The Joint Subcommittee to Study Mental Health Services in the Commonwealth in the 21st Century met on December 4, along with its two workgroups, to finalize recommendations for the upcoming 2019 General Assembly session, to plan its work for the remainder of 2019, and to discuss the future of the Joint Subcommittee after its scheduled expiration in December 2019.
Discussion at the System Structure and Finance work group largely continued a conversation from previous meetings regarding the issuance of temporary detention orders (TDOs) and their effect on overcrowding at state hospitals, including the need to improve community-based services so as to address mental health needs before they spiral into crises. Members also discussed the need for alternatives to hospital emergency rooms for individuals to receive care when they are experiencing crisis, such as psychiatric emergency centers, which typically allow individuals to recover from crises over the course of 24 hours with the assistance of peer recovery specialists, medical and mental health staff. The work group received a briefing from staff from the Institute for Law, Psychiatry, and Public Policy, which included several recommendations that were approved by the workgroup and subsequently adopted by the full Joint Subcommittee.
The Criminal Diversion work group received a presentation on behalf of its Expert Advisory Panel from Leslie Weisman, Client Services Entry Bureau Chief of the Arlington County CSB, who discussed the differing interpretations among many jail staff members and health care providers of what health-related information may be shared about jail inmates without violating privacy laws, and encouraged legislators to clarify that information may be shared for the purposes of providing treatment. The work group continued to discuss the issue of requiring the adoption of standards for the provision of mental health care in local and regional jails, but did not recommend that CSBs be mandated to provide treatment within jails.
The full Joint Subcommittee adopted a series of legislative and budgetary recommendations for the 2019 Session, including:
- Prioritizing funding for detailed planning for the replacement of the aging Central State Hospital
- Requiring the Department of Behavioral Health and Developmental Services (DBHDS) to develop a plan to “right-size” the state hospital system relative to the need for inpatient beds
- Allowing magistrates to issue medical TDOs (which allow temporary detention of patients who are incapable of consenting to treatment when the medical standard of care calls for intervening to avoid injury or death) without requiring that a judge be determined to be unavailable
- Allowing information sharing between private hospitals and CSBs when CSBs are involved in discharge planning for patients in private hospitals
- Clarifying that a law enforcement officer has the authority to keep a person subject to a TDO in custody until the TDO is served (this recommendation addresses a situation in which the eight-hour emergency custody order expires between the TDO being issued and when it is served)
- Directing that a study be undertaken of options for treating individuals with mental illness who also have complex medical needs
- Requesting that JLARC undertake a study of CSB funding and supervision, including how models of other state-supervised, locally-administered systems might be applied
- Requesting funding for a pilot psychiatric emergency center
- Recommending that the General Assembly take under consideration a package of recommendations on telemental health services, including additional funding for a telemental health pilot project in southwest Virginia, requiring the state Medicaid agency to allow schools to be used as sites for telehealth services, and creating a workgroup to explore models of contracting for telepsychiatry services for CSB clients
- Requiring that the Department of Criminal Justice Services include sensitivity to individuals experiencing mental health or substance abuse crises in its training standards and model policies
- Requiring the Office of the Executive Secretary of the Supreme Court to develop a statewide evaluation model and conduct ongoing evaluations of the effectiveness of local specialty dockets
- Clarifying when health-related information regarding CSB clients who are incarcerated may be shared between jail staff and CSB staff
- Requiring the Board of Corrections to develop standards for the provision of mental health services in local and regional jails
Joint Subcommittee members also agreed to recommend extending the Joint Subcommittee’s duration for two additional years, and discussed several options for ensuring a continued focus on mental health in the future, such as establishing a permanent commission.
VACo Contact: Katie Boyle