Behavioral Health Commission Plans Course

May 20, 2022

The Behavioral Health Commission met on April 26 and again on May 17 to receive updates from the Department of Behavioral Health and Developmental Services and to discuss the Commission’s plan of work for the year.  The Commission was established as a permanent legislative entity in 2021, as a continuation of the Joint Subcommittee to Study Mental Health Services in the 21st Century, and now has an Executive Director and is in the process of hiring several staff members.

At the Commission’s April meeting, Executive Director Nathalie Molliet-Ribet outlined a proposed work plan for the balance of the year.  One of the major tasks included in the outline is the development of a five-year strategic plan, which is scheduled to be completed in October 2022; a companion project is the development of a report on key behavioral health system metrics, which is scheduled to be completed in December 2022.

In addition to these overarching projects, several bills were referred to the Commission for study of specific issues.  HB 2047/SB 1315 were passed in 2021 and allow certain evidence of a defendant’s mental condition at the time of an alleged offense to be admissible in court under certain circumstances.  The bills directed the Commission’s predecessor, the Joint Subcommittee, to provide recommendations regarding the standard of danger to self or others that would be appropriately applied to individuals who are found not guilty under the legislation with respect to the issuance of emergency custody or temporary detention orders (TDOs), or other mandatory mental health treatment.  A workgroup of the Joint Subcommittee considered the issue in 2021 and referred the matter to the new Commission for further study in 2022 due to the complexity of the issues involved.  SB 198 (Mason), which was passed in 2022, allows courts to dismiss charges in certain misdemeanor cases for individuals found not competent to stand trial and to order the Community Services Board to evaluate the defendant for a possible TDO, instead of ordering treatment to restore competency.  The Commission will be examining the extent to which the new law, which expires in 2023 if no further legislative action is taken, addresses the concerns that prompted its enactment.

Commission staff also plan to participate in two workgroups, assuming the final budget directs their creation.  One study group would examine the overall structure of the Department of Behavioral Health and Developmental Services (DBHDS) to determine whether its responsibilities should be divided into separate entities and if the current structure can be enhanced to improve service delivery.  A second workgroup would examine the Problem Gambling Treatment and Support Fund to determine the most effective strategies in serving individuals with gambling addiction.

At the May 17 meeting, Commission staff presented options to address matters that Commission members had expressed interest in exploring at the April meeting, but which staff do not have capacity to study this year, as well as three additional bills that have been referred to the Commission:

  • Monitoring the implementation of STEP-VA: Staff recommended requesting periodic updates from DBHDS, as well as from Community Services Boards, and determining whether additional oversight is needed.  Senator Creigh Deeds, who chairs the Commission, emphasized the importance of receiving a comprehensive update from CSBs, since their resources and service areas vary widely.
  • Legislation regarding arrests and prosecutions for assault and battery: HB 613 (Bourne) and SB 453 (Boysko) failed to pass in 2022.  HB 613 would have barred arrest or prosecution for an assault or assault and battery against a law-enforcement officer if at the time of the offense the alleged assailant was experiencing a mental health emergency or met the criteria for issuance of an emergency custody order and the law-enforcement officer was responding to a call for service requesting assistance for the individual.  SB 453 would have provided that any person charged with a simple assault and battery offense, when the offense was related to the individual’s diagnosed autism spectrum disorder, intellectual disability, or serious mental illness, would not be subject to mandatory minimum punishment.  Commission staff pointed out that estimating numbers of individuals who would meet the conditions in these bills would require extensive data collection and analysis, and instead recommended that the Commission receive a briefing at a future meeting regarding the academic research on this topic.
  • Certificates of public need and temporary detention orders: HB 743 (Bell), which was continued to 2023, would have required the Commissioner of Health to impose certain conditions related to caring for individuals who are subject to TDOs when issuing certificates of public need for projects involving inpatient psychiatric services, and to disregard certain existing services when issuing certificates of public need if the existing services do not provide adequate services to individuals subject to TDOs.  Commission staff recommended gaining a better understanding of historical trends for TDO admissions at private hospitals in order to understand current system capacity.
  • Improving collaboration between CSBs and the criminal justice system: Staff recommended incorporating this complex issue into Commission’s strategic plan, and noted that the Joint Legislative Audit and Review Commission will be examining this issue in its study of CSBs, which is scheduled to be completed this year.
  • Determining the net cost benefit of closing training centers: Staff cautioned that this project would require extensive analysis; some members questioned whether the matter might extend beyond the Commission’s purview.

DBHDS Commissioner Nelson Smith made presentations at both meetings.  In April, Commissioner Smith focused his remarks on the agency’s “North Star” strategic plan, which seeks to attain three major objectives by December 2025:  strengthen the workforce; expand a comprehensive continuum of care for individuals with mental health disorders, substance use disorders, and developmental disabilities; and modernize systems and processes, especially IT systems.

In May, the Commissioner provided updates on state hospital utilization, as well as several agency initiatives.  DBHDS’s data for FY 2022 projects a decline in TDOs to a level below FY 2015, a departure from previous trends that is not fully understood by the Department and that sparked a series of inquiries among Commission members, who wanted to understand whether the decline is attributable to better availability of services in the community, such as mobile crisis, or to delayed admissions that discourage family members from seeking TDOs at all.  Although TDO numbers are down, hospitals remain stressed due to staffing shortages, which limit the number of available beds.  Commissioner Smith reported on a pilot program that is intended to address stresses on local law enforcement associated with delayed admissions to state hospitals by providing hourly payments to off-duty law enforcement to maintain custody of individuals under TDOs; the Department is awaiting approval of additional funding to expand alternative custody options, which is expected to be included in the state budget.  The Department will be participating in a workgroup to examine ways to increase the use of alternative custody, which was directed by the General Assembly.  The Department continues to try to free up beds at the state hospitals by reducing the numbers of individuals who are clinically ready for discharge but cannot be released for a variety of reasons, such as a lack of a placement in a willing assisted living facility.  Commissioner Smith also reported on the Department’s suicide prevention programming, and the upcoming rollout of the 988 system in July, which will be the new number for the National Suicide Prevention Lifeline.

The Commission’s next meeting is scheduled for June 14.

VACo Contact:  Katie Boyle

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