10 to 14.5%, Comer said in a phone interview last week, referring to recent data from the federal Substance Abuse and Mental Health Service Administration.  

“It’s empirical data, and I break it down,” he said. “In the Roanoke Valley there are about 300,000 people. With 14.5 percent of that population addicted, that makes that number about 47,000 to 50,000. That’s a large number.”

But it gets worse, Comer said. For every one person currently addicted to drugs, an average of five people are dramatically and negatively impacted, usually within the immediate family. “This means that 72 percent of the population in the Roanoke Valley is negatively impacted by addiction, even if they themselves aren’t addicts,” he said. “So if we talk about that number, that number should make people sick to their stomach.”

While a coalition of organizations in Southwest Virginia have worked for some time to tackle not just substance abuse treatments but the future of mental health care – among them Virginia Tech, Carilion Clinic in Roanoke, the Fralin Biomedical Research Institute – some stakeholders, including Comer, believe that the state-owned Catawba Hospital, which first opened in 1858 in the Catawba Valley as a healing springs resort to treat tuberculosis patients, could show the way to the future by becoming a state-of-the-art campus offering substance abuse treatment and addiction recovery in addition to its current mental health services. 

“What it could do is be a pilot project,” said Comer. “We spend a modest amount of money to try and create this recovery campus, and we connect it to resources in the Roanoke Valley of which there is a tremendous amount of providers of some level of addiction and recovery services who are not all linked. Catawba could be that link.”

Spearheading the effort to repurpose Catawba is Del. Sam Rasoul, D-Roanoke, who in January filed legislation that would direct the Department of Behavioral Health and Developmental Services to study the feasibility of transforming the hospital – which has not undergone any major renovations in recent history – into such a hub. (See previous story about the Virginia Tech class that inspired Rasoul’s bill.)

“This is a state resource, and being a state legislator I see this resource with hundreds of acres that could be the perfect place,” Rasoul said of his proposal in an interview last week. “It’s close enough for us to access it and yet have enough space to have a comfortable amount of resources there, and it was a great opportunity to make the best use of a state-owned property.”

Catawba Hospital is located in the western part of Roanoke County, ten miles north of Salem on the county’s northern border and about half an hour from Roanoke City. During its early days as a sanatorium, the 700 acre property extended up the mountain from the Catawba Valley. The state purchased the resort in 1901 and later reopened it as Virginia’s first sanatorium. 

Today, the hospital is part of Virginia’s public behavioral health system, specializing in serving adults including geriatric individuals who are in need of mental health care, but also offering a wide array of services, from therapeutic aid (including occupational, music, horticulture and recreation therapy) to traditional medical care, nursing, psychology as well as social work and counseling. Last summer, at the height of the pandemic, Catawba was among five of nine state-owned mental hospitals that halted new admissions for nearly a month during a staffing crisis. 

Dr. Charles Law, the hospital’s director, said in an interview that he was unable to comment on the proposed changes to the hospital. But he said that despite the recent challenges, Catawba is a “gorgeous place to recover” and that it was doing “a wonderful job” with patients. “We are turning our beds rather well, we get people assessed and back into the community.” Of the facility’s 270 beds, 110 are currently staffed, including 60 geriatric and 50 adult beds, Law said. 

In February, Rasoul’s House Bill 105 passed in the House of Delegates by a unanimous vote, and the House Appropriations Committee allocated $1 million for the study in its revised biennial budget that has yet to be finalized. But to Rasoul’s surprise, the Senate Rules Committee on March 4, one week before the regular legislative session adjourned, voted to carry his bill over to next year, essentially killing it. 

“I’ve been waiting for years for an entity or someone to take the lead on redeveloping the Catawba campus for exactly that purpose – upgrading our mental health services and substance abuse treatment services – but it seems that it’s not quite been sexy enough for it to be a top priority,” Rasoul said. “Especially with a very sound budget situation, now is the time to make the types of investment that we absolutely need, not only from the angle of mental health and substance abuse disorder, but also these are types of critical investments that we need to prioritize.”

But 14 of the 16 member of the Democratic-led committee disagreed, including Sens. Creigh Deeds, D-Bath County, and Steve Newman, R-Bedford County. While both expressed support for Rasoul’s measure, they voted to include Catawba in a larger study of Virginia’s entire mental health system.

“I think this is a good idea, as we look over the long haul, our focus has to be on providing services in the community. And there have been a couple of efforts in the last 25 years,” Deeds said during the committee meeting. “It is just the question whether we do it through the budget or through an independent study commissioned with $1 million. We have language in the budget to examine what to do with the hospital system, because it’s clear we have crises in different areas,” he said.

When reached by phone Thursday, Deeds reiterated that he thought Rasoul’s proposal was a good idea. But he also said that he doesn’t believe that one hospital should be singled out to be studied. 

“Catawba does not exist in a vacuum, it is part of a system of hospitals, and we have to think about the big picture for how we create the best system,” he said, adding that “it would be a tragic mistake if we said one unit was more important than the rest.”

Deeds said that the Senate’s budget includes a $1 million allocation for a broader study by the Department of Behavioral Health and Developmental Services of all of Virginia’s state-owned hospitals that Catawba is a part of. “We ought to look at more hospitals, whether it is for opioid addiction treatment, or other mental health issues. We have the facilities, we spend more money per capita on bedspace than most other states and we’re going to have to figure out what to do with some of those hospitals. I’m confident that something will move forward with the budget.”

Rasoul, however, said he was disappointed in the committee’s decision to carry over his proposal. “I had hoped it would move forward, as we were not talking about building a facility tomorrow, but to continue the care with the backbone of this new campus, a very pragmatic step for where we could study behavioral health in Virginia and have a community to embrace this next step,” he said.

Comer, the RVCR director, credits Rasoul with recognizing the underutilization of the Catawba campus. “It is a large landmass that has little or no benefit to the community,” he said. A recovering addict himself, Comer said he understood the need for a modern campus dedicated to all forms of addiction and recovery services, calling it a recovery ecosystem. 

“It’s not rocket science, it’s just like a biological ecosystem there would have to be a variety of players and partners that are involved, and then an ecosystem has to sort of maintain and self-regulate its systems of checks and balances,” Comer said.

Catawba could be a hub, and then out from that hub “folks could get connected to all these other resources like housing, education, meal services, treatment, stabilization, a place for people to go who are incarcerated, some place for people who have an addiction problem. And rather than clog the justice system, send them to Catawba for treatment and then we can begin the process of rehabilitating them back into society.”

Comer added that he was “totally shocked at the shortsightedness” of the comments from senators from both sides of the aisle who voted against Rasoul’s legislation. “They were petty, they really were. What they need to understand is that Catawba can be a demonstration project on how to do this statewide.”

Although the Senate panel rejected Rasoul’s proposal, his idea could still become reality if Republicans and Democrats are able to agree on the $1 million allocation for a Catawba study proposed by the House once lawmakers return to Richmond on April 4 to finalize the budget.  

“Regarding mental health issues we need to start looking at some regional facilities to accommodate those needs, and I think Sam’s approach was good,” said Del. Terry Austin, R-Botetourt County, a member of the House Appropriations Committee. “I would hope we can maybe pull something out in conference during the special session, I would hope to keep it alive, it holds a lot of promise.”

Austin said that he would try and seek the help of Del. Mark Sickles, a Democrat from Fairfax. “We’ll see if we can bring it back and get conferees to agree on something, trying to get some money to fund this study,” Austin said. 

In a further display of bipartisanship, Rasoul’s idea also has the blessing of Gov. Glenn Youngkin. “We understand the critical need for additional capacity for mental health and substance use disorder care at our state-operated and private hospitals, as well as in our local communities. One way to do that is to better support and maximize our facilities,” John Littel, Virginia’s new secretary of Human Health & Resources said in an email. 

Catawba is an important community resource and the state’s relationship with Virginia Tech and Carillion creates an opportunity to grow a best-in-class program, Littel said. “The governor is committed to working with our local team, regional partners and legislators to do this,” he added. 

As the hospital’s fate remains uncertain until lawmakers return to Richmond to finalize the budget during a special session next week, Rasoul remains optimistic about the upcoming budget negotiations. “Hopefully we will be able to find a compromise and solution that the House and Senate can agree to, and we are looking forward to continuing the conversation through the budget to hopefully allow us to have some Catawba campus specific resources for studying it over the next year,” Rasoul said.