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Behavioral Health Commission Discusses Funding, Mental Illness and Criminal Justice, and the Role of Private Hospitals

The Behavioral Health Commission’s June 14 meeting featured a series of briefings for members, including an overview of behavioral health-related items in the budget conference report recently passed by the General Assembly, an analysis of data regarding individuals with mental illness who are charged with assaults against law enforcement officers, and an update from the Virginia Hospital and Healthcare Association on the role of private hospitals in inpatient psychiatric care.

The Commission’s Executive Director, Nathalie Molliet-Ribet, informed members of two adjustments to the Commission’s work plan for the year.  The conference report, as passed by the legislature, no longer includes Commission participation in the planned study of the Problem Gambling Treatment and Support Fund.  However, the Commission will be participating in a workgroup established by stand-alone legislation this session that seeks to increase the use of alternative custody arrangements for individuals who are subject to an emergency custody or temporary detention order, in order to relieve stresses on law enforcement agencies (this workgroup will be meeting on June 16; VACo will be reporting on its discussions).

Mike Tweedy, Senior Legislative Fiscal Analyst for the Senate Finance and Appropriations Committee, presented the overview of the conference report’s provisions related to behavioral health.  Major General Fund investments include:

  • Funding for the remaining services in STEP-VA ($50.5 million over the biennium)
  • Funding to expand permanent supportive housing ($34 million over the biennium)
  • Support for mobile crisis teams and crisis receiving centers ($51.5 million over the biennium)
  • Funding to increase direct care staff compensation at state facilities to 50 percent of the market median ($109.8 million over the biennium)
  • Additional funding for the current alternative transportation contract ($3.8 million over the biennium)
  • Funding for alternative custody options for individuals subject to Temporary Detention Orders (TDOs) ($5.4 million over the biennium)
  • Language directing a workgroup to evaluate restructuring of the Department of Behavioral Health and Developmental Services, to include an analysis of reimagining Catawba Hospital as a facility to provide a continuum of substance use disorder services

Senator Creigh Deeds, who chairs the Commission, noted that the state will need to monitor the implementation of STEP-VA to ensure that adequate resources are available to provide services in all communities.  Members also discussed the importance of mental health services in schools in light of the funding provided for school-based mental health integration pilot projects ($2.5 million in FY 2023).

Commission members received a briefing from Dr. Heather Zelle with the Institute of Law, Psychiatry, and Public Policy at the University of Virginia regarding the prevalence of individuals with mental illness being charged with assaults against law enforcement officers.  This briefing resulted from two pieces of legislation that failed to pass in 2022 (HB 613 (Bourne) and SB 453 (Boysko)), and were referred to the Commission by letter.  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 had indicated in an earlier meeting that extensive data analysis would be needed to estimate the prevalence of these kinds of cases and had suggested that the Commission receive information on current academic research on this issue.

Dr. Zelle’s data analysis indicated that a statewide average of 10 percent of charges of assault against a law enforcement officer involved a person with mental illness.  However, she emphasized that these estimates do not account for individuals with mental illness who were charged with assaults against law enforcement officers but were not previously subject to an Emergency Custody Order (ECO) or a TDO.  Her research found that defendants with a history of mental illness (as evidenced by a previous ECO or TDO) spent more time incarcerated, on average, than individuals without a history of mental illness.  She pointed out that involvement with the criminal justice system may exacerbate mental health problems for these individuals.

Julie Dime made a presentation on behalf of the Virginia Hospital and Healthcare Association (VHHA) on inpatient psychiatric care in private hospitals in response to information requests made by Commission members at previous meetings.  Similar to the situation in the state hospitals, workforce shortages limit private hospitals’ capacity; according to a recent survey conducted by VHHA, 85 percent of licensed adult psychiatric beds are staffed; 82 percent of licensed child and adolescent beds are staffed.  While private hospitals are admitting a smaller percentage of individuals under TDOs in recent years than were admitted in FY 2015, Ms. Dime pointed out that private hospitals are serving larger numbers of voluntary admissions, and are also experiencing increases in patients’ average length of stay, with these factors combining to further stress hospitals.  Challenges cited by the VHHA include behavioral health workforce shortages, patients presenting with higher-acuity needs, and patients experiencing longer wait times in emergency departments.

The Commission’s next meeting is scheduled for July 26.

VACo Contact:  Katie Boyle

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