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Mental Health Study Commission Discusses Proposed Financial Realignment of Public Mental Health System

The Joint Subcommittee to Study Mental Health Services in the Commonwealth in the 21st Century (often referred to as the “Deeds Commission”) met on September 28 to receive updates from its expert advisory panels and to discuss current initiatives underway at the Department of Behavioral Health and Developmental Services (DBHDS).

Dr. Jack Barber, Interim DBHDS Commissioner, spoke about the implementation of the STEP-VA plan, which requires a standard menu of services to be available at all Community Services Boards (CSBs) by July 2021. The new services are to be phased in, with the first addition, same-day access to screening at CSBs, available by July 1, 2019. Funding was provided in the 2017 Appropriations Act to enable 18 CSBs to provide this service; it is anticipated that funding for the remaining 22 CSBs will be included in the Governor’s budget in December. In discussion among joint subcommittee members, some concern was expressed that the timeline for implementing the remainder of the STEP-VA services (which include primary care integration, psychiatric rehabilitation, and behavioral health services for veterans) may be too aggressive.

Commissioner Barber also discussed DBHDS’s work on a “financial realignment” proposal that was directed by budget language in the 2017 session. The plan seeks to address the problem of over-reliance on state hospitals by proposing to direct a portion of state General Funds currently distributed to state hospitals instead directly to CSBs, who would be responsible for purchasing bed-days at the state hospitals. The plan contemplates that the redirected General Fund dollars would be used to develop community services in accordance with STEP-VA, which would provide alternatives to hospitalization. As discussed with VACo’s Health and Human Resources Steering Committee, a major concern with the plan is that it will require a significant increase in community services before any state hospital funds could be redirected; in addition, without some kind of funding reserve at the state level to mitigate unexpected needs for state hospital beds, localities could potentially be responsible for these costs in the event that hospital utilization is underestimated. Additional details of the plan will need to be refined, such as how to develop a fair funding formula for allocating funds to CSBs, and how to address cash flow issues with the state hospitals.

The subcommittee received updates from its Expert Advisory Panel on System Structure and Financing, which is preparing to embark on a study of the relationships between local governments and CSBs, a project discussed by the panel’s chair, Dr. Richard Bonnie, with VACo’s HHR Steering Committee in August. This project will examine local funding contributions as well as potential regional collaborations. The Expert Advisory Panel on DBHDS Oversight Authority and Responsibility also made a report on its plan of study, to include the role of DBHDS in managing quality improvement and data collection. The chair of the panel reviewing emergency services discussed its work plan, including reviewing models for alternative transportation for emergency custody and temporary detention orders, enhancing telemental health services, and examining the current eight-hour window for emergency custody orders to determine whether additional time could allow resolution of some crises without resorting to hospitalization. A representative from the panel examining criminal justice issues reported on its work, which includes coordinating with the Compensation Board on its implementation of a standard mental health screening instrument for jails and surveying localities with successful diversion programs, especially in rural localities.

VACo Contact: Katie Boyle

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