Joint Study Committee on Treatment Options
for Offenders who have Mental Illness or
Substance Abuse Disorders (SJR 97/HJR 142, 2002)

Meeting Summary

November 25, 2002

Senator Stephen H. Martin, Chair of the Committee Studying Treatment Options for Offenders with Mental Illness or Substance Abuse Disorders (SJR 97/HJR 142, 2002) convened the third and final meeting for 2002 to (i) hear presentations on the status of recent budget actions, a Chesterfield County diversion grant, and reports requested by the 2002-2004 Appropriation Act and (ii) take action on information received at previous meetings. The Committee will continue its work during the 2003 interim with a final report and recommendations due to the 2004 Session of the General Assembly.

Secretary of Public Safety

The Deputy Secretary of Public Safety reported that recent budget actions have had the following effects on mental health and substance abuse services for offenders in the Public Safety Secretariat:

  1. Department of Corrections

    • Mental Health Staffing--reductions of $321,540 in FY 2003 and $1.8 million in FY 2004; reduction of 30 positions--reduces levels of psychological testing, psychoeducational groups, individual contacts, monitoring and updating offender classification status, and planning for aftercare services.

    • Regional Substance Abuse Clinical Supervisors--reductions of $40,111 in FY 2003 and $178,802 in FY 2004; reduction of 4 positions--loss of oversight may impact program consistency.

    • Treatment Program Supervisors--reductions of $1.4 million each year; reduction of 31 positions--increases wait time for case management services.

    • Substance Abuse Reduction Effort (SABRE)--reductions of $4.4 million each year; reduction of 31 positions--reduces substance abuse treatment services to 6,700 offenders in FY 2003.

  2. Department of Juvenile Justice (DJJ)

    • Substance Abuse Screening and Assessment--funding eliminated, $765,461 in FY 2003 and $1.3 million in FY 2004; reduction of 35 positions--eliminates screening for 8,800 juveniles and assessment for 3,670 juveniles each year based on FY 2002 data.

    • SABRE--reduction of $2.3 million each year--eliminates funding for substance abuse treatment for 3,000 juveniles each year based on FY 2002 data.

    • Virginia Juvenile Community Crime Control Act (VJCCCA)--reduction of $15 million each year (approximately 50 percent of total funding); funds were used to provide mental health assessments for 100 juveniles and substance abuse assessment and treatment for 2,000 juveniles.

    • Purchase of Private Provider Treatment Beds--reduction of $350,000 each year; funding was used to purchase beds in treatment hospitals/centers for 4 to 5 juveniles with needs that DJJ cannot meet.

  3. Department of Criminal Justice Services

    • SABRE--funding eliminated ($2.5 million per year); funding was used for drug screening, assessment and treatment.

    • Drug Courts--funded at reduced level ($2.1 million) in FY 2003; funding eliminated in FY 2004--eliminates state funding for 11 drug courts, affecting between 10 and 100 individuals per court per year.

Secretary of Health and Human Resources

The Secretary of Health and Human Resources reported that recent budget actions have had the following effects on mental health and substance abuse services for offenders in the Health and Human Resources Secretariat:

  1. Ten percent reductions in mental health and substance abuse treatment funds for community services boards ($12.9 million in FY 2003; $12.8 million in FY 2004).

  2. Jail-based substance abuse therapeutic community programs--reductions of $221,868 in FY 2003 and $171,868 in FY 2004--200 inmates will not receive therapeutic community services in FY 2003 and 125 will not receive services in FY 2004.

  3. Potential effects of reductions

    • Increased probability of recidivism, re-arrest, and re-hospitalization of offenders with mental illness and substance abuse disorders.

    • Additional strain on courts system.

    • Increased levels of inmate management problems in jails due to lack of jail-based treatment.

    • Decreased funding for forensic evaluation by community services boards may increase the number of hospital admissions for court-ordered evaluations.

    • Greater incentives to develop programs to divert nonviolent offenders with mental illness and substance abuse disorders into community treatment, thus avoiding costly jail or hospital admissions.

Chesterfield County Diversion Grant

Representatives of Chesterfield County reported to the Committee that the County was awarded a $300,000 federal grant (renewable for two years) to pilot a locally run alternative sentencing program that combines intensive supervision with substance abuse treatment for nonviolent substance-abusing defendants. Individuals will be diverted from jail and provided treatment services during the pretrial phase. The trial will occur as normal; but at sentencing, the Day Reporting Center will provide the court with extensive information about the client's disease, treatment progress and appropriate post-disposition treatment resources. The target population will be dually diagnosed offenders with no past or present history of violence, who remain in jail following arraignment.

2002-2004 Appropriation Act Reports

The 2002-2004 Appropriation Act required the Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) to make certain reports to the Committee.

Web-based Data on Inpatient Psychiatric Beds for Children and Adolescents. The purpose of this study was to (i) determine the technical feasibility of developing a web-based system that collects and reports bed availability data, (ii) examine how such a web-based system would be received by those who use it and maintain it, and (iii) identify the costs and timeframes. The benefit of such a system would be to facilitate admissions to public and private facilities by allowing providers to quickly determine the availability of beds appropriate for their clients needing specific services. Potential difficulties are obtaining consensus on what the system should look like and the information it should provide, ensuring all providers update the system in a timely manner and ensuring the information is accurate. Virginia Health Information (VHI) already collects approximately one-third of the facility demographic data and has the staff and hardware capacity to design and develop a web-based system. The estimated cost for VHI to design, develop and implement a web-based bed availability system for children and adolescents would be $23,350 in the first year for start-up and maintenance and $8,700 annually thereafter for maintenance. Delivery of the final, fully operational product would be eight to 10 weeks after the project start date.

The Committee voted to recommend a budget language amendment in the 2003 Session, requiring the DMHMRSAS to explore a public/private partnership to underwrite the costs of developing and maintaining a web-based data system on inpatient bed availability for children and adolescents.

Treatment for Children and Adolescents. The DMHMRSAS gave a status report on development of an integrated policy and plan to provide access by children, including juvenile offenders, to mental health, mental retardation and substance abuse services, as required by the Appropriation Act. The DMHMRSAS is required to report on the plan to the Chairmen of the Senate Finance and House Appropriations Committees by June 30 of each year. Through a series of meetings, the work group has identified 8 focus areas: restructuring/building the system; funding; service needs; buy-in; advocacy; education on best practices; child and family involvement; and identification of existing service providers by region. The work group will continue to meet during 2003 to analyze and refine the preliminary recommendations from members of the group and will report on its progress to the General Assembly in June 2003.

The DMHMRSAS also reported on their work related to House Bill 887/Senate Bill 426 (2002), which requires the Department to collect, compile and report (i) the number of licensed and staffed acute inpatient psychiatric beds, (ii) the number of licensed and staffed residential treatment beds in facilities and (iii) information on children and adolescents for whom admission to acute or residential care was sought but not obtained. First quarter data indicated the following:

  • Acute beds: 371 licensed; 346 staffed.

  • Residential beds: 1,850 licensed; 1,539 staffed.

  • Most common reasons for residential discrepancy between licensed and staffed beds: low census, large number of children requiring single bedrooms.

  • Youth not admitted: 3 youth who were referred to acute care by a community services board; 11 youth who were referred to residential treatment by a community policy and management teams.

  • Reasons given for failure to admit for residential treatment: aggressive, violent or difficult to control behaviors or specific reasons such as children with mental retardation, history of elopement, or treatment needs that could not be met. (There were too few cases in the first quarter to determine data trends for acute care).

Access to Psychiatric Care by Jail Inmates. The DMHMRSAS reported that current practice standards mandate the provision of several basic elements of mental health and substance abuse treatment for jail inmates: intake screening at booking; evaluation following screening when needed; use of the full range of appropriate psychotropic medication; substance abuse counseling; counseling services; emergency hospitalization; and case management. Based upon available data, there is unmet need for some services in local jails. However, the Committee was told that efforts at facilitating mental health and substance abuse services in jail settings should take place within an overall strategy that includes diverting nonviolent, mentally ill and substance dependent individuals from incarceration whenever possible.

On specific issues, the Committee learned:

  • Referrals from jails for emergency hospitalization to state facilities are typically completed in a timely manner and without major impediment; however, some cases reportedly require additional wait times prior to admission. Some delays also occur with the admission of those individuals who have been court-ordered to state hospitals for nonemergency evaluations and treatment.

  • Jail medical services routinely provide atypical psychotropic medications to jail inmates, although the high cost of these medications is a concern.

  • Development of specialized regional jail facilities would allow for all jails to have potential access to an enhanced level of jail-based mental health and substance abuse treatment services, using a referral approach that is currently used for state hospitalization.

Telepsychiatry in Medical Shortage Areas. The DMHMRSAS reviewed the current status of telepsychiatry within the Department and other state agencies with which links could facilitate the expansion of telepsychiatry in rural areas. The DMHMRSAS will continue to give priority to installing equipment and educating staff in underserved areas. In addition, the DMHMRSAS made the following recommendations: explore the feasibility of expanding linkages with universities and hospitals in Virginia; appropriate sufficient funds to support the telecommunications system; designate coordinators in community services boards and DMHMRSAS facilities; develop a consortium of universities and state agencies to develop a strategic plan and identify research funding, grants, and other resources that can be shared to expand telemedicine and telepsychiatry.

Evaluation of Therapeutic Communities in Local Jails. In 1995, Virginia received federal grant funding to expand the availability of substance abuse therapeutic communities in criminal justice settings. The grant, which supported therapeutic communities in six local jails, terminated in 2000, but the General Assembly allocated special funds to support these sites. However, the funds were eliminated in FY 2003 because of budget reductions. The DMHMRSAS was able to use a portion of the federal Substance Abuse Prevention and Treatment Block Grant to support three sites at full funding and reduced services at the remaining three sites. The Department's evaluation focuses on the fully supported programs at the Fairfax County and Virginia Beach jails. The Department outlined its evaluation plan for the Committee, including the specific research questions and the data sources. The cost of the evaluation (approximately $80,000) will be supported from the administrative allowance of the Substance Abuse Prevention and Treatment Block Grant. A status report and outcome data will be presented to the Committee in 2003.

Committee Actions

The Committee took certain actions related to information received at the meeting on October 18, 2002:

Evaluation of Treatment Services for Offenders. By letter, the Chairman will request that the Secretaries of Public Safety and Health and Human Resources complete their preliminary evaluation, including the inventory of past evaluations and the identification of outcome measures, costs and potential sources of funding for evaluation of treatment initiatives, and report to the Committee by September 1, 2002. The Secretaries will also be asked to provide periodic reports to the Committee during 2003 concerning the specific effects on individuals and regions of the Commonwealth (i.e., dollar reductions, reductions in the number of individuals served, reductions in categories of service and service units, reductions in professional positions, increases in wait time) of budget actions related to mental health and substance abuse services for offenders.

Cross-Training and Innovative Practices. By letter, the Chairman will request the DMHMRSAS to continue development of the cross-training curriculum and dissemination of innovative practice information and present a final report to the Committee by September 1, 2003.

Access to Medications and Discharge Planning. (1) By letters to the Department of Corrections (DOC), the Virginia Sheriffs' Association, and the Virginia Association of Regional Jails, the Chairman will request the distribution of basic information and application forms for Medicaid, disability programs, Temporary Assistance to Needy Families, and veterans' programs to all mental health services professionals and case management counselors in correctional institutions and regional and local jails to aid in release planning. (2) By letter, the Chairman will request that the DOC, DMHMRSAS, and community services boards develop an interagency agreement based on the recommendations in the report to the Committee and review and refine procedures for discharge planning for individuals released from DOC facilities who require mental health or substance abuse services.

Medicaid Access. By letter, the Chairman will ask Department of Medical Assistance Services and the Department of Social Services to (i) furnish information and training to Medicaid eligibility workers in local departments of social services to raise awareness about pre-release procedures and (ii) develop a fact sheet for correctional facilities concerning Medicaid eligibility of inmates and those pending release.

Uniform Screening for Juveniles. By letter, the Chairman will ask the Director of Department of Juvenile Justice to provide updates on the implementation of uniform screening in secure detention facilities. The Committee decided to defer action on uniform screening for pre-dispositional investigations until the 2004 Session.

Drug Courts. By letter to the Chairmen of the Senate Finance and House Appropriations Committee, the Chairman will provide information collected by this Committee and endorse the continued funding and operation of drug courts.

JOINT COMMISSION ON BEHAVIORAL HEALTH CARE

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