The over-representation of individuals with behavioral health challenges in the criminal justice system is not a new problem or a problem isolated to the Commonwealth of Virginia. Rather, for many years most states have reported having more individuals with behavioral health challenges incarcerated than are reported in national community prevalence rate studies. Nationally, there continues to be strong encouragement for the development of criminal justice diversion programs for individuals with serious mental illness who can be more effectively treated in the community. Even when the Commonwealth does have robust diversion programs, it remains likely that individuals with behavioral health challenges will end up in local/regional jails, as not all cases can/should be diverted. In light of this, it is imperative that state minimum standards for behavioral health care provided inside the jail be established (bolstered).

During the 2019 General Assembly Session, Delegate Robert Bell sponsored House Bill 1942, which was approved by both chambers and was signed into law on April 3, 2019. HB 1942 amended Virginia Code § 53.1-68 (Minimum Standards for local correctional facilities and lockups; health inspections, behavioral health services inspections, and personnel). Specifically HB 1942 requires the Board of Corrections to establish minimum standards for behavioral health services in local correctional facilities and procedures for enforcing such minimum standards, with the advice of and guidance from the Commissioner of Behavioral Health and Developmental Services and the State Inspector General. HB 1942 lays out some minimum components, which the standards must address to include at least one unannounced annual inspection of each local correctional facility. Finally, HB 1942 requires that the Chairman of the Board of Corrections convene a work group to include representatives of sheriffs, superintendents of regional correctional facilities, community services boards, the Department of Behavioral Health and Developmental Services, the Department of Medical Assistance Services, the Virginia Association of Counties, the Virginia Municipal League, and such other stakeholders as the Director shall deem appropriate to determine the cost of implementing the provisions of this Act. The work group shall report its findings and conclusions to the Governor and the Chairmen of the House Committee on Appropriations, the House Committee for Courts of Justice, the House Committee on Health, Welfare and Institutions, the Senate Committee on Finance, the Senate Committee for Courts of Justice, the Senate Committee on Education and Health, and the Senate Committee on Rehabilitation and Social Services by November 1, 2019. This is the purpose of this report.

The following are the recommendations from the advisory panel to the BOC on the minimum standards for behavioral healthcare in jails:

1. Access to care - Inmates have access to care to meet their mental health needs.

2. Policies & Procedures - The facility has a manual or compilation of policies and defined procedures regarding mental health care services which may be part of a larger health care manual.

3. Communication of Inmates’ Needs - Communication occurs between the facility administration and treating mental health care professionals regarding inmates’ significant mental health needs

4. Mental Health Training for Correctional Officers - A training program established or approved by the responsible health authority in cooperation with the facility administration guides the mental health related training of all correctional officers who work with inmates.

5. Medication Services - Medication services are clinically appropriate and provided in a timely, safe and sufficient manner.

6. Mental Health Screening - Mental health screening is performed on all inmates on arrival at the intake facility to ensure that emergent and urgent mental health needs are met.

7. Mental Health Assessment - All inmates receive mental health screening; inmates with positive screens receive a mental health assessment.

8. Emergency Services - The facility provides 24 hour emergency mental health services.

9. Restrictive Housing - When an inmate is held in restrictive housing, staff monitor his or her mental health.

10. Continuity & Coordination of Health Care During Incarceration - All aspects of health care are coordinated and monitored from admission to discharge.

11. Discharge Planning - Discharge planning is provided for inmates with mental health needs whose release is imminent.

12. Primary Mental Health Services - Mental health services are available for all inmates who suffer from serious mental illness.

13. Suicide Prevention Program - The facility identifies suicidal inmates and intervenes appropriately.

14. Identification & Treatment of Substance Use Disorders – Inmates are screened for substance use disorders & provides treatment based on the individual’s needs, amenability to treatment, and availability of resources.

15. Management of Intoxication, Withdrawal, and Overdose – Protocols exist for managing and responding to inmates under the influence, experiencing withdrawal, or showing signs of overdose.

HB 1942 instructed the work group to determine the cost of implementing provisions of the act. The workgroup constructed a self-assessment survey to be filled out by all jails. The survey inquired about the jails ability to meet the proposed standards and in cases where the jail did not feel they could meet the standard (with current resources) what additional resources or assistance would be needed in order to be able to meet the standards. The estimated cost of the resource needs will be further analyzed by a separate workgroup as outlined in the 2019 Budget ITEM 395.Paragraph J.4.