RICHMOND Governor Timothy M. Kaine Wednesday ceremonially signed several General Assembly bills that arose from the Virginia Tech tragedy of a year ago and that will improve protections for our citizens and treatment for people with mental illness.
The Virginia Tech tragedy reminded us that we must address the mental health needs of those in our family, among our friends, and in our community, Kaine said. Working with members of the General Assembly, we will make significant investments in our mental health system and the bills before me today will establish standards for the system and increase accountability.
Among the bills before the Governor Wednesday were the Omnibus Mental Health bills, House Bill 499(Hamilton) and Senate Bill 246(Howell). These bills, which will be corrected with technical amendments, include comprehensive changes in the mental health system and incorporate many of the bills listed below. The bills address the following:
- Commitment criteria;
- Disclosures of mental health information between parties (in various Code sections relating to juvenile and adult commitment, jail transfers, and the Health Records Privacy statute);
- Definition of responsible person who may initiate the involuntary treatment process;
- Evidence that can be considered in issuing emergency custody orders (ECO), temporary detention orders (TDO), and commitment orders;
- 2-hour ECO extension for good cause;
- Feedback from community services boards to the petitioner or physician if a TDO will not be recommended;
- Pre-hearing independent examination and CSB preadmission screening;
- Required elements of independent exam;
- Requirements for examiner and CSB to attend and participate in hearings;
- Procedure for transfer of cases between courts, when necessary;
- New Mandatory Outpatient Treatment (MOT) requirements and procedures;
- And, confidentiality of court records.
Other bills before the Governor include:
House Bill 559(Bell) changes the criteria for ECOs, TDOs, juveniles and involuntary commitment. It includes how that criteria is applied to prisoners and juveniles, so that a person may be taken into custody, temporarily detained, or involuntarily committed if the person is mentally ill and there exists a exists a substantial likelihood that, as a result of mental illness, the defendant will, in the near future, cause serious physical harm to himself or others as evidenced by recent behavior causing, attempting, or threatening harm and other relevant information, if any,.
Disclosure/Sharing of Information
House Bill 576(Watts) provides that any health care provider or other provider rendering services to a person subject to involuntary commitment proceedings shall disclose to magistrates, juvenile officers, courts, attorneys, independent evaluators and community service board all information necessary and appropriate for them to perform their duties related to the commitment proceedings. The bill also provides that any health care provider shall be immune for any harm resulting from the disclosure of health records unless he intended the harm or acted in bad faith.
Senate Bill 336(Cuccinelli) provides that a health care provider or designee of a local community services board or behavioral health authority shall not be required to encrypt email containing information or medical records provided to a magistrate unless there is reason to believe that a third party will attempt to intercept the email.
House Bill 1005(Bell) requires the board of visitors or other governing board of any public institution of higher education to establish policies and procedures requiring the notification of a parent of a dependent student when the student receives mental health treatment at the institution’s student health or counseling center. The notification applies when there exists a substantial likelihood that the student will, in the near future, cause serious physical harm to himself or others as evidenced by recent behavior or any other relevant information or suffer serious harm due to his lack of capacity to protect himself or to provide for his basic human needs.
House Bill 1058(Amundson) requires the board of visitors or other governing board of any public institution of higher education to establish policies and procedures requiring the release of a student’s educational record if the parent requesting the record claims the student as a dependent.
Senate Bill 538(Obenshain) mandates that by January 1, 2009, each public institution of higher education establish a comprehensive, prompt, and reliable first warning and emergency notification system for students, staff, and faculty.
Senate Bill 539(Obenshain) requires that the board of visitors or other governing body of every public institution of higher education establish a threat assessment team. The bill also requires the team to adopt a campus-wide committee charged with education and prevention of violence on campus.
Senate Bill 636(Cuccinelli) allows each public and private institution of higher education to request from its students complete student records, including any mental health records held by the originating school. These records shall be kept confidential as required by state and federal law.
House Bill 1449(Crockett-Stark/Shuler) and Senate Bill 256(Deeds) require the board of visitors or other governing body of each public institution of higher education to develop and keep current a written crisis and emergency management plan.
Custody/Transfer of Custody/Transportation
House Bill 401(Hamilton) and Senate Bill 81(Cuccinelli) allow the law-enforcement agency providing transportation to a person pursuant to an ECO to transfer custody of the person to the facility or location to which the person is transported for evaluation. This bill provides that the facility or location which accepts custody of a person may not require the law-enforcement agency to pay any fees or costs for the transfer of custody.
Emergency Custody Orders (ECO) and Temporary Detention
House Bill 583(Marsden) allows the magistrate to extend the time of ECOs for two hours if good cause exists to grant the extension.
Independent Examiner/Community Services Boards Reports and Participation
House Bill 560(Bell) requires the independent examiner and the community services board employee or designee who prepared the prescreening report to attend the commitment hearing.
Senate Bill 141(Edwards) clarifies that a discharge plan prepared by the community services board for persons discharged from a state hospital or training facility shall identify the services that the person discharged will require upon release and the public or private entities that will provide the services.
House Bill 708(Janis) clarifies that TDOs and the records pertaining to them are admissible as evidence because they are considered judicial records.
House Bill 1144(Fralin) allows the magistrate, when considering whether to issue an ECO or a TDO, to consider: the recommendations of any treating or examining physician; any past actions of the person; any past mental health treatment of the person; any relevant hearsay evidence; any medical records available and any affidavits submitted, if the witness is unavailable; any other information available that the magistrate deems relevant to the determination of whether to issue a TDO.
House Bill 1323(Toscano) requires a magistrate to issue TDOs upon the recommendation of any responsible person, any treating physician or upon his own motion after an in-person evaluation by an employee or designee of the local community services board.
Senate Bill 142(Edwards) requires that each involuntary commitment hearing be recorded separately, so that no more than one hearing is recorded per tape or other recording.
Access to Firearms
House Bill 709(Janis) and Senate Bill 226(McDougle) require that a person seeking to purchase a firearm from a firearms dealer answer questions on the state background check consent form concerning whether the applicant has ever been acquitted by reason of insanity, been adjudicated legally incompetent or mentally incapacitated, or been involuntarily admitted to a facility or involuntarily ordered to out-patient mental health treatment.
House Bill 815(Albo) Central Criminal Records Exchange; requires reporting of involuntary commitment of persons who were the subject of a TDO and who subsequently agreed to voluntary commitment.
Senate Bill 216(Edwards) clarifies that orders for both involuntary inpatient and outpatient mental health treatment must be forwarded by the clerk of court to the Central Criminal Records Exchange, and that persons ordered to either involuntary inpatient or outpatient treatment are prohibited from purchasing, possessing, or transporting a firearm. This portion of the bill codifies Executive Order 50 (2007).
House Bill 400(Hamilton) and Senate Bill 67(Howell) provides that minors 14 years of age or older who are incapable of making an informed decision may be admitted to inpatient treatment upon the application of a parent.
House Bill 402(Hamilton) and Senate Bill 68(Howell) provide that a petition for the involuntary commitment of a minor shall be served upon the minor and the minor’s parents unless the petition has been withdrawn or dismissed.
House Bill 582(Marsden) increases from 72 hours to 96 hours the length of time to hold a hearing for the involuntary commitment of a minor or the emergency admission of a minor for inpatient treatment, and that a minor may be admitted by his parents to a facility over his objections.
Senate Bill 247(Howell) provides that a court shall appoint a guardian ad litem and counsel for a minor for involuntary commitment hearings and proceedings for the judicial approval of the admission for inpatient treatment of a minor 14 years of age or older over his objections.
Further Study of Mental Health Reform
The General Assembly has acknowledged the value in continuing to study the issue of Mental Health Reform. Senate Joint Resolution 42(Lucas) requests the Joint Commission on Health Care to study mental health reform.
The General Assembly included flexibility for DMHMRSAS to work with system stakeholders to determine how funds can best be allocated to meet the pressing need for improved care surrounding the civil commitment process.
The biennium budget includes $28.3 million to be allocated in key areas, including:
- Emergency Services Helps increase emergency services capacity by:
(1) Improving access to emergency psychiatric care, (2) Increasing emergency staff to provide crisis response, participate in commitment hearings, etc. and (3) Expanding the number of residential crisis stabilization programs. Expanded emergency services would provide intensive services, rapid access and peer-provided services as part of the civil commitment process.
- Outpatient Services Expands and improves outpatient services by adding new outpatient clinicians as part of the civil commitment process.
- Case Management Increases case management throughout the Commonwealth to provide coordination and linkage services with a focus on helping individuals adhere to a treatment plan as part of the civil commitment process.
In addition, over the biennium, the mental health budget includes:
-$6 million to expand a pilot program for jail diversion services funded in the 2006-08 biennial budget that will provide diversion and wrap-around services for an estimated 300-500 people.
-$5.8 million to hire clinicians specializing in childrens mental health to help
serve children who are not eligible for services through the Comprehensive Services Act.
-$600,000 to create positions in DMHMRSAS to expand monitoring of CSBs and to develop core service standards and service improvement plans. These positions will allow for better oversight of community-based services expansion.
-$600,000 to establish a training program for crisis intervention to enable law enforcement to respond to crisis situations involving individuals with mental illness.
-$345,000 to expand licensing staff to help monitor and ensure program quality.