McDonnell announces new funding for mental health system

Gov. Bob McDonnell announced budget proposals today to expand crisis response and crisis prevention services for Virginia’s behavioral health system. 

The governor’s proposals would infuse $38.3 million over the biennium into critical mental health and substance-use disorder programs. Separately, funding for the DOJ mental health and training center settlement and DMAS resources, a total of $95.8 million, will be provided during the next biennium. McDonnell also announced through Executive Order 68 the convening of a Task Force on Improving Mental Health Services and Crisis Response.

The Task Force calls for leaders in the mental health field, law enforcement communities, the judicial system and private hospitals along with individuals receiving mental health services and their families to seek and recommend solutions that will improve Virginia’s mental health crisis services and help prevent crises from developing.

“Over the years, including the events of April 16, 2007, Virginians have experienced tremendous heartache as a result of mental health tragedies,” McDonnell said. “These experiences serve to underline the need to ensure that all individuals and families experiencing mental health crises have access to the needed services without delay. Working together with the General Assembly we have made progress, but there is much more to do. It has become clear that Virginia’s mental health system can sometimes be difficult to navigate for families seeking assistance, or even for workers inside the system.

“While there are quality services in place to address most types of mental health needs, we must increase the capacity and availability of those services in all Virginia communities so that every person in crisis is able to receive much-needed help. Simultaneously, we must look for ways to expand the availability of ongoing treatment and support services that will prevent mental health crises. This significant and strategic investment of funds and Executive Order 68 are substantial steps forward to making critical mental health improvements.  I’m pleased to report that Gov.-elect Terry McAuliffe is fully supportive of these changes and investments, and will continue the Executive Order Task Force during his term.”

The governor and the General Assembly have been working during strained economic times to make targeted and impactful investments to improve critical mental health services across Virginia. Expanded programs include funding for child psychiatry and children’s crisis response services, crisis intervention team (CIT) programs, crisis stabilization services and discharge assistance programs. In addition, funds were added to restore and stabilize state hospital bed capacity at Northern Virginia Mental Health Institute and Southwestern Virginia Mental Health Institute. Finally, as part of the Governor’s School and Campus Safety Task Force, expansions were made to mental health first aid programs, secure assessment centers and suicide prevention efforts.

The governor’s budget provides the following funding for mental health efforts:

Mental Health Crisis Response Improvements

• ·         Provide for Emergency Custody Order (ECO) extension – Negligible funding is needed to add an optional two hour extension that can be ordered by a magistrate only after clinical determination of need for TDO and only if a bed has not been found within the maximum ECO period to permit additional time to complete the bed search phase.  Virginia’s current maximum ECO period is six hours.
• ·         Provide for Temporary Detention Order (TDO) extension to 72 hours – $1,300,000 in FY 2015 and $1,600,000 in FY 2016 to provide for TDO extension that extends the TDO period from the current 48 hours to 72 hours (with a 24-hour minimum).
• ·         Expand availability of secure crisis intervention team (CIT) assessment centers – $1,800,000 in FY 2015 and $3,600,000 in FY 2016 to allow a person to be held safely for evaluation and finding a bed without tying up law enforcement personnel.   This funding would support six centers in FY2015 and 12 in FY2016.
• ·         Maintain current adult capability at Eastern State Hospital (ESH) – $5,000,000 each year to maintain current adult capability at ESH.  This will enable ESH to avoid a loss of bed capacity due to the reduction of Medicaid revenues related to the need to serve fewer geriatric patients.
• ·         Expand adult bed capacity at ESH in FY 2015 – $2,200,000 each year to prevent loss of adult capacity by opening a vacant geriatric 20 bed unit to accommodate adult civil and forensic patients in the catchment area.
• ·         Ensure operational supports for new Western State Hospital (WSH) facility – $670,000 in FY 2015 and $690,000 in FY 2016 to provide operational supports for the new WSH facility.

Behavioral Health Treatment and Support Services

• ·         Expand mental health outpatient services – $3,500,000 in FY 2015 and $4,000,000 in FY 2016 for mental health services for older teens and young adults transitioning from school, college, or early in their adulthood when most serious mental illnesses first make their    onset, and engagement in treatment is imperative.  This item was recommended by the Governor’s Task Force on School and Campus Safety.
• ·         Expand Program Assertive Community Treatment (PACT) programs – $950,000 in FY 2015 and $1,900,000 in FY 2016 to provide intensive clinical outreach and support to persons with serious and persistent mental illness to reduce crises and hospitalization. Virginia currently has 19 PACT programs.
• ·         Expand telepsychiarty capacity – $1,100,000 in FY 2015 and $620,000 in FY 2016 for new telecommunication equipment to allow community services boards to conduct clinical evaluations offsite and more rapidly.
• ·         Peer Support Recovery – $550,000 in FY 2015 and $1,000,000 in FY 2016 to provide support to people with behavioral health needs by people who are themselves in recovery from such problems and are trained as peer providers.
• ·         Substance Abuse Community Recovery Program – $300,000 each year for the community recovery program which combats substance use disorders through employment and long-term recovery.

The Task Force’s responsibilities shall include the following:

• ·         Recommend refinements and clarifications of protocols and procedures for community services boards, state hospital, law enforcements and receiving hospitals.
• ·         Review for possible expansion of the programs and services that assure prompt response to individuals in mental health crises and their families such as emergency services teams, law enforcement crisis intervention teams (CIT),  secure assessment centers, mobile crisis teams, crisis stabilization centers and mental health first aid.
• ·         Examine possible extensions or adjustments to the emergency custody order and the temporary detention order period.
• ·         Explore technological resources and capabilities, equipment, training and procedures to maximize the use of telepsychiatry.
• ·         Examine the cooperation that exists between the courts, law enforcement and mental health systems in communities that have incorporated crisis intervention teams and cross systems mapping.
• ·         Assess the availability of psychiatric beds in Virginia, the assessment process hospitals use to select which patients are appropriate for those beds, and to explore whether psychiatric bed registries and/or census management teams improve the process for locating beds.
• ·         Review for possible expansion those services that will provide ongoing support for individuals with mental illness and reduce the frequency and intensity of mental health crises. These services may include rapid, consistent access to outpatient treatment and psychiatric services, as well as critical supportive services such as wrap-around stabilizing services, peer support services, programs of assertive community treatment, housing, employment and case management.
• ·         Recommend legislative and budget proposals that will enable implementation of the above.
• ·         Recommend how families and friends of a loved one facing a mental health crisis can be taught to improve the environment and safety of an individual in crisis.
• ·         Examine workforce development activities and recommend any improvements to ensure an adequate mental health workforce.

The Task Force shall be co-chaired by the Secretary of Health and Human Resources and the Secretary of Public Safety.

Membership shall include the following individuals or representatives:

• The Attorney General of Virginia or his representative
• Chief Justice of the Supreme Court of Virginia or her representative
• Commissioner of the Department of Behavioral Health and Developmental Services
• Commissioner of the Department of Social Services
• Superintendent of the Virginia State Police
• At least three community services board emergency services directors
• At least three law enforcement officers, including at least one sheriff
• At least two executive directors of community services boards
• At least two magistrates
• At least two private hospital emergency department physicians
• At least two psychiatrists
• At least one representative of a state mental health facility
• At least two representatives from Virginia’s private hospital system
• At least two individuals receiving mental health services
• At least two family members of individuals receiving services

The governor may appoint other members as he deems necessary.

More information on the Gov. McDonnell’s Executive Order 68 to create the Task Force on Improving Mental Health Services and Crisis Response will be available online at http://www.governor.virginia.gov/PolicyOffice/ExecutiveOrders/ later today.