RD292 - Estimated Costs of Meeting Minimum Standards for Mental and Behavioral Health Services in Virginia Jails – July 2021
*This report was replaced in its entirety by the Department of Criminal Justice Services on July 20, 2021.
House Bill 1942 (2019) directed the Board of Corrections (since renamed the Board of Local and Regional Jails) to consult with the Commissioner of Behavioral Health and Developmental Services and the State Inspector General to develop minimum standards for mental and behavioral health services in Virginia jails and to estimate the costs of compliance with those standards. Budget language during the 2019 Session (Item 395 J.4) also directed the Virginia Department of Criminal Justice Services (DCJS) to work with key partners to provide estimates of implementation costs for the standards developed by the HB 1942 work group. This report fulfills the requirements set forth in Item 395 of the 2019 Appropriations Act.
The minimum standards for mental and behavioral health services in jails developed by the HB 1942 work group and adopted by the Virginia Board of Local and Regional Jails are consistent with industry standards and constitutional obligations to inmates.
Categorization of Standards
The 15 standards developed in response to HB 1942 can be categorized by their implementation components, or items or actions that are necessary to meet the standards: written policies and procedures (15 of 15 standards); training for correctional staff (7 of 15); service or care delivery (12 of 15); and communication of inmate needs (12 of 15).
Costs of Implementing Standards: Staffing and Non-Staffing
The costs of implementing each of these components vary both within and across categories as well as by community needs, and many implementation costs are already accounted for in Virginia’s criminal justice system.
Staffing costs, or the costs of salaries, benefits, and physical infrastructure for qualified staff, represent the main driver of implementation costs as a whole. Many services can be provided via telehealth without compromising quality or effectiveness. Although no formula exists for determining the precise staffing or service levels needed for mental and behavioral health services in any given jail, baseline staffing levels for mental and behavioral health services in each jail should reasonably include:
• 24/7 coverage, either onsite or on-call, by a registered nurse;
• On-call and regularly scheduled services from a psychiatric provider;
• A qualified mental health professional to provide regularly scheduled group and individual therapy services; and
• Behavioral health case management services, to include discharge planning, provided by a minimum of one full-time equivalent case manager per jail and one additional full-time equivalent case manager per 160 inmates.
Non-staffing costs generally cannot be estimated as readily as staffing costs due to the substantial variation in possible approaches that could be taken by individual jails or even the state acting on jails’ behalf.
Regardless of guidance or resources provided by the state, whether or not mental and behavioral health services in a given jail are adequate will depend upon the services actually needed and received by inmates, with particular consideration for service timeliness and quality. The state may need to consider collecting more detailed and/or more frequently updated data on inmates’ need for and jails’ delivery of services. Many jail leaders have repeatedly expressed a commitment to doing what they can to address inmates’ mental and behavioral health needs.
Funding Mechanism(s), Division of Costs, and Strategies for Minimizing Costs where Appropriate
The state could consider several funding approaches, such as applying the existing mechanisms and funding split administered by the Compensation Board (SCB) to minimum infrastructure—including staffing—for mental and behavioral health services in jails.
Specific strategies for meeting minimum standards in a cost-effective manner generally involve leveraging the state’s purchasing power, such as procuring the services of an expert consultant to inform model policies, procedures, and training. To ensure consistent baseline service availability regardless of jail resources or capacity, policymakers could consider adopting an existing approach taken by the Virginia Department of Corrections and securing a contract between the Commonwealth of Virginia and a hospital system for telehealth services provided at negotiated rates upon request by individual jails. The Board of Local and Regional Jails currently lacks the capacity to administer such contracts, however, and would require additional staff and funding in order to take on those responsibilities.