RD319 - Report on Civil Commitment Process Information (Item 273.C, 2010 Appropriation Act)


Executive Summary:
Item 273.C of the 2010 Appropriation Act, a continuation of Item 282.C in previous Acts, states:

"The Secretary of Health and Human Resources, in consultation with the Executive Secretary of the Supreme Court, shall develop a reporting system to collect relevant information on emergency custody orders (ECOs), involuntary commitment orders (TDOs), and mental health commitment hearings by fiscal year. The data shall include, but not be limited to, the number of ECOs, TDOs, and commitment hearings that occur each year by locality, and the estimated cost, duration, location, and disposition of each proceeding. The information collected shall comply with all relevant state and federal health privacy laws and shall not include any personal identifiable information. The data collected shall be reported to the Governor, the Chairmen of the Senate Finance and House Appropriations Committees, and the Supreme Court each year."

This report describes activities of the Department of Behavioral Health and Developmental Services (Department) on behalf of the Secretary of Health and Human Resources (HHR) and with the Office of the Executive Secretary of the Supreme Court of Virginia (OES) in response to this item.

The intent of this report was to provide useful information to enable analysis of any additional budget requests for the implementation of changes to the civil commitment process after extensive changes were made by the 2008 General Assembly. These changes have been implemented successfully within the additional funds appropriated for this purpose by the 2008 Session and without additional budget requests since that time.

The availability of data about the civil commitment process has improved since concerns noted in the Department’s initial Report Document 216 (2008) and ongoing information is now available outside of the requirements of this report. However, as Report Document 216 noted, there continues to be a high degree of variability with which the civil commitment process is implemented or administered across the state. For example, while the notion of an ECO may appear to be fairly clear and uncomplicated, the manner in which statutory provisions for ECOs are implemented varies considerably across Virginia. In some localities, few if any ECOs are issued by magistrates; instead, law enforcement officials take individuals into custody, as authorized by the statute, but there is no paper order issued by a magistrate. While there is no comprehensive information about the prevalence of this practice, most individuals familiar with the process indicate there could be thousands of paperless ECOs executed by law enforcement officials each year. It would be impossible to obtain information about the estimated cost, duration, location, or disposition of those paperless ECOs. Similarly, the manner in which temporary detention orders (TDOs) are issued and executed varies greatly, particularly regarding duration and location, and the availability of documentation about those TDOs also varies widely across the state. Finally, the location and scheduling of commitment hearings varies considerably across the state.

As a result of collaborative efforts in FY 2008, the Department, OES, and HHR developed a matrix, attached to this report as Appendix A, which describes how the community services boards (CSBs), Department, and OES planned to collect data to address the reporting Report on Item 273.C of the 2010 Appropriation Act requirements in Item 282.C. As noted in the Report Document 216 (2008), staff of the Health and Human Resources Subcommittees of the House Appropriations and Senate Finance Committees agreed in August 2008 that the presentation of data would be acceptable in general statements and trends, rather than in large amounts of detailed, specific data, which should reduce data collection and reporting efforts by CSBs. Department and committee staffs agreed to the following approaches for these data elements identified in Item 282.C, now Item 273.C.

Estimated Cost: A sampling approach based on estimated cost, rather than requiring CSBs to collect extensive data about estimated cost all of the time, is sufficient to respond to this data element. Data can be collected on estimated cost information for one month each quarter, and CSBs already collecting or readily able to gather estimated cost information should be in the sample. Unfortunately, it continues to prove difficult to collect cost data, but given the implementation of the statutory changes within appropriated funds, this data may not be needed.

Location: A sampling method for location also suffices for gathering this data element. Again, CSBs that already collect or could readily gather location information on ECOs and TDOs from their information systems should be in the sample.

Duration: Sampling also appears to be a feasible approach for this data element. There seemed to be some consensus that the important pieces of information being sought are how many ECOs are extended and how many consumers are released at the end of the six hour period due to inability to find a TDO placement, rather than measuring the exact length of each ECO.

Disposition: The intent of this data element is to measure movement through the commitment process. Data is collected on how many people come into the system through ECOs and how many individuals move to the next stage. For example, how many people were released at the expiration of ECOs and how many individuals advanced to a TDO.

The Department and CSBs support the continued collection of meaningful data about the civil commitment process. This is done for the behavioral health system through the automated Community Consumer Submission (CCS), a software application that extracts individual consumer and service data from local CSB information systems and transmits it each month to the Department. The consumer designation code in the CCS application is an example of integrating data collection about the civil commitment process into the CCS. The consumer designation code enables CSBs and the Department to link specific individuals to particular initiatives or episodes of care. Modifications to the CCS application for FY 2009 established a new consumer designation code (905) to identify individuals who were subject to mandatory outpatient treatment (MOT) orders, pursuant to § 37.2-817 of the Code of Virginia. When an individual is admitted to a CSB for mental health services under a MOT order, a consumer designation code is assigned to the person in a type of care record in the CCS. This record includes the date on which services under the MOT order were initiated and will include a date on which those services end. This code enables the CSB and the Department to link demographic, clinical, and service information about the individual to the MOT order.

In an effort to collect more data about the civil commitment process through the CCS, the Department worked with the VACSB Data Management Committee and its Executive Directors Forum to modify the CCS for FY 2010 to include service subtype codes that enable CSBs and the Department to identify subtypes of emergency services related to the civil commitment Report on Item 273.C of the 2010 Appropriation Act process. This produced information for FY 2010 about the numbers of individuals under emergency custody orders or in the emergency custody of a law enforcement officer or under temporary detention orders who were seen by CSB staff, the number of commitment hearings attended and the CSB staff time involved, and the number of mandatory outpatient treatment order review hearings attended and the CSB staff time involved. This is a new data collection effort that will reflect more complete information after FY 2010 reports.