Workgroup Examining Responsibility for Mental Health Evaluations Begins Work

August 6, 2020

A stakeholder workgroup directed by the General Assembly to examine and potentially reform the current process for conducting evaluations of individuals who are experiencing mental health crises to determine whether they meet the criteria for temporary detention held its first meeting on July 16.

The genesis of this effort was a broader workgroup, also directed by legislation, that met during the spring and summer of 2019 to address the overcrowding of the state’s mental health hospitals. One of the topics of discussion, though not consensus, in that workgroup was allowing professionals other than employees or designees of the Community Services Boards to conduct evaluations for temporary detention orders. Currently, when an individual in crisis is taken into custody by a law enforcement officer, or a magistrate issues an emergency custody order, an emergency services worker evaluates the individual to determine if he or she meets the criteria for a temporary detention order (TDO). If a TDO is determined to be necessary, the emergency services worker begins the process of locating an available bed; if no bed can be secured in a private hospital before the expiration of the emergency custody order period, the state hospital system serves as the bed of last resort. The requirement for a CSB employee to perform the evaluation and locate a bed was instituted in the 1990s in order to ensure that less-restrictive alternatives to hospitalization were considered. With an increasing reliance on state hospitals to serve as the “bed of last resort” when an emergency custody order is close to expiring without a private hospital bed being secured, there has been renewed interest in examining the TDO process.

Some members of the 2019 workgroup believed that allowing other professionals, such as hospital clinicians, to perform the evaluation would streamline the process by eliminating the wait for the emergency services worker to arrive, and would improve care by allowing the individual to begin treatment more promptly. Other workgroup members were opposed to the idea, arguing that the delay within the emergency custody order time period is attributable to difficulties in locating a suitable bed for the individual and not the completion of the evaluation itself, and stressing the need to proceed with caution in changing a complex process.

Legislation enacted in 2020 directed that the issue of authorizing additional personnel to conduct evaluations be reconsidered. Staff from the Department of Behavioral Health and Developmental Services convened the new workgroup, which includes representatives from hospitals, Community Services Boards, law enforcement, and advocates for individuals with mental illness, among others. VACo and VML are participants in the workgroup. At the July 16 meeting, DBHDS staff provided an overview of the current TDO process, a review of discussions of similar issues in 2015 and 2019, and information about the civil commitment process in other states. Several workgroup members pointed out the need for services other than hospitalization, whether in the public or private system, for individuals in crisis. Members also expressed interest in streamlining the process of completing the evaluation and locating a bed. The workgroup is currently scheduled to hold two more meetings; an overarching concern that was expressed is whether three meetings will provide enough time to address such a complex policy question, or if an extension should be requested.

The workgroup’s next meeting is scheduled for August 11.

VACo Contact: Katie Boyle

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