The first meeting of the Joint Subcommittee Studying Mental Health Services in the Commonwealth in the 21
The Subcommittee was given a briefing on the mental health law changes by Allyson Tysinger (same as delivered at the regional trainings on mental health law changes).
Commissioner Ferguson then provided a broad overview of the structure of the publicly funded mental health system followed by detailed information regarding funding in the system over the last decade, specific information on ECO/TDO dispositions from 01 January 2014 through 30 April 2014 (May and June data will be available in the next few weeks), and an outline of the Department’s goals in shoring up the mental health system.
The last presentation was from the Treatment Advocacy Center (TAC) and focused mostly on how Virginia should amend its commitment criteria and related laws to allow for a “need for treatment” standard. In general, that standard allows involuntary commitment to treatment based on inability to seek needed psychiatric and medical care, inability to make an informed medical decision and the person’s need for intervention to prevent further physical, psychiatric or emotional deterioration.
I provided public comments on behalf of the VACSB which were centered on our willingness to assist the Subcommittee in any way it deems appropriate as well as on the spectrum of services, from least to most intensive, that helps keep individuals stable in the community. VOICES, NAMI, VOCAL, two family members and a generally concerned citizen also provided public comment.
Both Delegate Bell and Senator Deeds questioned Commissioner Ferguson heavily on the details of the data on slide 17 of her presentation (link below) related to the number of incidences when a TDO was sought for an individual but was ultimately not obtained due to a lack of a willing facility. The total number of cases for which that was true between January and April was 37. Several had re-contact plans in place, which Senator Deeds pointed out was also the case for his son, equating it to leaving with nothing.
Of the 37 cases:
18 (49%) were medical admissions or were medically admitted until a psychiatric bed was located.
4 (11%) individual left before a plan or follow-up was scheduled
2 (5%) another TDO was obtained and executed
2 (5%) individual provided with a crisis plan
2 (5%) individual left the ER against medical advice and could not be subsequently located
1 (3%) individual voluntarily admitted to a CSU
1 (3%) individual accepted voluntary outpatient treatment
1 (3%) left AMA and was subsequently located after being legally detained in jail
1 (3%) remained in a nursing facility, was reassessed and no longer met TDO criteria
1 (3%) individual subsequently admitted to a psychiatric hospital voluntarily
Commissioner Ferguson went on to say that the new laws would prevent these scenarios from happening in the future. Commissioner Ferguson’s presentation was overall a positive one, focusing on access to a system of care that addresses an individual’s need before s/he enters into crisis. Senator Deeds thanked Commissioner for her vision, specifically the principles outlined on slide 2 of her presentation.
Senator Deeds proposed several work groups, but is in the process of soliciting feedback from the Subcommittee members and solidifying the work group structure. Senator Deeds suggested a work group devoted solely to children’s mental health issues, one devoted to emergency/crisis interventions, one devoted to examining the role of law enforcement, one to look at continuity of care (this would encompass looking at the current DBHDS and CSB structure) and one group to look at criminal justice involvement. Delegate Bell suggested keeping the number of work groups to a minimum so that they can make sure the groups are coordinating well and getting a sense of the big picture.
Many of you have read the press coverage in this morning’s paper which quoted Delegate Bell as questioning whether CSBs should even exist. He did make the statement as quoted, but it was followed by him saying that he hoped people listening found his statement alarming. He was making a point about how the entire system should be examined and questioned and was not necessarily saying that CSBs should be done away with as a foregone conclusion. The statement is indeed alarming, as he intended, but I do not believe that the Subcommittee will ultimately be interested in dismantling a system that works so well for so many people. Keep in mind that this is a 4 year study and that this was just the first meeting.
The next meeting date for the Subcommittee has not yet been set but it is likely to be in late August or early September. That meeting is envisioned as being mostly informational (presentations) and then some amount of time devoted to the work of the smaller work groups. No indication was given as to how or when individuals/advocacy organizations/experts will be contacted to participate on these work groups.
Senator Deeds was elected as the Chair, Delegate Bell was elected as Vice Chair and as a reminder, the members of the Subcommittee are:
The Honorable Robert B. Bell
The Honorable T. Scott Garrett, Member of House Appropriations Committee
The Honorable Peter F. Farrell
The Honorable Joseph R. Yost, Member, House Committee on Health, Welfare and Institutions
The Honorable Margaret B. Ransone, Member, House Committee on Health, Welfare and Institutions
The Honorable Vivian E. Watts
The Honorable Luke E. Torian, Member of House Appropriations Committee
The Honorable Janet D. Howell
The Honorable Emmett W. Hanger Jr.
The Honorable Linda T. Puller
The Honorable R. Creigh Deeds
The Honorable George L. Barker
Presentations from yesterday’s meeting are linked below, and please feel free to contact me with any questions you may have.
John Snook (TAC):