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Lawmakers: Continue mental health work

Richmond Times-Dispatch - 12/7/2016

The reluctant Board of Corrections would be charged with additional scrutiny of jail deaths as one of about a dozen proposals advanced Tuesday by the Joint Subcommittee Studying Mental Health Services in the 21st Century.

The move comes over the objections of the panel of seven citizens currently overseeing Virginia's system of local and regional jails, which wrote the proposal's architect in October expressing concerns about their capacity to investigate cases such as the death of Jamycheal Mitchell.

"This is what we're doing," said Del. Robert B. Bell, R-Albemarle, who developed the draft legislation in response to questions that still linger more than a year after Mitchell's August 2015 death at Hampton Roads Regional Jail. "We have a gap in oversight, and we need to fill the gap."

The proposal is an accountability outlier in a package of plans aimed largely at expanding and improving treatment and support services for those with mental illness, both in jails and in the community.

State Sen. R. Creigh Deeds, D-Bath, has said repeatedly since establishing the study in the wake of his son's suicide that he hoped the group would focus on the nuts and bolts of improving Virginia's fragmented system of care instead of becoming enmeshed in reacting to tragedies.

"It's about making a real difference in people's lives," Deeds said in an email Tuesday. "These proposals can begin the fundamental change that will create a state system of care out of a loose confederation that allows too many people to fall through the cracks."

The pitches Tuesday - for everything from same-day access to care at the 40 community services boards that form the backbone of Virginia's public mental health system to standardized mental health screenings for jails across the state - come as the four-year study was expected to enter its final year.

But toward the end of discussion Tuesday, group members said they thought the work had gained momentum this year and needed to continue, possibly carrying on as a permanent subcommittee.

Deeds initially said he doubted the legislature would support extending the work, but those concerns appeared to dissipate after state Del. S. Chris Jones, R-Suffolk, chairman of the House Appropriations Committee, emerged from the crowd in Senate Room A to voice his support for a two-year extension of the Dec. 1, 2017, deadline.

"I think that I can speak for a good majority of those who don't sit on this working group that y'all have done an outstanding job," Jones said. "For too long, it has not gotten the attention it needs. A great body of work has been done, but there's much more to be done."

Among the work that remains to be tackled: a potential overhaul of the structure of the mental health system. That process may take more than a year to complete.

"Do we need a Department of Behavioral Health and Developmental Services with 239 employees and a loose confederation of 40 service providers?" Deeds said. "What should the empire look like?"

Until a new structure is established, lawmakers are seeking ways to improve the system. Among the proposals recommended Tuesday:

A requirement that all CSBs offer same-day access and outpatient primary care screening by July 2018; and a phasing in of eight more required mental health services by 2021. The proposal would dramatically beef up services - only four of 40 CSBs currently offer same-day access - and clean up what's currently a patchwork of services across the state.A requirement that state officials develop a comprehensive plan by Nov. 1, 2017, for how those with serious mental illness can receive care when integrating back into society after a period of incarceration in a local or regional jail.A requirement that jails begin using a screening tool designated by state behavioral health officials to identify whether inmates entering the facility have a mental illness; and a requirement that if mental illness is identified, a qualified mental health professional must evaluate the person within 72 hours.A requirement that the Department of Housing and Community Development, in consultation with other agencies and stakeholders, develop and implement strategies for housing individuals with serious mental illness.

All told, the proposals would require the General Assembly to approve tens of millions more for mental health spending. The state is facing a $1.5 billion revenue shortfall when the assembly convenes in January.

Bell's jail oversight measure is aimed in part at strengthening protections for inmates diagnosed with a mental illness who cannot be adequately treated in a correctional setting, at a time when officials acknowledge that more people with mental illness are housed in jails than in state mental hospitals.

Although at least five entities reviewed Mitchell's case, none was able to reach a conclusion about how a physically healthy but mentally ill man was allowed to waste away in plain sight. A state medical examiner ruled that he died of complications from wasting syndrome after losing 46 pounds over his 101-day stay at the Portsmouth facility. He was arrested for allegedly stealing $5 in snacks from a 7-Eleven.

"This notion of everybody pointing fingers certainly leaves me uncomfortable," Bell said of the reports on Mitchell's case.

He said that as envisioned, his bill would require the Board of Corrections to submit their finding to state lawmakers, which would result in a report being published online.

Also at work are measures aimed at preventing so-called frequent flier users of local jails and state mental health facilities from ending up at either.

About 5,080 people with serious mental illness are in need of housing and other services that could help keep them stable, according to an analysis from the state Department of Behavioral Health and Developmental Services.

The subcommittee's housing work group is asking for $10 million in new funds for permanent supportive housing that would help 660 - about one in four - people identified among 2,684 identified by community services boards across the state as the top fifth of crisis and emergency services users.

Shifting resources to house those people and reducing the strain on emergency services would result in millions of dollars in savings annually, said Mira Signer, executive director of the National Alliance on Mental Illness of Virginia.

Signer said the people most in need of supportive housing in recent years have not been a priority "because when you have thousands of mentally ill people in jails hidden away who are voiceless, whose incarceration is largely funded by local governments, the state government gets away largely scot-free."

Bill Shelton, the head of the state housing and community development agency that would be assigned to oversee the implementation of those plans, said he would welcome the directive so long as it comes with support.

Providing rental subsidies to keep a roof over someone's head is not enough to guarantee stability in cases of serious mental illness, Shelton said.

"Those support services, quite frankly, are the most critical piece of this," he said.

He also said the agency would need adequate financial support and time. Although the department currently works to house those with mental illness, establishing the population as a priority would come at the expense of other vulnerable groups unless enough new resources were awarded to support the directive, he said.

"If we're just adding another priority without additional resources that's a concern," said Shelton, noting the agency has been focused on new strategies to house those with intellectual and developmental disabilities to bring the state in compliance with federal law.

Signer said vulnerable groups should not be pitted against one another.

"These are all needy and desperate populations," Signer said. "Virginia needs to stop shortchanging these folks, figure out how to fund housing, and provide it as a core service for certain populations, i.e. those with disabilities - all disabilities. There are thousands of mentally ill people "housed" in jails. How is that acceptable?"

kevans@timesdispatch.com

(804) 649-6922Twitter: @kburnellevans

skleiner@timesdispatch.com

(804) 649-6601Twitter: @sarahkleiner9