Joint Subcommittee to Study Mental Health Services in the 21st Century Meets

November 1, 2016

The Joint Subcommittee to Study Mental Health Services in the 21st Century met on October 26 in Richmond, along with its four workgroups. While the Joint Subcommittee took no formal votes at the meeting, it discussed a number of potential proposals for the upcoming 2017 General Assembly session, as well as more complex items that will require continued study in the next year of the subcommittee’s work.

In addition to receiving a presentation on federal mental health legislation currently pending in the Senate, the Joint Subcommittee collected reports from its four workgroups: Housing, Crisis and Emergency Services, Criminal Justice Diversion, and System Structure and Financing. An expert advisory panel has been convened to assist each of these workgroups.

The Criminal Justice Diversion workgroup, chaired by Delegate Robert Bell, is considering requirements for standardized screening of jail inmates for mental illness and better discharge planning, as well as the creation of specialized court dockets (an issue that is currently under review by the judicial branch).  This workgroup is also examining the oversight of in-custody deaths in regional jails.

The Crisis and Emergency Services workgroup, chaired by Delegate Scott Garrett, is investigating whether statutory clarification is needed for physicians to be able to prescribe controlled substances via telemedicine. This workgroup is also exploring alternative options for transporting individuals subject to Emergency Custody or Temporary Detention Orders, rather than continuing to rely on law enforcement – a practice that taxes the resources of police and sheriffs’ departments, particularly in rural areas, and can be traumatic for an individual in crisis. The workgroup is also pursuing a potential collaboration among hospitals, physicians, and health plans to develop a plan to address “super-utilizers” of hospital emergency rooms by improving coordination of care.

The Housing workgroup, chaired by Senator Janet Howell, is recommending several options for the upcoming 2017 session, including a request for $10 million in state funding to increase the number of permanent supportive housing units for individuals with mental illness. In a permanent supportive housing arrangement, an individual pays a portion of his or her income for rental housing in the community, and flexible, voluntary services are available to address the individual’s behavioral health needs. This model has been demonstrated to reduce participants’ use of emergency rooms and inpatient treatment. The workgroup is also recommending a statutory amendment to require that a portion of the existing state Housing Trust Fund be spent on permanent supportive housing, and that a study of strategies to finance housing costs through Medicaid reimbursement be undertaken.

The System Structure and Financing workgroup, chaired by Senator Emmett W. Hanger, Jr., held a lengthy discussion with the chair of its expert advisory panel, Dr. Richard Bonnie. The workgroup developed general consensus to support state funding to enable Community Services Boards (CSBs) to provide same-day access to services and outpatient primary care screening and monitoring services. The workgroup also is interested in pursuing potential changes to the state’s existing Medicaid-funded programs for mental illness and substance abuse that would enable the state to draw down additional federal dollars by expanding eligibility and services. The workgroup agreed with its expert advisory panel that further work is needed to review elements of the behavioral health system that are contributing to high usage of state hospitals, and agreed to recommend legislation for 2017 that would enable information-sharing between the judicial system and the Department of Behavioral Health and Developmental Services.

In addition to the reports from its workgroups, the full subcommittee also discussed several long-term areas of interest, including potential restructuring of the CSBs’ catchment areas. Senator Creigh Deeds, the joint subcommittee’s chair, also expressed interest in finding a vehicle for continued work on mental health issues after the expiration of the joint subcommittee, perhaps by adding to the responsibility of the Joint Commission on Health Care. The subcommittee had a robust discussion about whether to recommend a package of services that would address problems statewide, or to limit its request to funding services in a limited number of CSBs as a pilot, in recognition of the state’s constrained fiscal situation.  In addition to the participation of Senator Hanger, the Co-Chairman of the Senate Finance Committee, on the joint subcommittee, it was noted from the dais with appreciation that Delegate Chris Jones, the Chairman of the House Appropriations Committee, was in the audience, signaling a commitment by both “money committee” chairs to address issues of mental health in the next budget.

The scope of the joint subcommittee’s requests for 2017 will be determined at a meeting in December, when it will make recommendations on a package of proposals for the upcoming session.

VACo Contact: Katie Boyle

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