By
Chris L. Jenkins and Tim Craig
Washington Post Staff Writers
Saturday, December 15, 2007; B04
Gov.
Timothy M. Kaine (D) announced a plan yesterday to pump $42 million into
Virginia's troubled mental heath system, a proposal that advocates and state
officials said is the beginning of an intense discussion about how aggressively
the state should adopt reform.
At
a news conference in Richmond, Kaine stood alongside mental health advocates
and the parents of two students injured in the Virginia Tech massacre, which
prompted the reforms. He said he was seizing a "historic opportunity and
responsibility" to boost funding for mental health programs, change the
criteria required for someone to be involuntarily committed and impose new
regulations on community-based clinics.
The
system has come under intense scrutiny since 32 people were killed at Virginia
Tech by a gunman with a history of psychiatric problems. Kaine's proposal
follows closely the recommendations of the independent panel that investigated
the April 16 shootings by Seung Hui Cho.
"We
cannot ignore the mental health needs of students, neighbors, seniors, those in
the streets or those in jail, anywhere in Virginia," he said.
The
reforms are part of the two-year proposed budget Kaine presents Monday to the
legislature's budget-writing committees. "The fixes are not going to be
easy or cheap, but they are fixes that need to be made," he said.
Kaine
stopped short of proposing broader, more aggressive reforms that some lawmakers
have suggested they would like to see when the General Assembly convenes next
month. For instance, several legislators said in interviews that they would
like to see bills broadening the ability of the state to coerce people into
outpatient treatment. Such proposals are expected to ignite debate on how far
and how fast the state should change its system.
The
governor's plan, which must be approved by the legislature, calls for
additional money over the next two years to fund more caseworkers,
psychiatrists and other staff to help monitor the mentally ill in their
communities.
In
addition, Kaine proposed spending $10.3 million over two years to hire 80
additional clinicians to focus on youth or adult counseling at outpatient
facilities. A recent report by the state auditing agency said Virginia is in
dire need of more services for children.
"When
someone steps forward and says, 'Hey I need help,' you have to be able to take
advantage of that window," Kaine said.
A
major part of the package directs about $14.6 million to emergency mental
health services. The money would provide greater access to psychiatrists who
specialize in treating mental patients in crisis, increase staffing at
intervention centers and create more local crisis stabilization units, which
are designed to stabilize those having a mental health crisis in a small clinic
instead of admitting them to a hospital.
"It's
years overdue, but we're off to a very good start," said Mira Signer,
executive director of the National Alliance on Mental Illness for Virginia.
Virginia
will spend $154.8 million this year for community-based services, which served
more than 118,000 people in 2006.
One
of the more controversial changes that Kaine announced yesterday was in the
criteria for emergency custody and temporary detention. Judges and magistrates
currently cannot order people into a treatment facility unless they are "an
imminent danger to [themselves] or others as a result of mental illness"
or so seriously mentally ill as to be "substantially unable to care for
[themselves]."
Virginia
is one of only five states to have such a high bar for commitment, and
supporters say the proposed change would improve treatment for many mentally
ill people.
Kaine's
proposal would change that standard to a "substantial likelihood that in
the near future" a mentally ill person will cause "serious physical
harm to himself or another person."
But
some mental health advocates were skeptical of the proposed change.
"They're
going down this path without any proof that anyone can concretely predict
whether someone will become dangerous or violent," said Diane Engster,
president of the Northern Virginia Mental Health Consumers Association, an
advocacy group that opposes changing the commitment standard. "Changing
the standard won't help that."
Still,
politicians from both parties predicted that many of Kaine's proposals would
sail through the General Assembly.
Lori
Haas, mother of injured Virginia Tech student Emily Hass, said she had mixed
feelings about the governor's plan.
"There
is certainly more to be done, but this is certainly a big and grand first
step," she said.
© 2007 The Washington Post Company
Office
Timothy M. Kaine
FOR IMMEDIATE RELEASE
Governor
December 14, 2007
Contact: Gordon Hickey
Phone: (804) 225-4260
Cell Phone: (804) 291-8977
Internet: www.governor.virginia.gov
GOVERNOR KAINE ANNOUNCES
MENTAL HEALTH BUDGET AND LEGISLATIVE INIATIVES
~ Proposals will expand
emergency services, provide more accountability ~
“The
tragedy at Virginia Tech in April of this year has drawn attention to our
mental health care system in an unprecedented way,” Governor Kaine said. “Now
is the time for us to work together to make the changes and to provide the
funding and the accountability our mental health system needs.”
Many of
the Governor’s recommendations are based on the report of the Virginia Tech
Review Panel, released earlier this year.
The Panel’s report highlighted the need to strengthen the community
services board system, recommending expansions for its emergency services
capacity, as well as its case management capacity.
Over 90
percent of community services board case managers in
In
addition, the proposed budget increases the number of clinicians and therapists
who are available on an outpatient basis, with funding to support 40 new
clinicians recommended over the biennium.
The Governor’s budget also funds an additional 40 clinicians specializing
in children’s mental health at local community services boards statewide, to
support those children who are not eligible for services through the
Comprehensive Services Act.
To ensure
that individuals who are subject to temporary detention orders are receiving
attention in a timely and focused manner, the Governor has recommended funding
to support emergency mental health services, including around-the-clock
emergency psychiatric consultation, emergency clinicians, and crisis
stabilization. In addition to this
funding, the Governor announced legislative proposals to address how emergency
detention orders are implemented.
The
Governor’s proposed legislation will:
ü Allow an emergency custody order to be extended to 8 hours
and matching emergency custody order criteria to commitment criteria (VT Panel
recommendation IV-13)
ü Require the independent evaluator and the treating
physician of a temporary detention order patient to be available during hearing
(VT Panel recommendation IV-20)
ü Require community services board staff to participate in
hearings (VT Panel recommendation IV-19)
ü Change the criteria for emergency custody and temporary
detention from the “imminent danger” terminology to: “substantial likelihood that in the near future
he will (a) cause serious physical harm to himself or another person, as
evidenced by recent behavior causing, attempting, or threatening such harm, or
(b) suffer serious harm due to substantial deterioration of his capacity to
protect himself from such harm or provide for his basic human needs” (VT Panel recommendation IV-15)
ü Clarify the roles and responsibilities of the community
services boards and the independent examiner throughout the detention process,
the commitment hearing, and the subsequent disposition (VT Panel recommendation
IV-17)
ü Explicitly authorize the disclosure of information between
providers in order to deliver, coordinate or monitor treatment, and between
providers and the courts to monitor and report on service delivery and
compliance with treatment (VT Panel recommendation V-22, 24)
“In
addition to properly funding our mental health care system, we must also ensure
an accountability structure that focuses on outcomes,” Governor Kaine
said. “Through the development of
service standards across the community services boards, we will move toward a
more uniform system of emergency response times, service admission criteria,
staff credentialing and training requirements, and of mandatory activities,
like attending temporary detention order hearings.”
To
further address accountability across the community services boards, the
Governor’s budget calls for additional staff to provide oversight for regional
and local services, to enhance accountability and to improve quality
management. These positions will monitor how service are delivered, measuring
them against recommended standards.
The
Governor has also recommended funding to expand a pilot program for jail
diversion services and to expand training for law enforcement responding to
crisis situations involving individuals with mental illness.
The
Governor’s budget includes:
ü $14.6 million over the biennium to improve emergency mental
health services, including around-the-clock emergency psychiatric consultation,
emergency clinicians and crises stabilization. The increase will assist
community services boards in providing legally mandated emergency services.
ü $8.8 million to increase the number of case managers for
mental health services provided through community services boards. A total of 106 additional case managers will
be hired by the end of the biennium.
ü $5.8 million to hire 40 clinicians specializing in
children’s mental health over the biennium. This funding will help serve
children who are not eligible for services through the Comprehensive Services
Act.
ü $4.5 million to increase availability of outpatient
clinicians and therapists at community services boards. These funds are
necessary to address significant delays in accessing outpatient mental health
services.
ü $875,000 over the biennium to create four positions to
expand monitoring and accountability of community services boards and to
develop core standards and service improvement plans. The addition of these
positions will allow for better oversight and monitoring of recent
community-based service expansion.
ü $6 million over the biennium to expand a pilot program for
jail diversion services funded in the 2006-08 biennial budget. It is
anticipated that these funds will provide diversion and wrap-around services
and support for an estimated 300-500 people.
ü
$600,000 over the biennium to establish a
training program for crisis intervention. The training will enable law
enforcement to respond to crisis situations involving individuals with mental
illness.
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