Local Support of Behavioral Health System Under Discussion; Mental Health Standards in Jails Contemplated

September 20, 2018

The Joint Subcommittee to Study Mental Health Services in the Commonwealth in the 21st Century has met several times over the spring and summer, and its System Structure and Finance Subcommittee continues to examine local support for Community Services Boards (CSBs). Dr. Richard Bonnie of the University of Virginia’s Institute of Law, Psychiatry, and Public Policy (ILPPP) made a presentation on CSB funding to the subcommittee on September 5 (presentation is available on the Joint Subcommittee’s webpage). The ILPPP’s review found that local support for CSBs varies considerably throughout the state and that administrative policy CSBs, which are more integrated into local government structures, receive the bulk of local financial support, while operating CSBs (which typically serve several jurisdictions) experience more financial instability, which may be compounded by delays in Medicaid reimbursements, due to their increased reliance on Medicaid funding. ILPPP suggested that an alternative to the required local match (10 percent of the total state and local funds received by the CSB) should be developed as a means of increasing local support for mental health services; it also suggested that the current method the state Department of Behavioral Health and Developmental Services (DBHDS) uses to distribute state General Funds to CSBs should be reviewed. Joint Subcommittee members have discussed the possibility of establishing a structure for mental health funding similar to the Standards of Quality in K-12 funding, in which the state establishes minimum standards for service provision, with state and local cost-sharing. The Joint Subcommittee is expected to meet again this fall to refine its proposals for the 2019 Session.

The provision of mental health services in local and regional jails continues to be a subject of interest among legislators and state agencies. During the 2018 General Assembly session, legislation was introduced that would have required CSBs to provide mental health and substance abuse services in local and regional jails; VACo objected to the bills’ lack of clarity on how these services would be funded and how they would fit with the existing set of required CSB services that is being phased in as part of the STEP-Virginia plan. The bills, which were ultimately left in the House Appropriations Committee, also would have required the Board of Corrections to adopt standards for the provision of mental health and substance abuse services in local and regional jails.

The Joint Commission on Health Care received a report this week on a two-year study of health care in correctional facilities, to include the question of whether CSBs should provide mental health care in all jails. The staff report notes that CSBs provide the majority of mental health treatment within jails, but do not serve all jails, some of which use contractors or jail mental health staff to meet their treatment needs. The report does not recommend that CSBs be required to provide services within jails, but includes as a policy option for consideration requiring the Board of Corrections to impose minimum health care standards for local and regional jails that are not accredited. In a related effort, a work group formed by DBHDS earlier this year recommended 14 mental health care standards for local and regional jails, several of which the report acknowledges would require additional resources to implement. This topic is expected to be the subject of a presentation to the Joint Subcommittee this fall, and legislation on this issue can be expected during the 2019 Session.

The Joint Commission on Health Care is soliciting public comments on its policy options until October 15, 2018. Comments may be provided by email to jchcpubliccomments@jchc.virginia.gov; via fax to 804.786.5538; or via U.S. Mail to the Joint Commission on Health Care, P.O. Box 1322, Richmond, Virginia 23218.

VACo Contact: Katie Boyle

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