Previous Page  6 / 32 Next Page
Show Menu
Previous Page 6 / 32 Next Page
Page Background







, W




Mental health and related challenges

such as substance use disorder have gained

traction in the dialogue about enhancing

population health. Attention on these

issues is a good thing— it means stigmas

associated with mental health challenges,

while still persistent, are receding as

public awareness about treatment needs


Virginians are familiar with these

issues through high-profile events that left

us shocked and heartbroken in the face

of tragedy. Closer to home, there are countless personal examples

of families dealing with a loved one experiencing mental health

challenges. Indeed, behavioral health issues have touched nearly

every Virginian in some form.

Across the Commonwealth, law enforcement deals with the

challenges, as do health care and behavioral health providers, our

public leaders, and many other advocates and stakeholders. As with

any illness, the failure to properly address mental health needs can

have serious consequences.

That’s why the Virginia Hospital & Healthcare Association is

pleased to announce its 2017 behavioral health legislative package,

an agenda for long-term success, driven by bi-partisan solutions,

and stakeholder outreach. Virginia leaders and advocates in recent

years have collaborated to enhance mental health policy to better

serve patients. The VHHA package reflects hospitals’ continuing

contribution to that work. Hospitals play a key role in meeting

patients’ mental health treatment needs. For instance, private

hospitals provide 1,300 of the roughly 2,922 psychiatric beds

in Virginia.

Mental health challenges are not uncommon in Virginia where,

in 2014, more than 1.1 million adults were diagnosed with Any

Mental Illness (AMI). Also that year, 213,565 adults were identified

as having a serious mental illness (SMI). Almost half of those

people went without treatment.

While we’ve seen commendable work done on mental health

issues over the years, more can be done. And that’s why Virginia’s

hospital community is engaging with stakeholders on ways to

enhance services. Over the past six months, VHHA has worked with

the Virginia College of Emergency Physicians to identify baseline

standards for conducting a medical assessment of people presenting

with a psychiatric illness, commonly known as medical clearance.

Enhancements in medical assessment procedures will allow patients

to begin treatment quicker.

We’ve met with the Virginia Sheriffs’ Association and the

Virginia Ambulance Association for conversations about identifying

opportunities to improve mental health transportation. We’ve

participated in discussions with some regional Community Services

Boards to improve the identification of inpatient psychiatric beds

for patients under a Temporary Detention Order (TDO). And

VHHA hospital members continue efforts to identify solutions to

issues around the delivery of behavioral health care and to find

more opportunities to partner with external stakeholders.

Our four legislative recommendations are critically important

proposals to improve mental health care in Virginia. We are thankful

to have a bipartisan group of legislators sponsoring them, including

Senator George L. Barker (D-Fairfax County), Senator A. Benton

“Ben” Chafin Jr. (R-Russell County), Senator Janet D. Howell

(D-Fairfax County), Delegate Roxann L. Robinson (R-Chesterfield

County), and Delegate Joseph R. Yost (R-Giles County).The

proposals focus on the emergency psychiatric evaluation process,

inpatient bed identification, commitment hearings, and funding

to support the behavioral health needs of families, friends, and

neighbors in the communities hospitals serve. They include:

Preadmission Screening Evaluations

One challenge in getting patients who are in psychiatric crisis

the necessary care is that CSB emergency evaluators can’t always

reach emergency departments swiftly to start the psychiatric pre-

screening process. That can delay the start of treatment when timing

is critical, especially for patients under an emergency custody order

due to a state law providing an eight-hour evaluation period for

patients to either be detained or discharged. In response to situations

when a CSB evaluator can’t arrive within two hours of a call for

a preadmission screening, proposed legislation would authorize

alternative behavioral health professionals to conduct emergency

psychiatric evaluations.

Emergency Department Psychiatric Patient Registry

Virginia’s Psychiatric Bed Registry on its own isn’t sufficiently

reducing delays in identifying available inpatient psychiatric beds

for patients under a TDO. Proposed legislation would authorize

the development of a psychiatric patient registry to store de-

identified information about every psychiatric patient in need of

an inpatient bed. Hospitals with available beds can find potential

patients to admit through the patient registry, which would be used

in conjunction with the Bed Registry.

24-Hour TDO Stabilization Period

TDO patients’ commitment hearings sometimes occur too soon,

preventing a patient from receiving treatment and stabilizing before

a commitment decision is made. Insufficient patient evaluation and

crisis stabilization can contribute to higher rates of involuntary

commitment and longer hospital stays.

Proposed legislation would mandate that patients under a TDO

are stabilized and treated for up to 24 hours before appearing at a

commitment hearing. This proposal would not alter current state

law granting physicians providing care the authority to discharge a

patient who is determined to no longer need psychiatric care at any

time within the TDO period.

Local Inpatient Purchase of Service (LIPOS) Funding

Current use of LIPOS, or Local Inpatient Purchase of Service

funding, is limited to involuntarily committed patients at a private

hospital. Expanded use of these funds for patients in need of

voluntary or involuntary psychiatric care will improve access to

care for all patients. Proposed budget language would seek a state

study regarding the potential authorization of greater flexibility in

the use of LIPOS funds linked to patient clinical needs rather than

commitment status.

During the 2017 Virginia General Assembly session, Virginia’s

hospital and health system community stands ready to work with

lawmakers, advocates, and other stakeholders on these and other

policy ideas developed to enhance treatment and care options for

patients experiencing mental health challenges.

Jennifer Wicker is Intergovernmental Affairs Director for VHHA.

She previously served as Deputy Legislative Director for Virginia

Governor Terence R. McAuliffe, as Legislative Coordinator for

former Richmond Mayor Dwight C. Jones, and as Legislative

Assistant for two members of the Virginia House of Delegates.

She also has experience in the financial sector. Wicker earned a

Bachelor’s Degree from Randolph-Macon College, a Master’s

Degree in Social Work from Virginia Commonwealth University,

and has a Certificate in Non-Profit Management.

Pursuing Bi-Partisan Solutions

to Enhance Behavioral Health

By Jennifer Wicker Virginia Hospital & Healthcare Association

Director of Intergovernmental Affairs