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V
irginia
C
apitol
C
onnections
, W
inter
2017
6
Mental health and related challenges
such as substance use disorder have gained
traction in the dialogue about enhancing
population health. Attention on these
issues is a good thing— it means stigmas
associated with mental health challenges,
while still persistent, are receding as
public awareness about treatment needs
increases.
Virginians are familiar with these
issues through high-profile events that left
us shocked and heartbroken in the face
of tragedy. Closer to home, there are countless personal examples
of families dealing with a loved one experiencing mental health
challenges. Indeed, behavioral health issues have touched nearly
every Virginian in some form.
Across the Commonwealth, law enforcement deals with the
challenges, as do health care and behavioral health providers, our
public leaders, and many other advocates and stakeholders. As with
any illness, the failure to properly address mental health needs can
have serious consequences.
That’s why the Virginia Hospital & Healthcare Association is
pleased to announce its 2017 behavioral health legislative package,
an agenda for long-term success, driven by bi-partisan solutions,
and stakeholder outreach. Virginia leaders and advocates in recent
years have collaborated to enhance mental health policy to better
serve patients. The VHHA package reflects hospitals’ continuing
contribution to that work. Hospitals play a key role in meeting
patients’ mental health treatment needs. For instance, private
hospitals provide 1,300 of the roughly 2,922 psychiatric beds
in Virginia.
Mental health challenges are not uncommon in Virginia where,
in 2014, more than 1.1 million adults were diagnosed with Any
Mental Illness (AMI). Also that year, 213,565 adults were identified
as having a serious mental illness (SMI). Almost half of those
people went without treatment.
While we’ve seen commendable work done on mental health
issues over the years, more can be done. And that’s why Virginia’s
hospital community is engaging with stakeholders on ways to
enhance services. Over the past six months, VHHA has worked with
the Virginia College of Emergency Physicians to identify baseline
standards for conducting a medical assessment of people presenting
with a psychiatric illness, commonly known as medical clearance.
Enhancements in medical assessment procedures will allow patients
to begin treatment quicker.
We’ve met with the Virginia Sheriffs’ Association and the
Virginia Ambulance Association for conversations about identifying
opportunities to improve mental health transportation. We’ve
participated in discussions with some regional Community Services
Boards to improve the identification of inpatient psychiatric beds
for patients under a Temporary Detention Order (TDO). And
VHHA hospital members continue efforts to identify solutions to
issues around the delivery of behavioral health care and to find
more opportunities to partner with external stakeholders.
Our four legislative recommendations are critically important
proposals to improve mental health care in Virginia. We are thankful
to have a bipartisan group of legislators sponsoring them, including
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
proposals focus on the emergency psychiatric evaluation process,
inpatient bed identification, commitment hearings, and funding
to support the behavioral health needs of families, friends, and
neighbors in the communities hospitals serve. They include:
Preadmission Screening Evaluations
One challenge in getting patients who are in psychiatric crisis
the 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 detained 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
alternative behavioral health professionals to conduct emergency
psychiatric evaluations.
Emergency Department Psychiatric Patient Registry
Virginia’s Psychiatric Bed Registry on its own isn’t sufficiently
reducing delays in identifying available inpatient psychiatric beds
for patients under a TDO. Proposed legislation would authorize
the development of a psychiatric patient registry 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 patient registry, which would be used
in conjunction with the Bed Registry.
24-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 up to 24 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
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. Proposed budget language would seek a state
study regarding the potential authorization of greater flexibility in
the use of LIPOS funds linked to patient clinical needs rather than
commitment status.
During the 2017 Virginia General Assembly session, Virginia’s
hospital and health system community stands ready to work with
lawmakers, advocates, and other stakeholders on these and other
policy ideas developed to enhance treatment and care options for
patients experiencing mental health challenges.
Jennifer Wicker is Intergovernmental Affairs Director for VHHA.
She previously served as Deputy Legislative Director for Virginia
Governor Terence R. McAuliffe, as Legislative Coordinator for
former Richmond Mayor Dwight C. Jones, and as Legislative
Assistant for two members of the Virginia House of Delegates.
She also has experience in the financial sector. Wicker earned a
Bachelor’s Degree from Randolph-Macon College, a Master’s
Degree in Social Work from Virginia Commonwealth University,
and has a Certificate in Non-Profit Management.
Pursuing Bi-Partisan Solutions
to Enhance Behavioral Health
By Jennifer Wicker Virginia Hospital & Healthcare Association
Director of Intergovernmental Affairs
V