Joint Commission on Behavioral Health Care

November 6, 2002
December 10, 2002
Richmond

The Joint Commission on Behavioral Health Care met in conjunction with the Joint Commission on Health Care on November 6, 2002, to receive reports on (i) the plan to restructure the mental health, mental retardation and substance abuse services and the progress of the Olmstead Task Force, (ii) the availability of inpatient psychiatric beds (SJR 94), and (iii) the plan to address suicide prevention (SJR 108).

Restructuring and Olmstead Task Force

The commissioner for the Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) reported that while Virginia had made some progress, the Commonwealth still lags behind the national average in reducing the use of state mental health facility beds. Certain pressures threaten continued progress in achieving a community-based services system: state facilities are operating at or in excess of capacity; the loss of private sector beds and HMO/insurance practices is placing increased demands on the public system; and reductions in community services are putting more consumers at risk of hospitalization.

The DMHMRSAS has launched a strategic planning process that includes plans for regional partnerships to examine potential opportunities for restructuring. Regional teams will meet through the spring of 2003 to solicit local views regarding service needs, priorities, and potential service realignments or restructuring; recommend strategies to improve regional and local systems of care; assess the region's readiness for significant facility and community restructuring; and offer recommendations regarding the potential closure or conversion of state mental health facilities.

The commissioner reported that strategies might include proposals to:

Realign or construct incentives to support a community-based system;
Shift the general focus for service delivery from facilities to localities;
Shift or share administrative and clinical staff from facilities to localities;
Shift certain facility-based forensic services to community-based alternatives;
Build acute and crisis stabilization services in localities to divert admissions from state facilities;
Shift inpatient geriatric services to community-based nursing homes or other residential alternatives;
Combine or consolidate administrative services across facilities;
Combine community services board services to create efficiencies, expand service availability and improve service delivery;
Establish a State and Community Consensus and Planning team to consider a state mental health facility closure or conversion to another use.

The commissioner also reported on the progress of the Olmstead Task Force. The Olmstead case involved a challenge under the Americans with Disabilities Act by two women with mental disabilities who lived in mental health facilities operated by the state of Georgia, but who wished to live in the community. The U.S. Supreme Court held that Georgia had violated the ADA by forcing the women to remain in a state mental hospital when they could be discharged. Based on this ruling, states must make "reasonable accommodations" in programs in order to provide community-based services to qualified individuals. Virginia has established an Olmstead Task Force, chaired by the Secretary of Health and Human Resources, to develop a plan for serving persons with disabilities. The task force is engaged in two concurrent planning processes: gathering information on populations and services and exploring barriers to community services and support through seven "issues" teams. These teams will meet frequently through next spring to complete their examination of the issues and recommend actions.

Inpatient Psychiatric Beds and Access to Outpatient Mental Health Treatment (SJR 94)

A work group, which was established to address the issues outlined in SJR 94 (2002), reported that Virginia is experiencing a significant problem across the system of mental health services, including insufficient capacity to care for Virginians who need acute or long-term psychiatric services. Providers are experiencing increased demand for services, hospitals are operating at capacity, and the resources necessary for hospital and community staff to discharge individuals into the community are in short supply, delaying discharges and limiting access to beds. The work group cited a number of short and long-term strategies that could help address supply-and-demand issues, including the decentralization of some processes, utilization management, resource sharing, incentives, and creation of regional structures with representatives from state hospitals, acute care community hospitals and community services boards to develop alternatives to state hospital placement, identify local and regional needs, and facilitate communication among providers.

Suicide Prevention (SJR 108)

SJR 108 (2002) directed the Joint Commission on Behavioral Health Care, in cooperation with the Department of Mental Health, Mental Retardation and Substance Abuse Services and the Department of Health, to develop a plan and strategy for suicide prevention. In response to SJR 108, staff reported to commission that suicide is the second leading cause of death for people aged 10 to 35 in the Commonwealth. On average, two adults per day and one teenager per week die through suicide. While some suicide activities in the Commonwealth are directed primarily at youth and the elderly, there is no overall suicide prevention strategy across the life span and no single agency acts as a clearinghouse or coordinator of activities related to suicide prevention. To address the issue of suicide prevention, the staff report recommended that the Secretary of Health and Human Resources, in cooperation with the Secretaries of Education and Public Safety, lead an interagency and cross-secretarial effort involving all stakeholders to develop a comprehensive Suicide Prevention Across the Life Span Plan for the Commonwealth.

December 10th Meeting

At its second and final meeting on December 10, 2002, the Joint Commission on Behavioral Health Care received a briefing on the activities of the Inspector General for the Department of Mental Health, Mental Retardation and Substance Abuse Services and took action on the reports related to Inpatient Psychiatric Beds (SJR 94) and Suicide Prevention (SJR 108). The commission recommended the following actions:

Suicide Prevention (SJR 108): By resolution for the 2003 Session of the General Assembly, request the Secretary of Health and Human Resources, in cooperation with the Secretaries of Education and Public Safety, to lead an interagency and cross-secretarial effort to formulate a comprehensive Suicide Prevention Across the Life Span Plan for the Commonwealth.

Agencies that should participate in this effort include the Departments of Health; Mental Health, Mental Retardation and Substance Abuse Services; Social Services; Education; Juvenile Justice; Criminal Justice Services; State Police; and Corrections; the Department for the Aging and any other state agency that has a specific interest, responsibility or role in the development of the plan.

The Department of Health and the Department for the Aging should be the agencies responsible for actually developing this plan, supporting the secretary's efforts. All affected stakeholders should be involved in the development of this plan.

The plan should address suicide prevention across the life span with a special emphasis on effective strategies to prevent suicide among adolescent and elderly Virginians and all other identified high-risk populations. The plan should establish Virginia's public policy regarding the prevention of suicide, identify the lead agency responsible for carrying out that policy, propose initiatives and interventions to effectively implement that policy, and identify the sources and amounts of resources to implement those initiatives and interventions. Finally, the plan should propose the creation of a permanent oversight body to monitor the implementation of the plan.

The plan should be completed by October 1, 2004, and presented to the Governor and the General Assembly for their consideration and possible action during the 2005 legislative session.

Inpatient Psychiatric Beds (SJR 108): (1) By letter from the chairman of the Joint Commission on Behavioral Health Care to the commissioner of DMHMRSAS and the Virginia Hospital and Healthcare Association, request that, as part of the restructuring efforts already underway, consideration be given to the facts and recommendations contained in the report of the Access and Alternatives Task Force and comments by the public as part of their efforts to develop community-based services. The department will also be asked to report to the Governor, the Secretary of Health and Human Resources, and the General Assembly on a regular basis on the progress of the restructuring process. (2) By letter from the chairman, request the department, in coordination with the Virginia Hospital and Healthcare Association and other stakeholders, to develop a plan to create a regional review structure that includes representatives from state hospitals, community services boards, and acute care community hospitals. Taking into consideration the restructuring efforts underway and guided by a centralized goal-setting process, these regional groups would develop appropriate alternatives to hospital placement; identify local and regional needs; and develop strategies to break down barriers in service coordination, communication, and consultation among providers. This group will be directed to designate who will be responsible for implementation and from where the resources will come.

Chairman:

The Hon. Stephen H. Martin

For information, contact:

Nancy L. Roberts
Division of Legislative Services

Website: http://dls.state.va.us/jcbhc.htm

THE RECORD