SJR 440

Joint Committee Studying Treatment Options for Offenders with Mental Illness or Substance Abuse Disorders

November 8, 2001; November 29, 2001, Richmond

The joint committee held a public hearing on its preliminary recommendations on November 8, 2001, and on November 29, the committee made its final recommendations for 2001. The committee categorized its findings and recommendations into five areas related to adult and juvenile offenders: Interagency Collaboration, Capacity, Clinical Guidelines, Cross Training, and Data Collection, Evaluation and Information Sharing. Because of the current budgetary situation, most of the recommendations are designed to lay the groundwork for future action: maintaining funds that are appropriated in the current biennium budget; gathering information about unmet needs; fostering interagency collaboration and planning; establishing minimum clinical guidelines; and providing a framework for information sharing and evaluating the effectiveness of current programs. Due to the size and scope of the problem, the committee plans to ask the General Assembly to expand its membership to include the Secretaries of Health and Human Resources and Public Safety and to continue its work for another year. Highlights of this year’s findings and recommendations follow.

Interagency Collaboration

Findings: Interagency collaboration and clearly defined responsibilities for serving adult and juvenile offenders with mental illness do not exist in many communities. Moreover, there does not appear to be a consensus as to whether the responsibility for providing treatment services should lie with the criminal justice or the mental health treatment system.

Key Recommendations:

1. Establish an interagency work group under the leadership of the joint committee to develop a screening-assessment-treatment model for offender groups with mental health needs. This work group will be asked to make recommendations concerning the statutory assignment of responsibility for providing needed treatment services; a regional planning process to foster state/local interagency collaboration; model memoranda of agreement that detail responsibilities for services, information exchange, and cross training of staff; and a framework to pilot the memoranda and evaluate the results.

2. Request the Office of the Secretary of the Supreme Court to examine the feasibility of designing and implementing a model court order that addresses mental health needs of offenders.

Capacity

Findings: Many communities lack sufficient capacity, including the availability of acute psychiatric care, to treat offenders with mental illness and substance abuse disorders while they are incarcerated and when they are released from state correctional facilities, jails or detention homes. Lack of a comprehensive and systemic approach to finding these services has resulted in inequitable access to care across Virginia. The community services boards estimate that the cost of meeting the unmet need for mental health and substance abuse services in local jails is approximately $34 million per year. The estimated cost of meeting the unmet need for mental health and substance abuse services in detention homes is approximately $3.4 million per year.

Key Recommendations:

1. Direct the Department of Criminal Justice Services, in collaboration with other stakeholder agencies and groups, to identify the unmet need for mental health and substance abuse treatment services for adult offenders and to develop a comprehensive plan, including the necessary resources and funding sources for covering the increasing costs of providing existing services and to fill service gaps.

2. Direct the Commissioner of Mental Health, Mental Retardation and Substance Abuse Services to make recommendations to the joint committee concerning access to psychiatric care for jail inmates and to ensure an adequate supply of acute psychiatric beds for children and adolescents.

3. Direct the Department of Medical Assistance Services to examine ways to provide immediate access to Medicaid to eligible offenders when they are released from prisons or jails.

4. Direct the Department of Corrections to recommend ways to ensure the appropriate management of medications for offenders when they are released from state correctional facilities.

5. Direct the Department of Mental Health, Mental Retardation and Substance Abuse Services and the Department of Juvenile Justice to identify and create opportunities for public-private partnerships and the necessary incentives to establish and maintain an adequate number of residential and acute psychiatric beds for the treatment of juvenile offenders.

6. Continue the funding for the “Keep Our Kids At Home” (KOKAH) project, which has demonstrated success at reducing inpatient hospitalization.

7. Include juvenile offenders in the plan being developed as a result of Item 323K in the current biennium budget to provide and improve access by children to mental health, substance abuse and mental retardation services.

8. Continue the funding for recruitment and retention of psychiatrists in medically underserved areas, which is currently $500,000 each year.

9. Appropriate $50,000 to expand the National Health Service Corp–Virginia Loan Repayment Program to include mental health professionals.

10. Explore ways to expand the use of telepsychiatry in underserved areas.

Clinical Guidelines

Findings: The state has not developed clinical guidelines for local and regional jails or detention homes to ensure an adequate level of mental health services for persons who are incarcerated. Uniform screening and assessments, access to services, and discharge plans are not available in many jails or detention homes.

Key Recommendation: Direct the State Board of Corrections, the State Mental Health, Mental Retardation and Substance Abuse Services Board and the Board of Juvenile Justice as appropriate to develop minimum guidelines for the provision of mental health and substance abuse treatment services in jails and detention homes and a plan, including the necessary fiscal and staff resources, for meeting the guidelines.

Cross Training

Findings: Cross training in balancing therapeutic goals with security needs and public safety is needed for law enforcement, judges, jail and detention staff and community treatment staff.

Key Recommendation: Request that the Department of Mental Health, Mental Retardation and Substance Abuse Services develop and make recommendations for implementing a curriculum for cross training law enforcement officers, judges, jail staff, and community treatment staff in security and treatment.

Data Collection, Evaluation and Information Sharing

Findings: No comprehensive mechanism exists to systematically collect complete and accurate data on treatment services provided to and needed by adult and juvenile offenders or to evaluate the effectiveness of the services.

Key Recommendations:

1. Request that the Secretary of Public Safety, in conjunction with other Cabinet Secretaries, develop a plan, including the estimated cost, for the collection of data on treatment services provided to and needed by state responsible adult and juvenile offenders and for the evaluation of the effectiveness of treatment services.

2. Continue the funding for intensive substance abuse treatment services in jails for the next biennium and direct the Department of Mental Health, Mental Retardation and Substance Abuse Services to conduct comprehensive process and outcome evaluation of therapeutic communities in local jails.

3. Direct the Virginia Commission on Youth to coordinate the collection and dissemination of information on effective treatment modalities and practices.

The Honorable Stephen H. Martin, Chairman
Legislative Services contact: Nancy L. Roberts

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