The Behavioral Health Commission’s Executive Committee met on November 4 to plan the Commission’s work for 2025, and the full Commission met on November 12 for a series of briefings from its staff, as well as staff to the Joint Legislative Audit and Review Commission, Deputy Health and Human Resources Secretary Leah Mills, and DBHDS Commissioner Nelson Smith. Based on its November 4 discussion, the Executive Committee will recommend that staff complete a study in 2025 of the implementation of the Marcus Alert initiative, and begin a study of behavioral health services available in local and regional jails. Commission staff would also be directed to review local contributions to Community Services Boards and determine why some localities are not providing the required local matching funds; staff would examine potential barriers at the local level, as well as alternative state funding structures.
The full Commission opened its November 12 meeting with an update by Associate Policy Analyst John Barfield, who provided an interim briefing on a study of the statutes governing the civil commitment process and their interaction with the components of the crisis system, which have received substantial state investments in recent years. This study was directed by legislation in 2024. Mr. Barfield explained that several elements of the crisis system can divert individuals from unnecessary hospitalization, but are in varying phases of development and implementation: the 988 call system, mobile crisis teams, the Marcus Alert initiative, and short-term crisis facilities. Staff will present a full report with findings and recommendations in 2025.
Assistant Policy Analyst Abigail Cornwell presented a report on the implementation of permanent supportive housing, as part of the Commission’s role in monitoring state-funded behavioral health initiatives. Ms. Cornwell explained that permanent supportive housing demonstrates beneficial outcomes for participants, who are less likely to be hospitalized or incarcerated. DBHDS manages Virginia’s program by contracting with CSBs, nonprofits, and local housing authorities; the state funding covers housing and related costs, but not the clinical services, which are provided by CSBs or private providers and funded through Medicaid, private insurance, other CSB funds, and federal grants. DBHDS has identified a need for 7,220 slots, and 3,377 have been funded, but only 1,712 of these slots are occupied, due to several barriers identified by staff, including the time required to select providers, find willing landlords, and match participants with available units, and limited rental stock, especially units that meet the needs of participants. Although Virginia’s program prioritizes individuals being discharged from state hospitals for permanent supportive housing slots, this option appears to be underutilized. Members discussed several ideas to enhance the program, including matching individuals clinically ready to leave state hospitals but awaiting community placements with permanent supportive housing slots; examining state tax credits to ensure that appropriate rental units are available; and potentially requiring local contributions toward rental assistance.
Members next turned to the complex issue of alternatives to state hospitalization for individuals with neurocognitive or neurodevelopmental disorders, with JLARC Chief Legislative Analyst Drew Dickinson providing a review of JLARC’s 2023 study on the topic. This study resulted in legislation in 2024 that sought to preclude individuals with these conditions, and without a co-occurring mental illness, from placement in state hospitals. Due to concerns about the lack of alternative placement options, this legislation included a re-enactment clause and required the convening of a workgroup. Deputy Secretary Mills reported on the workgroup’s discussions and recommendations. While the workgroup generally agreed with the intent of the legislation, it did not recommend its re-enactment, instead recommending continued focus on establishing a continuum of alternative placement options, enhancing provider capability to serve individuals in the community, and supporting caregivers, to include improving communication with caregivers in crisis response.
JLARC’s 2023 study also recommended that the state find or develop alternative placements for youth who would otherwise be served at the Commonwealth Center for Children and Adolescents, which has experienced persistent operational issues; this recommendation was incorporated in budget language in the 2024 session. Commissioner Nelson Smith provided background on the youth served by CCCA and staffing challenges at the facility. He noted that children in the custody of local departments of social services account for 21 percent of all admissions over the last two fiscal years, and account for 30 to 35 percent of all bed days. He offered several recommendations for alternative placement options, including creation of a new child and adolescent inpatient psychiatric unit in Southwest Virginia; creation of a specialized neurobehavioral unit; enhancement of specialized crisis services for children and youth; enhancement of specialized group homes; improving capacity in psychiatric residential treatment facilities; expansion of intensive community treatment options; and additional support for youth in foster care.
The Commission’s next meeting is scheduled for December 10.
VACo Contact: Katie Boyle