Magazine article Developments in Mental Health Law

Update: SJ 47 Joint Subcommittee to Study Mental Health Services in the Commonwealth in the 21st Century

Magazine article Developments in Mental Health Law

Update: SJ 47 Joint Subcommittee to Study Mental Health Services in the Commonwealth in the 21st Century

Article excerpt

Background

As described in more detail in the October and December 2015 issues of DMHL (available here) the SJ 47 Joint Subcommittee, consisting of twelve legislative members (five from the Senate, seven from the House) was given a comprehensive mandate by the 2014 General Assembly to review and assess Virginia's mental health laws and services system and to make 1) recommendations on "statutory or regulatory changes needed to improve access to services, the quality of services, and outcomes for individuals in need of services," and 2) recommendations on needed public and private services, programs, and facilities and the staffing, licensing, funding and governance requirements needed to sustain them. The Joint Subcommittee must submit its report to the Governor and the 2018 regular session of the General Assembly.

Much of the Joint Subcommittee's first two years was spent gathering information about, and opinions regarding, all aspects of the operation of Virginia's mental health services system and how it compares with those of other states. (Much of that process is described in the October and December 2015 issues of DMHL cited above.) The Joint Subcommittee's plan for its final two years, as described by its co-chair, Sen. Creigh Deeds, is to "utilize the information it has collected" and "make recommendations as to what services should be provided and the statutory or regulatory changes necessary to improve access to such services by persons who are in need of mental health care." The Joint Subcommittee's Work Groups were re-organized into the following four groups, reflecting the selected areas of focus: Work Group #1: System Structure and Financing, chaired by Sen. Hanger; Work Group #2: Criminal Justice System Diversion, chaired by Del. Bell; Work Group #3: Crisis and Emergency Services, chaired by Del. Garrett; and Work Group #4: Housing, chaired by Sen. Howell. The Joint Subcommittee developed a document (available here) that sets out the purpose of each Work Group and the specific topics they are to address.

The Joint Subcommittee also asked Professor Richard Bonnie, one of the nation's leaders on mental health law and policy, to assemble panels of experts to provide information and recommendations to each of these Work Groups and to respond to questions and concerns raised by Work Group members.

April 19, 2016 meeting

At its April 19, 2016 meeting (summarized here on the Division of Legislative Services website), the Joint Subcommittee's key agenda items were the following:

Report by DBHDS Interim Commissioner Barber. Dr. Barber spoke on the proposed reform of Virginia's public behavioral healthcare system. (His accompanying power point presentation is available here.) Dr. Barber cited the following as the "framing factors" to understand the issues facing Virginia's public behavioral health system: (1) available services, and access to them, vary considerably across Virginia, depending upon the locality, as Virginia's CSBs "are of inconsistent size, geography, local funding, payor mix, local priorities, etc.;" (2) insurance coverage for services is inadequate, as approximately 50% of individuals served by CSBs have no payor (private insurance, Medicare, Medicaid); (3) state inpatient mental health facilities are over-utilized, in part because they are "no cost" options for CSBs, jails, and the Department of Medical Assistance Services (adults); (4) federal laws (Olmstead/ADA) require integrated services; (5) nationwide, major reforms in health care overall are moving the system toward outcomes-based payment and a focus on lower cost, preventative care to decrease ER visits and hospitalizations; and (6) significant disparities exist in population health, health opportunities, and health outcomes across the state.

The Commissioner submitted that the model of the "Certified Community Behavioral Health Center" (CCBHC), set out in the federal Excellence in Mental Health Act, provides "the way forward" with a framework for statewide mental health services delivery that DBHDS is now pursuing, both through a federal grant that would enable the state to establish eight CCBHC "model sites" and through system-wide adoption of this framework. …

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