State hospital capacity continues to be a topic of concern at the General Assembly. Several bills address aspects of the temporary detention process in an effort to relieve pressures on state hospitals and law enforcement agencies. The Governor’s budget proposes several investments that are intended to address state hospital capacity, as well as enhancements to the state crisis system, and General Assembly members have proposed additional funding as well.
HB 1792 (Ransone) and SB 1302 (Deeds) would modify the current statute dealing with physicians’ ability to seek an order from a court or a magistrate authorizing temporary detention of an individual for testing, observation, or treatment when that person is incapable of making or communicating an informed decision regarding treatment due to a medical or physical condition and the medical standard of care calls for observation, testing, or treatment in order to prevent harm to the person. Under the legislation, in a situation where the mental or physical condition appears to be the result of intoxication, a physician could seek an order from the magistrate or the court for temporary detention of the individual.
HB 1976 (Bell) and SB 1299 (Deeds) would allow the director of a facility where an individual is awaiting transportation to a facility of temporary detention to release the individual prior to a commitment hearing if an evaluation conducted by the psychiatrist or clinical psychologist treating the person determines that the person would no longer meet commitment criteria. Under current law, this authority may be exercised by the director of a facility where an individual is detained. The fiscal impact statement accompanying the legislation indicates that the bill may reduce the number of individuals admitted to state hospitals if individuals are determined to no longer meet criteria for detention while they are awaiting transportation to the hospital.
SB 872 (Newman) seeks to expand use of alternative transportation for individuals subject to emergency custody or temporary detention orders by requiring the magistrate to authorize alternative transportation under certain circumstances. Language added to the legislation in subcommittee would authorize an employee or contractor of an alternative transportation provider under contract with the Department of Behavioral Health and Developmental Services who has completed certain training to use restraints if necessary to ensure the safety of the person being transported and less restrictive techniques have been determined to be ineffective.
SB 1512 (Mason) would allow a “certified evaluator” to conduct a temporary detention order evaluation in lieu of the employee or designee of the local community services board if the person subject to the temporary detention order evaluation is located in a hospital in Planning District 21 with a psychiatric emergency department. The bill stipulates certain educational and training requirements for the certified evaluators. The bill expires July 1, 2025.
As reported in VACo’s analysis of the Governor’s budget, the introduced budget proposes several investments in the state hospital system and crisis services in order to address capacity concerns within state hospitals, including:
- $58.3 million GF in FY 2024 to expand and modernize the comprehensive crisis services system, including investment in additional crisis receiving centers and crisis stabilization units and expansion of existing sites.
- $20 million GF in FY 2024 for comprehensive psychiatric emergency programs or similar models of psychiatric care in emergency departments.
- $20 million GF in FY 2024 for the one-time costs of establishing additional mobile crisis services in underserved areas.
- $4 million (and $110,000 for administrative costs) for a pilot program to assist sheriffs’ offices and regional jails with the costs of maintaining custody and transportation of individuals in their custody who are subject to an ECO or TDO. This funding will allow for up to 71 deputy sheriff positions to be allocated, with the balance of funds to be allocated to reimburse offices on an hourly basis. Positions and funding would be allocated by the Compensation Board based on workload. Language provides that these funds are to supplement and not supplant existing local spending on these services.
- Consolidation of funding for alternative transportation and funding for alternative custody for individuals subject to a temporary detention order, as well as an additional $1 million GF in FY 2024 for DBHDS to contract with local law enforcement agencies who have agreed to use off-duty officers to provide transportation services or to assume custody of an individual under a temporary detention order who is awaiting admission to a state facility.
- $8 million GF in FY 2024 for supervised residential care, with priority to be given to projects for individuals on the Extraordinary Barriers List (who are clinically ready for discharge, but remain in the hospital for more than 30 days after that determination).
- $1.5 million set aside from the existing appropriation of $7.5 million GF in FY 2024 to DBHDS to pursue alternative inpatient options to state hospitals or to increase capacity in the community for patients on the Extraordinary Barriers List to support the discharge of private hospital patients at risk of transfer to state hospitals.
- Expansion of eligibility for the existing funding for pilot programs to serve individuals with dementia who might otherwise be admitted to state facilities to allow all older persons (defined in a cited statute as persons aged 60 and older) to qualify.
In addition, several budget amendments have been proposed to expand crisis services:
Item 312 #2h (Cordoza) and Item 312 #2s (Mason) would authorize local law enforcement agencies to contract for alternative custody services.
Item 312 #3h (Brewer) and Item 312 #10s (Hanger) would provide $17 million in FY 2024 for the development of two Crisis Stabilization Units.
Item 313 #11h (Hope) and Item 313 #4s (Deeds) would provide $2.5 million in FY 2024 to hire additional CSB staff to support Crisis Stabilization Units that are underutilized due to a lack of staff.
Item 312 #8h (Hodges) and Item 312 #3s (Locke) would provide $70 million in FY 2024 to develop five new crisis receiving centers and to expand three to four existing crisis receiving centers.
Item 312 #1h (Reid) and Item 312 #7h (Delaney) and Item 312 #7s (Vogel) would provide $16.1 million in FY 2024 for the one-time development costs to establish a regional Crisis Receiving and Stabilization Facility in northern Virginia.
VACo Contact: Katie Boyle