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Alternative Custody Workgroup Begins to Consider Recommendations

The workgroup studying options to increase the use of alternative custody arrangements for individuals who are subject to an emergency custody order (ECO) or a temporary detention order (TDO) held its third meeting on August 9. This workgroup was established by legislation passed during the 2022 General Assembly session in response to the continuing stresses on law enforcement agencies posed by delayed admissions to inpatient psychiatric care. In keeping with the structure of previous meetings, several stakeholder groups kicked off the meeting with presentations outlining their perspectives on issues under consideration. Discussion at the August 9 meeting spotlighted stresses faced by emergency physicians and staff and Community Services Board (CSB) pre-screeners.

Dr. Joran Sequeira, representing the Virginia College of Emergency Physicians, discussed difficulties in the ECO/TDO process manifested in emergency departments, including physicians’ frustration that individuals subject to TDOs may wait for hours without receiving treatment, concerns about difficulties managing patients subject to TDOs, and the limitations inherent in the medical TDO process. Ryan Dudley, Director of Crisis Services for the Hampton-Newport News CSB, conveyed challenges facing CSB pre-screeners. Lengthy waits for the resolution of cases are exacerbating workforce shortages, and pre-screeners often must operate without knowledge of the length of the state’s current wait list or how it is prioritized.

Heather Norton, Assistant Commissioner at the Department of Behavioral Health and Developmental Services (DBHDS), provided an overview of the state’s efforts to transform its crisis system, based on an approach that encompasses a crisis call center, 24/7 mobile crisis, and crisis stabilization facilities such as crisis receiving centers. National research indicates that a majority of crisis calls for assistance can be resolved at the call center level or through other community-based supports, averting the need for higher levels of care. To provide opportunities to meet individuals’ needs without hospitalization, the state has invested funding in supporting crisis receiving centers, but more sites are needed to ensure statewide access; national best practices would call for one crisis receiving center per 250,000 people, and Virginia’s rural geography may necessitate additional sites.

Based on discussions at previous meetings, DBHDS staff circulated a set of potential recommendations for review and comment. The draft proposals include a suite of recommendations regarding alternative custody, to include expanding the current alternative transportation contract, expanding the existing program providing a stipend to off-duty law enforcement who maintain custody of TDO patients, and expanding mobile crisis and site-based crisis services. Other recommendations include clarifying statutory language governing the ECO and TDO process; developing additional training for magistrates; and developing standards for re-evaluating patients during the ECO and TDO process for possible diversion to more appropriate care options.

The workgroup’s final scheduled meeting is August 25.

VACo Contact: Katie Boyle

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