Lawmakers’ recommendations aimed at temporary detention order crisis, mental health in jails

A group of lawmakers made a series of recommendations Tuesday aimed at tackling a variety of problems within Virginia’s mental health system, which is marred by overcrowded hospitals and jails full of people with serious mental illness.

Sen. Creigh Deeds, D-Bath, chairman of the Joint Subcommittee Studying Mental Health Services in the Commonwealth in the 21st Century expressed an urgency to address some of the mental health challenges during the upcoming General Assembly session.

“It’s important for us to be as aggressive as possible in terms of reaching our overall goals in being able to provide services in every corner of the commonwealth,” Deeds said Tuesday.

The committee, known as the Deeds Commission, made several recommendations aimed at the flood of patients arriving at state psychiatric hospitals under temporary detention orders.

The number of TDO patients — those involuntarily detained due to a mental health crisis — admitted to state hospitals has shot up 300 percent since 2013, which threatens safety and patient care at hospitals.

The committee agreed to ask the Department of Behavioral Health and Development Services to prepare a plan to “right-size” the state’s hospital system, so the state is spending the appropriate amount on state hospitals to treat those in crisis while the majority of its funds are directed to community services in an effort to avoid having to take in involuntarily detain patients in the first place.

“We all understand we want to move away from the heavy emphasis on institutions, build more community-based services, and we need a plan that will move us in that direction,” said Sen. Emmett Hanger, R-Augusta.

Deeds noted that other states spend about 77 percent of their funding on community-based services and the remainder on hospital care while Virginia spends 50 percent of its money on hospital care.

Other legislative recommendations include:

• Devoting money in the upcoming budget to ensure Central State Hospital is replaced on an expedited timeline;
• Clarifying that an emergency custody order, which precedes a TDO, lasts until the TDO is actually executed to clear up confusion around custody that arises when a patient doesn’t receive the order within the allocated eight hours.
• Authorizing sharing information for discharge planning between private psychiatric hospitals and community services boards, which contract with the state to provide mental health treatment in their respective regions.
• The lawmakers also voted to recommend a series of measures meant to expand “telemental health,” that is, online or telephone therapy, services across the state.

The lawmakers also considered a host of issues involving mental health care in the criminal justice system.

Recommendations included:

• Adding sensitivity and awareness of mental health issues to the required basic training for law enforcement officers.
• Ensuring information about patients can be easily transferred between jails and community services boards.
• Requesting that the Board of Corrections develop minimum standards for mental health care in jails and enforce those regulations with surprise inspections.

“Under current law there are in fact no regulations requiring minimum care for mental health care in the jails,” said Del. Robert Bell, R-Albermarle. “After discussions with all the stakeholders, the conclusion is that it’s time.”

Virginia has made significant investments in its mental health system over the last several years, but a survey from a workgroup that is looking into redesigning Medicaid’s behavioral health system found several areas still wanting.

In the survey — sent out to providers, state agencies and advocacy groups, among others — 74 percent noted that the current array of services available in Virginia is not satisfactory in meeting treatment needs. Seventy-five percent reported that the state lacks a proficient workforce to provide the necessary mental health services.

The group finished the meeting with a discussion of the future of the commission: Should it continue on a permanent basis, be folded into another existing state committee or simply be extended a few more years?

The group ultimately decided to continue for an additional two years, mentioning that in the meantime it could discuss the merits of becoming a permanent committee and what its membership should be.

“My main concern in the beginning was this is an issue that’s been looked at about every 10 years,” said Deeds, who was nearly killed in 2013 by his son Austin, who later took his own life, while he was in the midst of mental health crisis.

“Volumes of studies have been created that sit on a shelf somewhere gathering dust,” the senator said. “And I wanted to make sure — I still want to make sure — that the ideas don’t gather dust. I’m proud of the work we’ve done, but we’ve got a heck of a lot more to do. We’ve just scratched the surface.”