HD77 - Review of the Involuntary Civil Commitment Process
Executive Summary: The Code of Virginia provides that individuals who are mentally ill and in need of hospitalization may either voluntarily admit themselves or be involuntarily committed to a hospital to receive treatment. According to statute, individuals thought to be in need of involuntary civil commitment are to enter the process through an emergency custody order (ECO) issued by a judge, special justice or magistrate. An ECO directs that an individual thought to be mentally ill and in need of hospitalization be taken into custody and evaluated. Following the evaluation, individuals are either released or a temporary detention order (TDO) is issued, and they are detained for additional evaluation and treatment. The General Assembly established the involuntary civil commitment fund to pay for the medical and legal costs associated with the temporary detention period and the in-voluntary civil commitment hearings. The Supreme Court administers the fund and made disbursements of more than $9.6 million in FY 1993. Item 15 of the 1993 Appropriation Act directs JLARC to examine "fiscal issues related to the involuntary Commitment Fund and operational and policy issues involving the involuntary mental commitment process." The mandate further directs that the study "promote improved efficiencies" in this area. This report presents three major preliminary findings. First, the costs of the involuntary civil commitment process are estimated to be approximately $20.1 million, which is more than twice the amount the State directs toward the involuntary civil commitment process through the involuntary civil commitment fund. Second, the State may be making duplicate payments from the involuntary civil commitment fund and from Medicaid claims for hospital stays. Third, while it appears that sheriffs are utilized as the primary method of transport for individuals under TDOS, sheriffs and community services board (CSB) directors agree that a law enforcement role may not always be necessary in this process. However, changes in this area may necessitate changes in other aspects of the current civil commitment procedures. There is a need for a more complete examination of the involuntary civil commitment processes in order to fully support detailed recommendations for improved efficiencies. More Than $20.1 Million Was Spent on Involuntary Civil Commitment Activities in FY 1993. While disbursements from the involuntary civil commitment fund totaled $9.6 million in FY 1993, JLARC staff estimate that more than $20.1 million was actually expended in that same year on involuntary civil commitment activities. Expenditure estimates from the sheriffs and CSBs, and data from the Department of Medical Assistance Services (DMAS) and the Department of Mental Health, Mental Retardation, and Substance Abuse Services (DMHMRSAS) indicate that an additional$10.5 million was spent on activities associated with involuntary civil commitment. The State May Be Making Duplicate Payments to Hospitals. It appears that the State may be making duplicate payments from the involuntary civil commitment fund and from Medicaid claims for hospital stays. JLARC staff analysis indicates that hospitals may not be subtracting Medicaid reimbursements they have received from the amounts they are billing the Supreme Court. Therefore, the Supreme Court may be reimbursing hospitals for amounts the hospitals have already received through Medicaid payments. DMAS, due to federal restrictions, could not provide data which would allow JLARC staff to match individual cases to determine definitely if duplicate payments are occurring, and it they are occurring, the amount of duplicate payments. Further re-view of DMAS Medicaid data is necessary to determine the amount of duplicate payments from the State to private hospitals, and to determine if cost-savings could be achieved. Therefore, the following recommendation is made: Recommendation: The General Assembly may wish to amend the study language in the Appropriation Act to require the Department of Medical Assistance Services to provide JLARC with the individual data necessary to determine if the State is double-paying for services provided individual during the temporary detention period. Sheriffs Are Divided in Their Opinions on the Extent of the Need for Their Involvement in Transporting TDOs. One hundred fourteen sheriffs responding to a JLARC survey on involuntary civil commitment, or 91 percent of the 125 sheriffs statewide, reported that they transported approximately 15,000 mental health patients in FY 1993. The average was approximately 140 transports per department. The majority of these sheriffs reported that they should be involved in the transportation of individuals under ECOs and TDOs. However, sheriffs are divided over what they believe their role should be. Almost half of the sheriffs responding to the JLARC survey on involuntary civil commitment indicated that their role in transporting mental health patients should be reduced or eliminated. Further, 78 percent of the sheriffs who responded to the survey reported that the responsibility of transporting mental health patients causes staffing problems. The Code of Virginia indicates that special justices have the option to assign some transportation responsibilities to parties other than sheriffs, such as CSBs or family members, but it appears that this rarely occurs. Transferring the responsibility from sheriffs to other entities for more of the transports could require some changes to the involuntary civil commitment procedures. Issues for Further Study. Further analysis is necessary for a complete review of the involuntary civil commitment process. JLARC staff have identified six issues for examination: • the efficiency and effectiveness of the management of the involuntary civil commitment fund; • the role community services boards should play in the emergency custody, temporary detention, and involuntary civil commitment processes; • the role the legal system (including courts, sheriffs, police, judges, special justices, and magistrates) should play in the emergency custody, temporary detention, and involuntary civil commitment process; • the efficiency and effectiveness of the use of public and private hospitals during the temporary detention process; • the extent to which the temporary detention process is used for purposes for which it was not originally intended; and • the options the State has to improve the emergency custody, temporary detention, and involuntary civil commitment processes and procedures. |
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