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Mental Health Commission Plots Course for 2020

The Joint Subcommittee to Study Mental Health Services in the Commonwealth in the 21st Century met August 5 to review progress on previous initiatives and plan for the Joint Subcommittee’s work for the remainder of 2020. Several bills generated by the Commission’s work in 2019 were enacted in the 2020 session, including legislation to improve information sharing between medical providers when an individual is incarcerated in a local or regional jail, clarify the temporary detention order process for individuals who are intoxicated, and refine the alternative transportation process for individuals subject to temporary detention orders. The Joint Subcommittee discussed several ongoing issues within the behavioral health system, notably overcrowding at state hospitals, as well as the emotional and financial stresses associated with the COVID-19 pandemic and ways the behavioral health system has adapted in order to continue providing services.

Department of Behavioral Health and Developmental Services Commissioner Alison Land provided an update on the state hospitals, which have struggled with overcrowding for the last several years. The hospital census had declined earlier in the year due to aggressive work to remove barriers to discharging patients who are clinically ready to leave the hospital, but with the gradual reopening of the state, admissions have surged, particularly among the geriatric population. Admissions have had to be halted at two hospitals to prevent the spread of COVID infections. Funding for discharge assistance planning and for pilot projects to address overcrowding has been “unallotted,” or paused, pending the revenue reforecast, and restoration of these funds, as well as retention of funding for outpatient services for children, are the Department’s priorities for the upcoming special session.

Commissioner Land also spoke about the effect of the pandemic on the Community Services Boards, which have continued to provide Code-mandated services, largely through a rapid pivot to the use of telehealth. CSBs have largely remained financially stable during the pandemic despite reductions in revenues caused by restrictions on the provision of services that were unable to be delivered via telehealth, but this stability has been achieved by reducing staff (through furloughs or layoffs) for programs that were affected by closures (generally day and residential programs).

Dr. Alyssa Ward from the Department of Medical Assistance Services discussed the flexibility afforded to providers by the Medicaid program during the pandemic, particularly in allowing services to be provided through telehealth. There is interest within the agency and among legislators in retaining telehealth flexibility long-term, as well as recognition that broadband access is a key component of service delivery through these means. Dr. Ward and Dr. Alexis Aplasca with DBHDS updated members on long-term efforts to align Medicaid-funded services with initiatives across human services programs (for example, by ensuring that all services required to be provided by CSBs through the STEP-VA initiative are covered by Medicaid). Funding for these efforts has also been unallotted.

Senator Creigh Deeds, who chairs the Joint Subcommittee, reminded members that the Joint Subcommittee is scheduled to expire at the end of 2021, and suggested that members consider whether its work should be extended, incorporated into an existing entity, or made permanent as a stand-alone commission. He suggested that the Joint Subcommittee’s work this year be divided among three workgroups: the existing System Structure and Financing and Criminal Justice work groups, and a new workgroup on aspects of the civil commitment process.

VACo Contact: Katie Boyle

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