Work groups of the Joint Subcommittee to Study Mental Health Services in the Commonwealth in the 21st Century have met throughout the month, reviewing legislation referred to the Joint Subcommittee and wrestling with the pressing issue of overcrowding in the state hospital system and its spillover effects on law enforcement. It is anticipated that proposals to direct some of the federal resources provided through the American Rescue Plan Act toward addressing hospital staffing needs or other ways of mitigating the census pressures may be under consideration in the special session this summer.
The June 8 meeting of the work group focusing on Emergency Custody Orders and Temporary Detention Orders and their effects on law enforcement, which is chaired by Senator Monty Mason, featured a series of short presentations by stakeholders who were asked at a previous meeting to return with additional information and potential solutions. John Jones, Executive Director of the Virginia Sheriffs’ Association, presented the results of a survey of sheriffs and advocated for the state to fund additional psychiatric beds and the associated staffing, as well as to expand the scope of the current contract for the state’s alternative transportation provider to allow these non-law enforcement staff to wait with individuals under temporary detention orders until beds at state hospitals become available, thus freeing law enforcement officers to return to regular duties. Jennifer Wicker of the Virginia Hospital and Healthcare Association provided data from a survey of private hospitals on “boarding” of individuals in the emergency department while they await a psychiatric bed and discussed workforce challenges facing private hospitals, which limit their ability to open additional beds.
Alison Land, Commissioner of the Virginia Department of Behavioral Health and Developmental Services, provided sobering statistics regarding census levels at the state hospitals and discussed efforts to recruit and retain staff; she emphasized that because overall compensation is not competitive, particularly for a challenging work environment, the Department is losing staff more quickly than they can be recruited. In addition to the Department’s work to improve recruitment and retention, she offered several options to address the census in the near term, including the expansion of the scope of the alternative transportation contract, pilot projects to care for individuals with dementia outside of the state hospitals, additional focus on expediting discharges, and an investment in crisis receiving centers as alternative sites for individuals in crisis to be stabilized and receive outpatient services. Commissioner Land offered similar thoughts to the Senate Finance and Appropriations Committee the following week, a presentation which met with concern from committee members, especially Chair Janet Howell, who characterized the need to address workforce issues in the state hospitals as a “moral imperative.”
Jennifer Faison, Executive Director of the Virginia Association of Community Services Boards, provided an overview of a recent report on the state’s system of Crisis Intervention Team Assessment Centers (CITACs), which was completed in 2020; the report discusses expanding the hours of availability of the existing sites and expanding the services offered (a concept of interest to CSBs, as long as it does not reallocate funding from existing centers). Ally Singer Wright, Program Director for the Virginia Mental Health Access Program (VMAP), concluded the meeting with a presentation on the program, which seeks to address the shortage of child and adolescent psychiatrists by enhancing the capacity of primary care physicians to treat mental health needs and assisting families in locating additional regional services.
The Special Populations Work Group, chaired by Delegate Vivian Watts, also discussed ways to reduce the state hospital census at its June 22 meeting, although the conversation focused on forensic patients and ways to reduce both jail and state hospital stays for individuals with mental illness. Christine Schein, Deputy Director of Forensic Services at DBHDS, also discussed the role of CITACs and their potential expansion in her presentation. She also noted that special mental health dockets in the court system have demonstrated success and could be further expanded to additional courts. She encouraged consideration of ways to streamline court-ordered evaluations and competency hearings for forensic patients, who now make up approximately 40 percent of the state hospital census. The work group expressed interest in receiving additional information on this topic, particularly with respect to the concentration of forensic patients in certain hospitals. In addition, the workgroup will consider an element of legislation that passed earlier this year dealing with the ability of courts to consider evidence related to an individual’s mental condition at the time of an alleged offense; the bill directs the Joint Subcommittee to make recommendations about the standard of danger to self or others that may be appropriately applied in the imposition of mandatory mental health treatments for individuals who are found not guilty under the provisions of the bill.
The Involuntary Commitment and Emergency Services Work Group, chaired by Delegate Patrick Hope, discussed two bills that were referred to the Joint Subcommittee over the last two legislative sessions. HB 2329 (Cox) deals with the release of an individual within 96 hours of an involuntary commitment order and would require both the psychiatrist treating the person and a second psychiatrist to determine that the person no longer meets the criteria for involuntary commitment before the individual could be released. SB 1049 (Deeds) seeks to provide ways for family and other supportive individuals to participate in the involuntary commitment process, discharge planning, and mandatory outpatient treatment process, as approved by the individual subject to the involuntary commitment or other processes. Several stakeholders participating in the meeting encouraged consideration of the psychiatric advance directive process as a way to meet the goals of the bill. Stakeholders also weighed in with broad consensus on the value of reorganizing the statutes governing mandatory outpatient treatment to make them less confusing (a previous stakeholder group had recommended legislation making more substantive changes to the statutes, which passed during the 2021 session with a delayed enactment date to allow for additional revision if necessary).
VACo Contact: Katie Boyle