2014 Virginia Mental Health Law Changes


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2014 Virginia Mental Health Law Changes, Jim Martinez at live session of May 20, 2014:

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2014 Virginia Mental Health Law Changes

  2. 2. GOALS FOR WEBINAR Part 1 Brief review Background on Virginia’s involuntary admission process Major changes for 2014 in Virginia law governing involuntary admissions Part 2 Case Examples Review selected cases Practice applying clinical knowledge and Virginia law
  4. 4. VIRGINIA AND OTHER STATES’ LAWS  This presentation [Part 1] includes material about Virginia’s involuntary treatment process for people with mental illness, which is based on Virginia law.  Individual states all have their own involuntary treatment laws.  State laws in this area are rooted in the Constitution and Supreme Court decisions. They share many similarities but are rarely identical. Standards and procedures can also be very different from state to state.  The situations discussed here are relevant anywhere, so it’s important to know the laws of your state.
  5. 5. THE INVOLUNTARY ADMISSION PROCESS • INVOLUNTARY ADMISSION IS THE CIVIL COURT PROCESS BY WHICH A PETITION IS FILED TO INITIATE INVOLUNTARY PSYCHIATRIC TREATMENT FOR A PERSON WHO NEEDS CARE BUT WHO IS UNWILLING, OR INCAPABLE OF VOLUNTEERING FOR TREATMENT (CODE OF VIRGINIA, §37.2-808, ET. SEQ) • The petition is adjudicated by a judge or special justice at a formal court hearing. • Due process protections are important, but balancing rights of individuals with community interests and public safety can often be difficult. Treatment resources are limited and controversies abound. • Procedures seem simple, but effective implementation is a complex task under best of circumstances.
  6. 6. *Operational procedures vary considerably by locality VIRGINIA’S INVOLUNTARY ADMISSION PROCESS Basic Steps*CSB Crisis Contact Court Hearing on Petition Emergency Custody Temporary Detention Release or Dismissal Mandatory Outpatient Treatment Voluntary Inpatient Involuntary Inpatient
  7. 7. 2014 CHANGES IN VIRGINIA LAW • Mental health legislation and studies were driven by Sen. Deeds’ family experience • Over 35 bills related to involuntary treatment process filed by legislators • The most significant changes were in the emergency custody and temporary detention procedures.
  8. 8. VIRGINIA’S INVOLUNTARY ADMISSION PROCESS Most significant 2014 legislative changes were in ECO and TDO process CSB Crisis Contact Court Hearing on Petition Emergency Custody Temporary Detention Release or Dismissal Mandatory Outpatient Treatment Voluntary Inpatient Involuntary Inpatient
  9. 9. Emergency custody and temporary detention are not required for every involuntary admission i.e., - ECO is not required for temporary detention - TDO is not required for commitment hearing BUT Both procedures are needed for due process, practical and clinical reasons: • Emergency custody allows a safe, in-person exam to confirm clinical condition and need for temporary detention or possible involuntary hospitalization. • Temporary detention keeps the person safe, enables treatment to start, and allows time to prepare for a fair court hearing. PURPOSE OF EMERGENCY CUSTODY AND TEMPORARY DETENTION
  10. 10. EMERGENCY CUSTODY SB260/HB478 ECO valid up to 8 hours from time of execution • 8-hour period applies to ECOs issued by magistrate and “paperless” ECOs (or “officer- initiated” ECOs) • Old law was 4 hours, with one possible 2-hour extension • No extension provision in new law ECO must be executed within 8 hours of issuance (ECO becomes void if not executed) • Old law was 6 hours 0 8 hrs
  11. 11. EMERGENCY CUSTODY SB260/HB478 Law enforcement agency that executes an ECO must notify the CSB responsible for conducting the evaluation as soon as practicable after taking the person into custody Notification requirement applies to paper ECOs and “paperless” ECOs The person taken into emergency custody must be given a written summary of the emergency custody procedures and the statutory protections associated with those procedures Written summary will be available from the courts for law officers (and others) to print and hand out.
  12. 12. DETERMINING TEMPORARY DETENTION FACILITY SB260/HB293 Upon receiving notification of the need for an evaluation, the CSB must contact the primary state facility and notify the facility that the individual will be transported to that facility upon the issuance of a TDO if an alternative facility cannot be identified by the expiration of the 8 hour emergency custody period Upon completion of the evaluation, CSB must provide information about the individual to the state facility to help the state facility determine the services the individual will need if admitted. Once notified, the state facility may search for an alternative facility State facility may contact another state facility if it is unable to provide temporary detention and appropriate care If state facility finds an alternative facility, it shall notify the CSB and the CSB shall designate the alternative facility on the preadmission screening report A state facility shall not fail or refuse to admit an individual who meets the criteria for a TDO unless an alternative facility agrees to accept the individual An individual who meets the criteria for a TDO shall not be released If a facility of temporary detention cannot be identified by the expiration of the 8-hour emergency custody period, the individual shall be detained in the state facility State facility shall be indicated on the TDO
  13. 13. CHANGE OF TEMPORARY DETENTION FACILITY HB 1172 CSB may change the facility of temporary detention and designate an alternative facility at any point during the period of temporary detention • CSB must determine that the alternative facility is a more appropriate facility given the specific security, medical, or behavioral needs of the person • CSB must provide notice to the clerk of the court of the name and address of the alternative facility If temporary detention facility is changed, then transportation is provided in accordance with § 37.2-810 • If law enforcement or an alternative transportation provider has custody of the person when the change is made, individual shall be transported to alternative facility • If individual has already been transported to initial TDO facility, CSB shall request an order from the magistrate specifying an alternative transportation provider or (if no alternative provider is available), the local law enforcement agency where the person resides or is located, if 50- mile rule is applicable
  14. 14. TEMPORARY DETENTION S260/HB478 • The person detained shall be given a written summary of the temporary detention procedures and the statutory protections associated with those procedures • Written summary will be on back of temporary detention order SB260/HB574 • Commitment hearing shall be held within 72 hours of execution of the TDO. [If 72-hour period ends on a Saturday, Sunday, legal holiday, or day on which the court is lawfully closed, person may be detained until COB on the next business day when the court is open] • Old law was 48 hours maximum before hearing
  15. 15. IMPLICATIONS OF ECO AND TDO LAW CHANGES TO SYSTEM • No individual will be released from emergency custody who needs involuntary treatment • State hospitals will be the “facility of last resort”, and cannot refuse an admission when no other facility can be found • Changes may alter decision–making paradigm of emergency departments, community psych hospitals, community services boards, law officers, and others when evaluating risk and response to individuals experiencing mental health crises • State hospital capacity likely to be stretched or strained
  16. 16. IMPLICATIONS OF ECO AND TDO LAW CHANGES TO PRACTICE • Effective utilization of limited state hospital resources will be important (managing the front-door and the back door). • Minimize use of involuntary or judicial intervention whenever possible. Use advance planning strategies (e.g., advance directives, WRAP) to help prevent and manage crises, and reduce coercive care. • Careful screening and assessment will be critically important, especially medical screening and medical assessment. • Good collaboration with safety net partners is essential to deliver effective care for individuals and families. Build and sustain these relationships actively. • Be proactive is dealing with safety net “glitches.”
  17. 17. VIRGINIA PSYCHIATRIC BED REGISTRY SB260/HB1232 DBHDS to develop and administer a web-based acute psychiatric bed registry to show available acute beds in public and private inpatient psychiatric facilities and residential crisis stabilization units, Registry intended to help identify willing and available facilities for temporary detention of individuals who meet the TDO criteria Registry in operation as of March 3, 2014 (Legislation was effective upon signing by Governor)
  18. 18. Bed registry includes: Descriptive information about each inpatient facility or crisis stabilization unit Contact information Real-time information about Number of beds curently available Type of patients that may be admitted Level of security provided Other information to help identify appropriateness for temporary detention
  19. 19. BED REGISTRY Required facility listings are: • State facilities • CSBs residential crisis stabilization units • Private inpatient providers licensed by DBHDS Registry allows searches by: • CSBs • Inpatient psychiatric facilities • Residential crisis stabilization units • Health care providers working in an ER or other facility rendering emergency medical care
  20. 20. CSB EVALUATORS – STUDY SB261/HB1216 • DBHDS to review the required qualifications, training, and oversight of individuals performing preadmission screening evaluations • Make recommendations for increasing qualifications, training, and oversight • Report findings to the Governor and General Assembly by December 1, 2014