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