RD195 - Annual Report on the Implementation of Senate Bill 260 (2014) – June 30, 2016
Senate Bill (SB) 260 (Chap. 691, 2014) amended and added several sections of the Code of Virginia related to emergency custody and temporary detention of adults and minors. The fourth enactment clause of this legislation reads as follows:
“4. That the Department of Behavioral Health and Developmental Services shall submit an annual report on or before June 30 of each year on the implementation of this act to the Governor and the Chairmen of the House Appropriations and Senate Finance Committees. The report shall include the number of notifications of individuals in need of facility services by the community services boards, the number of alternative facilities contacted by community services boards and state facilities, the number of temporary detentions provided by state facilities and alternative facilities, the length of stay in state facilities and alternative facilities, and the cost of the detentions in state facilities and alternative facilities.”
This report was prepared pursuant to the above language.
SB 260 arose from concerns about Virginia’s behavioral health crisis response system. In particular, there were instances across the Commonwealth where individuals, who met clinical criteria for temporary detention, were not hospitalized due to the lack of a willing facility to admit them. SB 260 was designed to eliminate these occurrences and guarantee that everyone who met clinical criteria for temporary detention was able to access this care.
A brief overview of the most salient impacts of SB 260 on Virginia’s emergency response system is provided below. Since the new law went into effect on July 1, 2014:
• No individual subject to an Emergency Custody Order (ECO) determined to meet clinical criteria for temporary detention has been turned away for lack of a psychiatric bed.
• There has been a consistent increase in the daily number of evaluations for involuntary hospitalizations.
* In FY 2015, Community Services Boards (CSBs) emergency services clinicians completed an average of 227 face-to-face evaluations for involuntary hospitalizations each day.
* In the first two quarters of FY 2016, (July 1, 2015 to December 31, 2015), they completed an average of 249 daily face-to-face evaluations for involuntary hospitalizations.
• There has been a consistent increase in the daily number of temporary detention orders:
* In FY 2015, magistrates issued an average of 67 TDOs each day for involuntary hospitalization.
* In the first two quarters of FY 2016, magistrates issued an average of 69 TDOs each day for involuntary hospitalization.
• There has been a consistent increase in the daily number of emergency psychiatric hospital admissions:
* In FY 2014, state hospitals admitted an average of 12 persons per day.
* In FY 2015, state hospitals admitted an average of 14 persons per day.
* In the first two quarters of FY 2016, state hospitals admitted an average of 15 persons per day.
As demonstrated above, concurrent with the requirements and implementation of SB 260, the Commonwealth of Virginia continues to experience a significant increase in the demand for emergency services, including all areas related to the involuntary admission process.
Operationally, this trend is reflected in both the community services and institutional facilities aspects of the public system continuum. CSBs have seen the need for increases in emergency evaluations conducted by CSB staff, while for state hospitals, this is reflected in the increased number of TDO referrals and hospital admissions overall. The data reflects that these statewide trends tilt the system towards more restrictive and resource intensive interventions. These approaches are inconsistent with national best practices and with Olmstead v. L.C.’s (Olmstead)(*1) interpretation of the American’s With Disabilities Act (ADA).(*2) The ADA requires states to provide services to individuals with disabilities in the most integrated community settings.
SB 260 has contributed to multifaceted changes in Virginia’s behavioral health emergency and crisis services. DBHDS has found it critical to ensure that a strong safety net be securely in place and that inpatient care be available to all who need this service, in order to address any crisis situation. However, DBHDS also recognizes that a healthy behavioral health system requires commitment to increasing prevention, early intervention, and ongoing supportive services.
A comprehensive array of community-based services across the life span is essential in order to avert crises, enable individuals with behavioral health needs to be served in their home community, and, whenever possible, avoid intensive hospital-based care and inappropriate contact with the criminal justice system.
(*1) Olmstead v. L. C., 527 U.S. 581 (1999).
(*2) Americans With Disabilities Act of 1990, Pub. L. No. 101-336, 104 Stat. 328 (1990).