House HWI Committee

June 18, 2007

On June 18 the House Health, Welfare, and Institutions Committee held its first meeting of the 2007 interim with Delegate Phillip Hamilton as chair. The Committee will explore issues concerning Virginia's mental health laws in general and involuntary commitment laws in particular.

Presentations:

Civil Commitment Overview
Ms. Allyson K. Tysinger, Assistant Attorney General, gave a brief overview of the laws governing civil commitment in Virginia. Ms. Tysinger discussed emergency custody orders, temporary detention orders, voluntary commitment, and involuntary outpatient and inpatient commitment orders, and explained the process involved and criteria which must be proven for each.

Mandatory Outpatient Treatment of Persons with Mental Illness
Mr. James M. Martinez discussed different types of mandatory outpatient treatment (MOT) laws and MOT laws in other states, highlighting New York's Kendra's Law. Mr. Martinez then discussed operation and policy issues related to MOT, including the need for new services, increased administrative costs, issues surrounding forced medication, and the need for additional training and support of special justices, law enforcement and mental health professionals. Mr. Martinez stated that Virginia's current transformation, with its focus on building capacity was working, and creating more options, and more person-centered, recovery-oriented care which would enhance voluntary engagement in services and lead to better outcomes. Mr. Martinez provided some examples of successful voluntary outpatient treatment systems in Virginia including the Assertive Community Treatment (PACT) programs and other crisis stabilization programs. In conclusion, Mr. Martinez stated that policy decisions about MOT must be made in the context of its full impact on the service delivery system in its entirety. Any expansion of MOT should be coupled with expanded community services, and a sufficient administrative infrastructure to support it.

Responding to Mental Health Issues: Understanding CSB/BHA Roles and Practices

Ms. Mary Ann Bergeron, Virginia Association of Community Services Boards
Ms. Bergeron provided an overview of the activities and role of Community Services Boards (CSBs) in mental health generally and the commitment process specifically. Ms. Bergeron explained the responsibilities of CSBs as mandated by the Code of Virginia, and described a number of factors, including differences in geographical catchment areas; workforce constraints; treatment resources within communities, including private hospitals; magistrate and court practices; public safety resources; and CSB/BHA state and local funding levels that result in varied local responses to these responsibilities.

Ms. Bergeron also identified a number of economic challenges facing CSBs, and provided several recommendations for the committee including a thorough review of the legal intervention process for consistency; emphasizing the needs of the person with the psychiatric condition; considering best alternatives to coercion; promoting training of all parties; addressing the workforce in meaningful ways; and promoting adequate flexible funding for service gaps.

Recommendations & Related Information from the Investigation of April 16, 2007 Critical Incident at VA Tech by the Office of the Inspector General

Mr. James Stewart, III, Office of the Inspector General for Mental Health, Mental Retardation and Substance Abuse Services
Mr. Stewart presented a summary overview of the finding of his investigation of the incident at Virginia Tech to the committee, including recommendations, and answered questions regarding these recommendations. In summary, the Office of the Inspector General recommended that the number and capacity of secure crisis stabilization programs be expanded, and that the commitment process be changed to facilitate the collection and interpretation of critical collateral information, and enable engagement of the individual in such a way that his or her journey of recovery is supported and facilitated. Mr. Stewart also recommended that specific changes be made to clarify and improve the outpatient commitment process, the capacity of outpatient treatment services be expanded, and the number of CSB case managers be increased.

Next meeting

The next meeting of the House Health, Welfare and Institutions Committee will be held at the General Assembly Building in Richmond on July 30, at 1:00 p.m.

Chairman:
The Hon. Phillip A. Hamilton

For information, contact:
Sarah Stanton, Greg O'Halloran, DLS Staff

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

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