Mental Health Budget and Legislative Initiatives
COMMONWEALTH OF VIRGINIA
Office of the Governor
Timothy M. Kaine FOR IMMEDIATE RELEASE
Governor December 14, 2007
GOVERNOR KAINE ANNOUNCES MENTAL HEALTH BUDGET AND LEGISLATIVE INIATIVES
~ Proposals will expand emergency services, provide more accountability ~
RICHMOND – Governor Timothy M. Kaine today announced budget and legislative proposals to improve the Commonwealth’s mental health system by offering care to more people who need it and enhancing the quality of those services. The Governor stood with elected officials from both parties and mental health care advocates as he unveiled a proposal that includes nearly $42 million to hire new case managers, therapists and clinicians, improve and expand emergency services, and provide for more accountability in the system.
“The tragedy at Virginia Tech in April of this year has drawn attention to our mental health care system in an unprecedented way,” Governor Kaine said. “Now is the time for us to work together to make the changes and to provide the funding and the accountability our mental health system needs.”
Many of the Governor’s recommendations are based on the report of the Virginia Tech Review Panel, released earlier this year. The Panel’s report highlighted the need to strengthen the community services board system, recommending expansions for its emergency services capacity, as well as its case management capacity.
Over 90 percent of community services board case managers in Virginia have caseloads that exceed the nationally recommended caseload of 25 patients. The Governor has proposed funding to increase the number of case managers by 106 statewide, over the biennium.
In addition, the proposed budget increases the number of clinicians and therapists who are available on an outpatient basis, with funding to support 40 new clinicians recommended over the biennium. The Governor’s budget also funds an additional 40 clinicians specializing in children’s mental health at local community services boards statewide, to support those children who are not eligible for services through the Comprehensive Services Act.
To ensure that individuals who are subject to temporary detention orders are receiving attention in a timely and focused manner, the Governor has recommended funding to support emergency mental health services, including around-the-clock emergency psychiatric consultation, emergency clinicians, and crisis stabilization. In addition to this funding, the Governor announced legislative proposals to address how emergency detention orders are implemented.
The Governor’s proposed legislation will:
ü Allow an emergency custody order to be extended to 8 hours and matching emergency custody order criteria to commitment criteria (VT Panel recommendation IV-13)
ü Require the independent evaluator and the treating physician of a temporary detention order patient to be available during hearing (VT Panel recommendation IV-20)
ü Require community services board staff to participate in hearings (VT Panel recommendation IV-19)
ü Change the criteria for emergency custody and temporary detention from the “imminent danger” terminology to: “substantial likelihood that in the near future he will (a) cause serious physical harm to himself or another person, as evidenced by recent behavior causing, attempting, or threatening such harm, or (b) suffer serious harm due to substantial deterioration of his capacity to protect himself from such harm or provide for his basic human needs” (VT Panel recommendation IV-15)
ü Clarify the roles and responsibilities of the community services boards and the independent examiner throughout the detention process, the commitment hearing, and the subsequent disposition (VT Panel recommendation IV-17)
ü Explicitly authorize the disclosure of information between providers in order to deliver, coordinate or monitor treatment, and between providers and the courts to monitor and report on service delivery and compliance with treatment (VT Panel recommendation V-22, 24)
“In addition to properly funding our mental health care system, we must also ensure an accountability structure that focuses on outcomes,” Governor Kaine said. “Through the development of service standards across the community services boards, we will move toward a more uniform system of emergency response times, service admission criteria, staff credentialing and training requirements, and of mandatory activities, like attending temporary detention order hearings.”
To further address accountability across the community services boards, the Governor’s budget calls for additional staff to provide oversight for regional and local services, to enhance accountability and to improve quality management. These positions will monitor how service are delivered, measuring them against recommended standards.
The Governor has also recommended funding to expand a pilot program for jail diversion services and to expand training for law enforcement responding to crisis situations involving individuals with mental illness.
The Governor’s budget includes:
ü $14.6 million over the biennium to improve emergency mental health services, including around-the-clock emergency psychiatric consultation, emergency clinicians and crises stabilization. The increase will assist community services boards in providing legally mandated emergency services.
ü $8.8 million to increase the number of case managers for mental health services provided through community services boards. A total of 106 additional case managers will be hired by the end of the biennium.
ü $5.8 million to hire 40 clinicians specializing in children’s mental health over the biennium. This funding will help serve children who are not eligible for services through the Comprehensive Services Act.
ü $4.5 million to increase availability of outpatient clinicians and therapists at community services boards. These funds are necessary to address significant delays in accessing outpatient mental health services.
ü $875,000 over the biennium to create four positions to expand monitoring and accountability of community services boards and to develop core standards and service improvement plans. The addition of these positions will allow for better oversight and monitoring of recent community-based service expansion.
ü $6 million over the biennium to expand a pilot program for jail diversion services funded in the 2006-08 biennial budget. It is anticipated that these funds will provide diversion and wrap-around services and support for an estimated 300-500 people.
ü $600,000 over the biennium to establish a training program for crisis intervention. The training will enable law enforcement to respond to crisis situations involving individuals with mental illness.
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Veteran's Resource Center
NAMI now has a "Veterans Resource Center" web facility as part of its national website. Please see:
This website contains information on such topics as:
| Posttraumatic Stress Disorder (PTSD) | Traumatic Brain Injury (TBI) |
| Public Policy and Legistration | Veterans Affairs and VISNs |
| Veterans and Mental Illness | For Families, Children, and Spouses |
| Women Veterans Resources | Multicultural Resources |
| Suicide Prevention | Homelessness |
| NAMI Veterans Council | Online Discussion Groups |
| Join NAMI | Veterans Tribute Honor Roll |
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Prince William Drop-In Center
During the summer months of 2007, consumers from Prince William County and the independent cities of Manassas and Manassas Park planned for and created a centrally-located drop-in center that's operated by and for consumers.
For more information, call 703-763-3865
www.PWDropInCenter.com
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Mental Health Reform in Virginia
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The following is an edited version of the e-mail response which various state residents received in response to their letters to Governor Kaine .. concerning the recent incident in Chantilly, VA. In that incident, a person suffering from a severe mental illness --- who was aware that he needed help, who had parents and friends who knew he needed help, and who had attempted to get help from professional resources in Maryland and Virginia --- ended up having an episode which tragically ended with his death and the deaths of two outstanding law enforcement officers. (Highlighting was provided by the NAMI-PW webmaster.)
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From: SecHHR [mailto:SecHHR@governor.virginia.gov]
Sent: Monday, May 22, 2006 8:00 AM
To: constituent@home-address.va.us
Subject: Mental health reform
Constituent
constituent@home-address.va.us
This is in reply to your email to Governor Kaine regarding the tragic death of Detective Armel. This recent event was indeed catastrophic and heartbreaking.
There is a critical need to expand mental health services in Virginia so that individuals and their loved ones may access mental health care before an actual emergency occurs. I share with you the need to re-evaluate and strengthen our current system of mental health care and improve access to crisis intervention services.
Since 1997, a number of bills have appeared before the legislature proposing a mandatory outpatient or assisted outpatient approach. Most recently, Senator Henry Marsh proposed Senate Bill 18, a mandatory outpatient program that was ultimately continued to 2007 in the Senate Committee on Education and Health. Historically, these bills have not been successful in Virginia as providers and advocates have pushed instead for a better-funded, more comprehensive system of care with more flexible and accessible services. The success of a law is largely based on the ready availability of the needed community services to which people could be referred by the courts.
While Senator Marsh’s bill has been continued until 2007, the 2005 General Assembly created an Interagency Civil Admissions Advisory Council, which I chair, to study the issues related to the involuntary civil admissions process (including outpatient commitment) for persons with mental illness and to make recommendations for improvement.
Also in October 2005, the Office of the Inspector General (OIG) in Virginia issued a study for the Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) entitled Review of the Community Services Boards: Emergency Services Programs. (The study in its entirety may be viewed at www.oig.virginia.gov.) The study’s major finding is that most communities in Virginia do not offer the necessary comprehensive range of crisis services for individuals with mental illness. The studies noted that most communities had access to inpatient services and also offer the least restrictive intervention, often in the form of phone intervention or hotlines, but very few communities were able to access the “crisis prevention” services that may avoid emergencies and obviate the need for inpatient hospitalization.
Chief Justice LeRoy Hassell of the Supreme Court of Virginia is also spearheading an effort to reform the civil commitment process for those individuals who do need effective inpatient psychiatric care. In December 2005, Chief Justice Hassell convened a conference of various stakeholders involved with the civil commitment process that highlighted several of your concerns regarding our current laws. Chief Justice Hassell continues to pursue this project in support of efforts to make legislative changes to Virginia’s current civil commitment process.
A more comprehensive system of care would indeed honor Detective Armel by closing the gaps in our continuum of care so that such tragedies may be avoided in the future. I certainly agree with you that it is time for transformation of Virginia’s mental health system toward a more recovery and wellness-oriented future.
On behalf of Governor Kaine, thank you again for sharing your comments and ideas regarding this vital issue.
Marilyn B. Tavenner
Secretary of Health and Human Resources
1111 East Broad Street
Richmond, Virginia 23219
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America's Report Card: NAMI Grades the States
(excerpt from the "NAMI Connection" e-newsletter*)
NAMI recently released the first comprehensive state-by-state report on the state of America's mental healthcare system for serious mental illness. The report, covered widely in media outlets throughout the United States, confirmed what President Bush's New Freedom Commission called "a system in shambles."
Simply put, treatment works, if you can get it. But in America today, it is clear that many people living with the most serious and persistent mental illnesses are not provided with the essential treatment they need. As a result, they are allowed to falter to the point of crisis. This neglect and lack of will by policymakers often results in horrendous consequences. The number of people with serious mental illness incarcerated in jails and prisons is on the rise. Emergency room use is increasing. The availability of housing is being threatened. Increasingly, access to effective treatments is being limited by many state governments.
This 2006 report, Grading the States: A Report on America's Health Care System for Serious Mental Illness, has a number of audiences. NAMI intends the report to be a consumers' guide to public services for adults with serious mental illness. We hope it will provide elected policymakers with a specific agenda for action. We also intend for this report to promote a dialogue among all stakeholders about what is and what is not working in the mental health system.
It is our strong sense that if we are to move forward, we must routinely engage in assessing the mental health care systems in every state. We hope that our publication of these reports at regular intervals will over time drive the creation of service systems in all states that are not "patchwork relics," but ones of hope, opportunity, and recovery.
The 230-page report, including individual state narratives and scoring tables, is available online at www.nami.org/grades.
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Grading the States 2006: Virginia (excerpted from the above-mentioned report)
Overall Grade: D
- Infrastructure (D)
- Information Access (F)
- Services (D+)
- Recovery Supports (D+)
Spending, Income (and National Rankings):
- Per Capita Mental Health Spending is $68.54. (30)
- Per Capita Income is $31,969.00. (12)
- Total Mental Health Spending is $496M. (18)
- (Suicide Rank is 32 --- tied with Michigan.)
Recent Innovations:
- Governor Warner's $450M investment initiative from state surplus
- Workforce development initiatives
- Jail diversion programs
Urgent Needs:
- Full funding of the Warner proposal
- Increased implementation of evidence-based practices across all Community Service Boards (CSB)
- Solution to private psychiatric bed crisis
- Culturally competent workforce
- Affordable, quality housing
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* The "NAMI Connection" brings periodic, lively news and stories of interest to NAMI supporters, supplementing The Advocate, NAMI's magazine for dues-paying members that arrives four times a year by regular mail. It provides a broader view of NAMI than our more specialized electronic newsletters, such as the NAMI E-News, StigmaBuster Alerts and Friday Facts.. Just one more reason to become a dues-paying member of NAMI.
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