Joint Commission on Behavioral
Health Care
November 28, 2000, Richmond
December 14, 2000, Richmond
The 2000 Session of the General
Assembly established the Joint Commission on Behavioral Health Care and
charged the commission with broad responsibilities related to all areas
of publicly funded behavioral health care management, financing, service
delivery, regulation, and evaluation. To help develop its work plan for
the next two years, the commission called upon individuals who have an
interest in mental health, mental retardation, and substance abuse issues
to make recommendations to the commission at its first meeting.
Those recommendations resulted
in a work plan that includes a broad range of issues, such as (i) system
restructuring, (ii) comprehensive policy development for community-based
services, (iii) strengthening the local system of services, (iv) child
and adolescent mental health, (v) mental health and substance abuse services
in local jails and juvenile detention centers, (vi) the mental retardation
waiver, (vii) best practice models, (viii) access to pharmaceuticals and
the aftercare pharmacy, (ix) workforce development, (x) Medicaid rates
of reimbursement, (xi) patient and financial management information, and
(xii) prevention activities.
The joint commission began to
consider some of those issues at its meetings in November and December
2000.
Aftercare Pharmacy
Under the authority of § 37.1-101
of the Code of Virginia, the Department of Mental Health, Mental Retardation
and Substance Abuse Services (DMHMRSAS) provides drugs and medicines to
individuals who have been discharged from a state hospital and are unable
to afford medicines prescribed by a member of the hospital medical staff.
What began as a relatively small operation in 1984 has grown to an operation
that serves approximately 15,000 consumers per month and dispenses 250,000
prescriptions per year. While the department has taken steps to modernize
the operation over the years, the Virginia Chapter of the National Alliance
for the Mentally Ill (NAMI) asked the commission to consider three items
for the 2001 Session of the General Assembly: (i) expanded access to the
Aftercare Pharmacy to help accomplish the goal of reducing and preventing
hospitalizations, (ii) creation of a Pharmacy and Therapeutic Committee
that would have the authority to make decisions and oversee formulary
issues, and (iii) a study of the Aftercare Pharmacy by an outside consultant.
Treatment Services in Local
Jails and Juvenile Facilities
National data show that the
incidence of substance abuse problems and mental illness is more prevalent
in local jails than for the general population. A 1997 study by the National
Gains Center indicates that approximately one-third of jail detainees
meet diagnostic criteria for alcohol or other drug dependence, and approximately
seven percent of jail detainees suffer from acute or serious mental illness
at booking. Five percent of jail inmates have concurrent mental illness
and substance abuse disorders. In addressing the commission, a representative
of the Richmond Behavioral Health Authority cited several service delivery
considerations: who should receive treatment; whether services should
be offered directly by local jails or by contract; space constraints on
the delivery of on-site services; case management and links to community-based
services; and barriers created by funding mechanisms.
The Virginia Beach Sheriff's
Office reported that local jails are not equipped to be alternative substance
abuse and mental illness treatment centers, although it sometimes happens
by default. Five to seven percent of the population in Virginia Beach
jails have been identified as having mental health problems. Currently,
20 inmates are waiting for transfer to a state hospital; the average wait
is three to five months, although one inmate has been waiting since July.
Fifty-seven inmates are on psychotropic medications. The Sheriff's Office
estimates that another three to five percent of the inmates may have mental
health problems that have not been identified. Approximately 66 inmates
in Virginia Beach are participating in a therapeutic community for treatment
of alcohol and other drug problems. These individuals are linked to persons
in the communities who will continue their care after release and provide
transition services such as housing, vocational training, and employment
services.
The chief deputy director of
the Department of Juvenile Justice reported that community services boards
differ in their ability to provide services to juveniles in detention
facilities. In addition, residential treatment services are difficult
to obtain. Juveniles can be sent to DeJarnette for evaluation and assessment,
but they are returned to the local detention centers. A 1994 report indicated
that, on any given day, eight to ten percent of youths in secure detention
homes in Virginia have serious mental health problems. This question was
posed to the commission: Are detention centers becoming de facto psychiatric
facilities for juveniles due to lack of other alternatives? The consensus
among detention superintendents is that the mental health needs of juveniles
are becoming more acute in our communities, and detention centers are
bearing the brunt of the increase.
Case Management and Part C
Early Intervention Services
Case management is not a Medicaid-mandatory
service but is provided as a state plan option for children enrolled in
the Part C Early Intervention program. Questions have arisen concerning
Medicaid reimbursement for targeted case management for Part C children.
No action has been taken to discontinue case management for this population,
but discussions are occurring with community services boards and others.
From DMAS' perspective, the issue is the appropriate funding mechanism
for this service. Without proper reimbursement, access to case management
is impeded. Staff was asked to look into what changes may be needed to
ensure that case management continues to be reimbursed for Part C children.
The Honorable Stephen H. Martin,
Chairman
Legislative Services contact:
Nancy Roberts
THE
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