Virginia Hospitals unveil 2017 behavioral health legislative agenda

Serving the needs of patients and families dealing with a mental health diagnosis is an ongoing challenge that cuts across many segments of society including health care providers and behavioral health professionals, law enforcement personnel, the judicial system, elected officials and public health infrastructure, and much more.

Mental health diagnoses have directly and indirectly affected millions of Virginians. The Commonwealth has experienced its share of high-profile mental health tragedies, and many families have also struggled to deal with personal behavioral health situations. In recognition of the ongoing community need for access to behavioral health services, the Virginia hospital and health system community has developed a package of legislative proposals addressing the preadmission screening evaluation process, inpatient bed identification, commitment hearings, and funding.

“Caring for people experiencing mental health challenges requires time, commitment, and individualized treatment,” said Mary N. Mannix, President and CEO of Augusta Health in Fishersville and Chair of the Virginia Hospital & Healthcare Association (VHHA) Board of Directors. “Based on experience and patient needs, we know that we must work to enhance behavioral health treatment protocols and options. Identifying workable policy solutions to patient behavioral health needs necessitates a bi-partisan approach that involves many stakeholders. The VHHA Behavioral Health Committee is committed to working with stakeholders to address barriers to appropriate care. The hospital community is reaching out to stakeholders to identify partnership opportunities on issues such as mental health transportation, medical clearance, psychiatric bed registration, and child and adolescent behavioral health.”

The bi-partisan group of Virginia legislators sponsoring aspects of the VHHA 2017 Behavioral Health Legislative Agenda include Senator George L. Barker (D-Fairfax County), Senator A. Benton “Ben” Chafin Jr. (R-Russell County), Senator Janet D. Howell (D-Fairfax County), Delegate Roxann L. Robinson (R-Chesterfield County), and Delegate Joseph R. Yost (R-Giles County).

The four key proposals in the package are:

Preadmission Screening Evaluations

• One challenge in getting patients necessary care is that CSB emergency evaluators can’t always reach emergency departments swiftly to start the psychiatric pre-screening process. That can delay the start of treatment when timing is critical, especially for patients under an emergency custody order due to a state law providing an eight-hour evaluation period for patients to either be temporarily detained for further evaluation or discharged. In response to situations when a CSB evaluator can’t arrive within two hours of a call for a preadmission screening, proposed legislation would authorize qualified alternative behavioral professionals to conduct emergency psychiatric evaluations.

Develop an Emergency Department Psychiatric Patient Matrix

• Virginia’s Psychiatric Bed Registry on its own isn’t sufficiently reducing delays in identifying available inpatient psychiatric beds for patients under a temporary detention order (TDO). Proposed legislation would authorize the development of a psychiatric patient matrix to store de-identified information about every psychiatric patient in need of an inpatient bed. Hospitals with available beds can find potential patients to admit through the matrix, which would be used in conjunction with the Bed Registry.

A 23-Hour TDO Stabilization Period

• TDO patients’ commitment hearings sometimes occur too soon, preventing a patient from receiving treatment and stabilizing before a commitment decision is made. Insufficient patient evaluation and crisis stabilization can contribute to higher rates of involuntary commitment and longer hospital stays. Proposed legislation would mandate that patients under a TDO are stabilized and treated for at least 23 hours before appearing at a commitment hearing. This proposal would not alter current state law granting physicians providing care the authority to discharge a patient who is determined to no longer need psychiatric care at any time within the TDO period.

Local Inpatient Purchase of Service (LIPOS) Funding Flexibility

• Current use of LIPOS, or Local Inpatient Purchase of Service funding, is limited to involuntarily committed patients at a private hospital. Expanded use of these funds for patients in need of voluntary or involuntary psychiatric care will improve access to care for all patients. A proposed budget amendment would authorize greater flexibility in the use of LIPOS funds linked to patient clinical needs rather than commitment status.

“Several high-profile tragedies in which behavioral health issues were a factor have made Virginians all too familiar with the challenges of addressing community health needs,” said Deborah Davis, CEO for Virginia Commonwealth University Hospitals and Clinics and a VHHA Board Member. “At VCU Medical Center, our clinical staff regularly treats and engages with people experiencing mental health diagnoses, spanning the spectrum from juvenile and adult patients to geriatric patients. Just as with VCU, hospitals and health systems throughout the Commonwealth are grappling with the behavioral health needs of patients to provide compassionate, quality care. This behavioral health agenda is another step in the journey to achieve the goal of long-term success through bi-partisan, collaborative work that engages key stakeholders.”

Speaking about the development of the behavioral health agenda, Sentara Healthcare Vice President of Behavioral Health Services Alison G. Land noted that “the proposals being announced are the product of extensive work in support of patients throughout the Commonwealth.”

“This legislative package reflects the core mission of Virginia hospitals and health systems to provide world-class care meeting the health needs of families, friends, and neighbors in the communities we serve,” added Land, who also Chairs VHHA’s Behavioral Health Committee.

VHHA restructured the Behavioral Health Committee this year, adding an Executive Steering Committee. Members from both bodies have been active in the development of this legislative package and in reaching out to stakeholders including some regional Community Services Boards (on improving TDO admissions), the Virginia College of Emergency Physicians (on medical clearance), and the Virginia Sheriffs’ Association and the Virginia Ambulance Association (on mental health transportation) to collaboratively identify approaches for improving Virginia’s behavioral health system.

Hospitals and health systems represented on the Executive Steering Committee include Bon Secours Virginia Health System, Carilion Clinic, Children’s Hospital of The King’s Daughters, HCA Virginia, Mary Washington Healthcare, Mountain States Health Alliance, Sentara Healthcare, VCU Health System, and Virginia Beach Psychiatric Center.

“People face challenges in their lives,” said Dr. Alexandria “Sandy” Lewis, Executive Director of the Virginia Treatment Center for Children at VCU Health System, and a member of VHHA’s Behavioral Health Committee. “Working together, the mental health community, the public sector, law enforcement, and Virginia’s hospitals can help people get through those challenges.”

“As someone who has spent a decade either working in or advocating for improvements in Virginia’s mental health system, mandating a minimum of 23 hours in the hospital under a temporary detention order before a commitment hearing is a straightforward solution to reforming our treatment delivery model,” added Del. Joseph R. Yost (R-Blacksburg), who is sponsoring a bill in the behavioral health package. “In doing so, we can allow for adequate time for evaluation and crisis stabilization of individuals with mental illness and greatly decrease rates of involuntary commitment and lengths of stay in hospitals.”

“As Executive Director of a community health center, I have seen firsthand the challenges experienced by people in need of behavioral health treatment,” said Senator George L. Barker (D-Fairfax County). “Developing policy solutions to address shortcomings in the current system so people can access needed treatment is critical. That’s why I am pleased to patron legislation to build on our strong Psychiatric Bed Registry with another way to help better connect hospitals with available psychiatric bed space to patients in immediate need of hospitalization.”