The last week of the 2019 General Assembly Session is drawing to a close. Conference committees are trying rapidly to come to agreement and produce a final compromise. The budget conferees just reached agreement, and the details should be available soon. I will provide an update on the budget in the coming days.
I’ve been using some time this past week to meet with various shareholders to make certain that the work of the Joint Subcommittee on Mental Health is planned out for the next nine months or so. I carried legislation (SJ 301) this year that passed both the House and the Senate extending the work of the Subcommittee through 2021. What I have found is that despite our best intentions to complete the work in timely manner, the work goes on. Transforming mental health care into a true system is monumental work. The slow progress is frustrating but ultimately rewarding.
These planning meetings with staff are intended to develop strategic work plans to ensure we stay on target in reaching our goal of building an integrated system statewide so that people in crisis or in need of help can access care no matter where they live. There are several things on which we are working.
The Joint Legislative Audit and Review Commission (JLARC) will be researching and developing funding options for community services boards (CSBs). Two years ago we passed STEP-VA to radically redefine the responsibilities of the CSBs. However, the ramp up in services is useless without sufficient funding. We need to determine the right balance in the responsibility of local government and the state in funding the build-out of services under STEP-VA. We cannot settle for window dressing. We need to make certain the services are available to anyone who needs the service regardless of where they live. We have so much work to do to get there.
At the same time, we are working to determine how our system of mental health hospitals should look. We currently have 10 public hospitals and spend about half of our mental health dollars in the state on hospital care. On average, other states spend about 22% of mental health money on hospitals. While we have heard those statistics repeatedly, it remains unclear what is driving that difference.
Coincident with that, we are having a crisis with our mental health hospitals that is driven in part by involuntary commitments, and we are looking very hard at the whole temporary detention order (TDO) admission process. We have almost five years of experience with the reforms passed in 2014, and the time has come to explore anew our emergency custody order and TDO processes.
At the same time, we are considering steps that would remake the Department of Behavioral Health and Developmental Services. One of the items under consideration is an increase in the regional presence of the Department so we can provide more accountability, oversight, and direction for CSBs.
While all of those discussions move forward, we have not lost sight of the fact that we continue to reinstitutionalize many individuals with mental health conditions in our jails and prisons. We need to redouble efforts to divert as many people as possible from the criminal justice system. We recognize that some people with mental health conditions will wind up in jail or prison, and it is beneficial to the individual and the community to ensure proper discharge planning for those individuals.
In the meantime, we still have an extraordinary barriers list of about 140 people who have been in our state psychiatric hospitals and ready for discharge for more than six months. The people on this list simply have nowhere to go, and we cannot release them to the street. This population puts extraordinary pressure on our system, filling limited hospital beds when they can be better served in the community. We have to do a better job of addressing this population.
I will stand for reelection to continue this work and to work for opportunity for all the people of the Commonwealth and for the people of the 25th Senatorial District.
Thank you for allowing me to serve you in the Senate of Virginia. If I can provide assistance, I can be reached beginning next week at my law office in Hot Springs at (540) 839-2473 or in Charlottesville at (434) 296-5491 or by email at [email protected].