DECLARATION OF STATE POLICY

The Commission offers a statement of policy to document the dedication of the Commonwealth to the provision of high quality services and care for its mentally handicapped citizens. The Policy calls for a coordinated system of statewide services providing treatment, training and care in the least restrictive environment possible. A fundamental element in adhering to the principles of the declaration of policy is a system of case management.

FINDINGS AND RECOMMENDATIONS

SERVING THE INDIVIDUAL

The prevailing theme of this report is the individualization of services for mental health, mental retardation and substance abuse in a community setting close to the home of the mentally handicapped individual and his family whenever possible.

I. PREVENTION AND PUBLIC AWARENESS

State and local human service agencies should begin to place high priority on the initiation of prevention and public awareness programs. The Secretary of Human Resources is requested to guide human services agencies in the development of appropriate programs for prevention and public awareness.

II. GUARDIANS AND COMMITTEES FOR LEGALLY INCOMPETENT AND LEGALLY
INCAPACITATED PERSONS

Legislation is recommended which revises the laws governing the appointment of guardians and committees. A definition of the term "legally incapacitated" is proposed to differentiate this condition from "legally incompetent." The court is authorized to order certain human services agencies to prepare a comprehensive evaluation of the alleged incompetent or incapacitated person to assist the court in an appropriate disposition of each case. Clear and convincing evidence must be presented as to the person's incompetence or incapacity and as to each provision in the court's order of appointment of a guardian or committee. Certain persons who have been adjudicated incompetent or incapacitated are authorized to petition the circuit court to restore them to competency or capacity.

The Commission proposes a new provision for the appointment of a standby guardian for a mentally handicapped person upon the petition of his parent or legal guardian.

SERVICE DELIVERY IN THE COMMUNITY

II. DEINSTITUTIONALIZATION AND COMMUNITY SERVICES

The Commission endorses the recommendations contained in the Joint Legislative Audit and Review Commission Report entitled "Deinstitutionalization and Community Services in Virginia." The establishment of a joint subcommittee of the House of Delegates and Senate to monitor the Department of Mental Health and Mental Retardation during 1980 and 1981 is recommended.

III. ADMINISTRATION AND MANAGEMENT OF THE COMMUNITY-BASED SYSTEM

State Board: Legislation is proposed which authorizes the State Board to establish programmatic and fiscal policy to govern the operation of community services boards. The State Board is required to develop and adopt by July 1, 1982 a policy establishing a core of mental health, mental retardation and substance abuse services for community services boards. Funding incentives shall be developed by the 1982-84 biennium to encourage localities to choose from the core services. Programs outside the core services shall also be specified by the Board and be funded at a lower rate with State
monies.

The State Board is required by July 1, 1981 to establish policy which mandates that each community services board institute by January 1, 1982, a reimbursement system to maximize the collection of fees from persons receiving services and from responsible third party payors.

A study by the State Board of the concept of "funds following the client" is proposed with a goal of the submission of recommendations to the 1982 Session of the legislature for several pilot projects during the 1982434 biennium.

It is recommended that the State Board adopt suggested salary ranges with appropriate fringe benefits to apply to all community services board employees beginning with the 1982-84 biennium. A study by the State Board on the need for and cost of providing liability insurance for community services board members and employees is requested to be submitted to the 1981 Session.

Department: In its relations with community services boards, it is the role of the Department to provide statewide direction and emphasis for program planning and evaluation. The Department's regional representatives should focus on technical assistance and guidance for the boards.

Local Governments; Statutory revision of the 1968 legislation establishing community mental health and mental retardation services boards is proposed. By July 1, 1983 it is required that every political subdivision establish singly or in combination with another such subdivision a community services board. Sixteen localities do not participate in a funded board at this time.

Community mental health and mental retardation services boards are re-designated "community services boards" to recognize their additional responsibility for substance abuse services. A county or city which comprises a single board and the county or city whose designated official serves as fiscal agent for the board is required to annually audit the board and its programs, approve a grievance procedure for employees of the board and arrange for legal services for the board.

The State Board is requested to promulgate guidelines to govern contracts for services entered into by community services boards.

IV. MANAGERIAL SERVICES

The Commission recommends four managerial services that must be provided by every community services board in the State: (i) preadmission screening; (ii) predischarge planning; (iii) a prescription team; and (iv) case management.

Preadmission Screening and Predischarge Planning All admissions to State institutions should be substantiated by referral of the local community services board. The board must be responsible for assessing the client's service needs, referring the client to appropriate services and presenting recommendations to the court regarding commitment to or certification for treatment in a State institution.

Commencing with the institutionalization of a mentally handicapped individual, a predischarge plan must be developed jointly by the State facility where the person is institutionalized and the community services board or community mental health clinic serving the locality to which he will return.

Prescription Team: The Commission recommends the establishment of an interagency prescription team coordinated by the community services board or clinic. The team shall be responsible for accomplishing the tasks of preadmission screening and predischarge planning, assisting the court in decisions regarding commitment to or certification for treatment in a State institution and working with State facilities and local services agencies to develop treatment plans for mentally handicapped individuals.

Effect of the Managerial Services: Prior to voluntary admission of a mentally ill, mentally retarded or substance abusing person to a State institution, the individual must have been screened by either the community services board or the community mental health clinic that serves the region. The prescreening report must recommend that the individual's service needs require hospitalization before the individual may be admitted voluntarily to a State facility.

Whenever a person is brought before the court for the purpose of voluntary commitment to a State institution, the judge must obtain a prescreening report from the community services board or clinic. The prescreening report must recommend that the individual needs hospitalization in order for the court to commit that person to a State facility.

In the case of involuntary commitments, the judge is encouraged to utilize the expertise of the community services board through the prescreening report process, but is not required to do so. The court is required by the Commission's statutory proposals, however, to inform the community services board that a person has been involuntarily committed to a State facility within ten days of the date of the commitment order.

The Commission recommends that the director of the State institution be required to furnish the community services boards a list of persons, who have consented to the release of such information, for whom predischarge plans are required.

The Criminal Justice Services Commission is requested to provide training for law-enforcement personnel in the recognition of mental disabilities and the proper handling of mentally disabled persons. It is proposed that the Executive Secretary of the Supreme Court provide information about the kinds of community resources available for commitment or certification hearing to the judges at the statewide judicial conferences.

Case Management; Local government, under the direction of the Department of Mental Health and Mental Retardation, is given the responsibility through the community services boards for the establishment of a case management system designed to monitor the care and treatment of its citizens in need of services for mental health, mental retardation and substance abuse.

It is requested that a two-year study of the "double diagnosis client" who is both emotionally disturbed and mentally retarded be conducted by the Department of Mental Health and Mental Retardation in cooperation with other relevant State and local agencies.

V. ZONING FOR COMMUNITY RESIDENTIAL FACILITIES

Current State policy concerning zoning ordinances relating to homes for mentally retarded and other developmentally disabled persons is affirmed.

STATE ADMINISTRATION OF THE SYSTEM

Significant weaknesses were found in the ability of the State Mental Health and Mental
Retardation Board to make policy for this system. The Commission questions the ability of the central office of the Department as presently structured to effectively administer the State institutions and oversee the statewide network of community services.

I. STATE MENTAL HEALTH AND MENTAL RETARDATION BOARD

The Commission proposes a revision of Title 37.1 of the Code of Virginia which realigns the powers and duties of the State Board and Commissioner and which re-establishes the Board as a policy-making body.

II. PERSONNEL MANAGEMENT AND EMPLOYEE RELATIONS

The Commission supports the participation of the Department of Mental Health and Mental Retardation in the Personnel Management Decentralization Plan being implemented by the Department of Personnel and Training.

It is recommended that the directors of State facilities be employed pursuant to the Virginia Personnel Act and not be subject to an appointed four-year term of office. The Commission proposes repeal of the statutory requirement that the person appointed Commissioner of Mental Health and Mental Retardation be a doctor of medicine.

III. STATE FACILITIES

Maintenance: The Commission recommends the Department consider reallocating existing positions within the central office to better accomplish its management and oversight responsibilities of the institutional maintenance systems.

The Governor is requested to develop by the 1982 Session a timetable for closing and demolishing or transferring to another agency institutional buildings for which maintenance has become economically or programmatically impractical.

Staffing: In the Commission's public hearings, the staffing of State institutions emerged as a factor contributing to the dissatisfaction of many institutional employees. Institutional directors, with the assistance of the Department, must seek to achieve a reasonable balance of administrative, programmatic and direct care staff.

VTCC-MCV Agreement: The Commission endorses the Agreement recently negotiated between the Virginia Treatment Center for Children and the Medical College of Virginia which is intended to define the unique relationship between VTCC and the Departments of Psychiatry and Pediatrics at MCV-VCU.

The Commission opposes the location of a parking deck by MCV-VCU adjacent to the Treatment Center which in any way encroaches upon the Center's air or land space.

IV. QUALITY OF SERVICES PROVIDED BY THE SYSTEM

Standards State Institutions and for Community Programs: The Department's responsibility to monitor the implementation of standards for the programs and services offered by State institutions and community services is affirmed.

Planning: Legislation is recommended to define the roles and responsibilities of the various State and local agencies involved in planning services for mental health, mental retardation and substance abuse.

Research: The Department's responsibility to promote and encourage research into the causes of mental illness, mental retardation and substance abuse is set out.

V. EFFORTS IN INTERAGENCY COOPERATION

The Commission reviewed several interagency efforts to coordinate and integrate human services. Concern is expressed about the lack of commitment and underutilization of resources by the Departments of Mental Health and Mental Retardation and Corrections and the Rehabilitative School Authority in implementing services for the State's mentally handicapped incarcerated population. A report is requested from the Governor's cabinet on efforts to improve this situation by the 1981
Session.

FINANCIAL MANAGEMENT OF THE SYSTEM

I. STATE AND LOCAL FISCAL POLICIES

Operational and Capital Outlay Budget Policies: Institutional budget requests for both operations and capital outlay must be reviewed and scrutinized by the Department more closely. A priority list of capital outlay projects for each biennium and a plan prioritizing such requests for the following two bienniums should be developed and submitted to the State Board, Governor and legislature.

Formula Funding of Community Services: The Department is requested to develop formulas for distributing a substantial percentage, though not all, of State general funds for mental health, mental retardation and substance abuse services pursuant to criteria specified in the report. The remaining State general funds should be administratively distributed to service areas of great need.

Title XX Program: The Secretary of Human Resources is requested to study the Title XX program and report to the legislature in 1981 on the feasibility of alternative methods of mandating Title XX services and of distributing these funds.

II. BUDGET RECOMMENDATIONS FOR THE 1980-1982 BIENNIUM

Operational Budget: In developing its requests for appropriations within its budget target, the Department found that significant employee layoffs could result in 1980-82. The Commission recommends that $5 million be added to the Department's budget to provide salaries for existing departmental employees to maintain the current level of services.

The Governor is requested to develop a ten-year plan which, by 1990, will result in 60% of State general funds supporting institutional services and 40% supporting community services. The current ratio is 83% institutional services and 17% community services.

To begin working toward this funding balance, the Commission recommends that an additional $10 million be appropriated for community services board programs for 1980-82 $6.16 million for grants to local boards and $3.84 million for local substance abuse programs.

Capital Outlay Requests: The Commission endorses the funding of two capital outlay requests by the Department for 1980-82:

* Ten projects considered essential to the health or safety of patients and residents. Cost: $4 million.
* Renovation and addition to the Virginia Treatment Center for Children. Cost: $4.3 million.

Alternatives are suggested to two other departmental capital outlay requests involving Lynchburg Training School and Hospital and Southwestern State Hospital.

The Commission requests that an interagency task force study the relocation of the children's program at DeJarnette Center for Human Development with a report being submitted to the 1981 Session.