Catawba Hospital. Courtesy of Department of Behavioral Health and Developmental Services.
Catawba Hospital. Courtesy of Department of Behavioral Health and Developmental Services.

RICHMOND – When Del. Sam Rasoul asked Virginia’s legislature last year to fund a study looking into the feasibility of transforming Catawba Hospital into a state-of-the-art campus offering substance use disorder treatment and addiction recovery, the Democrat from Roanoke knew that the need for such a facility was beyond dire. 

In 2021 alone, more than 2,600 Virginians died from drug overdoses, and according to data from the Virginia Department of Health, the Roanoke Valley is one of the hardest hit regions in the commonwealth suffering from substance use disorder. 

Del. Sam Rasoul, D-Roanoke.

When the General Assembly approved Rasoul’s proposal during the 2022 legislative session and included an appropriation to fund the study in the biennial state budget, he considered it a small but significant victory. “This is just one step of many steps. It would be a truly transformative project for the region,” the lawmaker told Cardinal News at the time. 

Almost one year later, Rasoul’s proposal took another major leap forward when the recently published 127-page report prepared by the VDH and the Department of Behavioral Health and Developmental Services agreed with his vision for the Roanoke County hospital. 

In a letter to the chairs of the House and Senate money committees dated Jan. 13, Secretary of Health and Human Resources John Littel recommended the “transformation of the Catawba Hospital Campus into a state-of-the-art substance abuse treatment and recovery services center capable of providing long-term, short-term, acute, and outpatient facilities to individuals in need of substance abuse disorder services.”

On Thursday, a House panel will weigh the next of Rasoul’s Catawba measures. Based on the report’s recommendation, House Bill 2192 formally directs the Department of Behavioral Health to begin with the transformation project.

“We’re very happy with the report, because it clearly shows that there is an immense need for not only acute treatment but residential treatment, because there are so many people who cannot get the in-patient treatment that they need,” Rasoul said in an interview at the state Capitol on Tuesday. 

Catawba Hospital opened in 1858 in the Catawba Valley as a healing springs resort to treat tuberculosis patients. The state purchased the 700-acre resort in 1901 and later reopened it as Virginia’s first sanatorium. 

The hospital made news two years ago when it was among the five of the state’s nine mental hospitals to halt new admissions for nearly a month during a staffing crisis. Today, it is one of three major mental health hospitals serving the Appalachian area of Virginia – the other two being the Southwestern Virginia Mental Health Institute in Marion and Staunton’s Western State Hospital.

According to the report, the rise in substance use disorder nationally, and particularly in the Appalachian area of Virginia, over the last 20 years has resulted in an “increased need to treat individuals for substance use disorder and the mental health issues” that often accompany the disease. 

Located at the epicenter of this growing crisis in the commonwealth, Catawba Hospital is “poised to become a state-of-the-art facility for substance use disorder treatment and recovery of individuals with this disease,” the report said.

The study further determined the feasibility of transforming Catawba Hospital into a facility at which “a continuum of substance use disorder treatment and recovery services, including long-term, short-term, acute, and outpatient services, are provided.” 

This would be in addition to the array of behavioral health services currently provided at Catawba to adult and geriatric individuals in need of mental healthcare.

Julian Walker, vice president of communications with the Virginia Hospital & Healthcare Association, in a phone interview Wednesday pointed at a new statewide poll showing a rising demand for behavioral health services in the commonwealth.

According to the survey, only 28% of Virginians said that they had access to many behavioral health services in their area, with 13% stating they had none. About 72% of those surveyed said that access to such services should be a high priority, and 76% said that they were in favor of their representatives in the state legislature working on a bipartisan basis to pass the “Right Help, Right Now” initiative, which is Gov. Glenn Youngkin’s three-year, $230 million plan to transform Virginia’s behavioral health system.

Support for the proposal is strong across gender groups (77% support among women, 74% among men), partisan affiliation (78% support among Republicans, 77% among Democrats, and 74% for independents), as well as across age groups, ethnic groups, and across all regions of the commonwealth.

“The data clearly shows that there is a rising demand for behavioral health’s services, and it shows tragically that there has been a rise in overdoses in recent years,” Walker said, adding that anything that can be done to increase system capacity – either by renovating existing facilities or by bringing on new facilities – is going to be helpful to enhance patient services. 

“We see it as a welcome sign that Governor Youngkin has promised significant multi-year investment in mental health and also support behavioral health workforce needs, which were only intensified and magnified by the pandemic,” Walker said. 

Virginia is currently ranked 37th among states in access to mental health services, according to the 2022 Mental Health America state rankings. Meanwhile, data from the Centers for Disease Control and Prevention (CDC) shows that the share of adults receiving mental health treatment in the previous 12 months has risen each year from 2019-2021. 

This increase in demand for treatment services is occurring as health care providers, including behavioral health providers, continue to struggle with staffing shortages that impact treatment capacity.

Littel, the Secretary of Health and Human Resources, said in an email Wednesday that the Youngkin administration understands the critical need for additional capacity for mental health and substance use disorder care at Virginia’s state-operated and private hospitals, as well as in the local communities.  

“One way to do that is to better support and maximize our facilities. Catawba is an important community resource and our relationship with Virginia Tech and Carilion creates an opportunity to grow a best-in-class program,” Littel said.  

Youngkin, Littel added, is committed to working with local staff, regional partners and legislators to do this. “The possible transformation of Catawba Hospital would take many years and the administration, in conjunction with the Department of Behavioral Health and Developmental Services, is still working through many of the details of how this transformation could occur. Our focus is on delivering the right help for individuals when and where they need it,” Littel said in the email.

In its report, the department proposes three tiers of renovations, ranging in scope and cost from $147 million to $192 million and $240 million. Each option provides for more in-patient beds, an education and research building unique to substance use disorder treatment, and a new outpatient facility ranging from a 52,000-square-foot, three-story building to 70,000 square feet over four floors. 

Besides his legislation directing the state to begin with the transformation project, Rasoul also filed an amendment to the state budget, seeking $147 million to fund the first model of the proposed renovations. The proposal will have to be considered by the General Assembly’s money committees, which is a separate process. 

“I put in what I believe to be a good first step, which is the least costly plan that makes critical investments in ensuring that we have residential treatment beds that integrate right onto the campus and has outpatient services that allows for campus to specialize in geriatric psychiatric issues, so it makes up the right type of investment for the region,” Rasoul said. 

“We’ve been talking not only with some of the key folks in the Senate, but clearly on the Appropriations side wanting to ensure that people know what this kind of investment can mean. But we have also been speaking very closely with the governor’s team, the Department of Behavioral Health, and Secretary Littel in trying to find a vision that works for the region.”

Rasoul also said that he is hoping that now that the Catawba transformation could be coming and that the state could invest in additional outpatient services on the campus and residential treatment services, Virginia could also “begin to earmark some of the opioid abatement dollars that are coming directly to localities, as well as working as a region to apply with the Federal Opioid Abatement Authority to get additional dollars there.”

As part of a recent $26 billion legal settlement with the nation’s three largest wholesale drug distributors and a major opioid manufacturer that helped fuel the devastating opioid crisis, Virginia and its localities are expected to receive a combined $530 million to fight back against the opioid epidemic and support efforts to reduce, prevent and treat addiction.

The money will be split up into three buckets – one that goes directly to the localities, the largest bucket goes to the Virginia Opioid Abatement Authority, and a third, smaller bucket goes to the general fund. 

“We want local funds for our region for our localities to be thinking about how this would be a great project as the Catawba project serves the greater region,” Rasoul said. 

But funding will not just go toward the brick-and-mortar renovation of Catawba Hospital. 

The study also found that while the facility currently has sufficient staff to perform its mission, to accommodate all three option models additional staff with potentially different expertise will be needed. 

“The effects of the pandemic on the healthcare workforce and rising wages have resulted in a tight labor market across the country. Virginia is no different and is not immune to these effects,” the report said.

To recruit and retain the workforce at the transformed Catawba Hospital, the commonwealth should consider “partnerships with education institutions that provide training and research opportunities for both the current and future staff” in addition to offering “innovative programs and initiatives to increase the attractiveness of the Catawba Hospital campus for professionals to start and further careers in mental health and substance use disorder,” the study advised. 

“You have a campus that currently employs about 200 people easily on a regular basis, so you could talk about several hundred jobs and the opportunity to bring in a private provider to help with some of this residential treatment,” Rasoul said. “So there is a lot of opportunity for growth and not only to just deal with substance abuse disorder and mental health issues but to really own it. And this is the kind of investment that we have been waiting for.”

Jeremy Holmes, the executive director of the Roanoke Valley-Alleghany Regional Commission and acting director of the Roanoke Valley Collective Response, said that the state’s investment into the transformation of Catawba Hospital would be a game-changer for the region in at least two ways.

“First, and most importantly, it would increase the kinds and quality of services available in the region to address those working to recover from substance use disorder,” Holmes said, adding that the results of the study recommend implementing a full continuum-of-care model in all three options proposed while recognizing that substance use disorder is not a disease that can be treated by addressing just a single symptom.  

“This would make Catawba just one of a handful of facilities in the nation offering such a deep level of treatment, and therefore would be an incredible tool in helping our neighbors and family members in their recovery journey,” Holmes said.

Second, and related, if this vision is achieved, a state-of-the-art Catawba Hospital would join the growing collection of healthcare and research facilities in the valley that could easily make the Roanoke Valley known across the nation as the destination for those working in the field of addiction recovery, Holmes said.

“Between VTCRI, the Fralin Biomedical Research Institute, Carilion, and the dozens and dozens of agencies working towards collective action in the Roanoke Valley Collective Response, the Roanoke Valley has already become a leader in this field of science and research. This vision of Catawba Hospital could be another jewel in that crown, hopefully bringing additional resources and investment to the region to continue expanding and modernizing treatment options.”

However, Holmes made clear that the proposed investment in Catawba wouldn’t solve Virginia’s mental health and opioid addiction crisis. 

“But it would be a massive step in moving us towards a solution,” he said. 

Markus Schmidt

Markus Schmidt is a reporter for Cardinal News. Reach him at markus@cardinalnews.org.