Final Report of the SJ 47 Statewide TDO Task Force

J.E., Oliver, R.J. Bonnie
March, 2019

PRODUCED BY THE
Institute of Law, Psychiatry, and Public Policy at the University of Virginia

This final report of the SJ 47-initiated TDO Task Force summarizes and updates the key findings and recommendations from the December 2018 Task Force Report, together with “next steps” that the Task Force was expecting to address in the anticipated second year of work before the General Assembly directed the Secretary to establish the SB 1488 Work Group to address the TDO crisis.

The TDO patient crisis in state hospitals: contributing factors, possible responses and continuing challenges

S.A. Larocco, R.J. Bonnie
December, 2018

PRODUCED BY THE
Institute of Law, Psychiatry, and Public Policy at the University of Virginia

These data regarding the increase in TDO admissions to state hospitals were presented at the December 4, 2018 TDO Task Force meeting. Ashleigh Allen updated the slides with the most up-to-date data in April, 2019.

Mental Health Crisis Emergency Response: Improving Care for People in Crisis in Virginia

Report to SJ 47 Joint Subcommittee and the Statewide Stakeholder Task Force Summarizing Deliberations of Regional Stakeholders Meetings

October, 2018

PRODUCED BY THE
Institute of Law, Psychiatry, and Public Policy at the University of Virginia

In response to the current crisis, the Joint Subcommittee to Study Mental Health Services in the 21st Century established a statewide Task Force to conduct a comprehensive study of the factors contributing to the crisis and to identify possible solutions. In collaboration with the SJ 47 Expert Panel on Emergency Services and Crisis Response, the Task Force convened stakeholder meetings over the course of several months in 2018 in each of the five Primary DBHDS Regions in Virginia. This preliminary report summarizes the observations, viewpoints, and recommendations that emerged out of that process. In addition, specific proposals for changes to or additional services for the crisis response system have been developing, with some of them emerging out of the regional meeting process and others having already started independently. Those service proposals, which are in various stages of conceptual development, are briefly described at the end of the report along with recommendations for how their development may be supported by financial or statutory actions of the General Assembly.

Developments in Mental Health Law

Volume 37, Issue 2, Winter 2018/2019

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This issue of DMHL presents (a) commentary regarding extreme risk protection orders; (b) an article from the American Psychiatric Association that provides an overview of risk-based gun removal laws; and (c) outlines of significant recent cases in various federal and state courts.

In This Issue:

I. Commentary: Extreme Risk Protection Orders — Effective Tools for Keeping Guns out of Dangerous Hands [p.2]

II. Article: APA Resource Document on Risk-Based Gun Removal Laws [p.6]

III. Case Law Developments
United States Supreme Court [p.17]
Federal Circuit Court Decisions [p.18]
State Court Decisions [p.26]

IV. Institute Programs [p.29]

Regional Variations in Civil Commitment Proceedings for Adults in Virginia, FY 2016

TM Ko, AA Allen, KM Faris
February, 2019

PRODUCED BY THE
Institute of Law, Psychiatry, and Public Policy at the University of Virginia

This report addresses regional variations in Emergency Custody Orders (ECOs), Temporary Detention Orders (TDOs), the disposition of commitment hearings, commitment orders, and other actions related to civil commitment for FY 2016.

Characteristics of Adult Residential Crisis Stabilization Units in Virginia

S.A. Larocco
October, 2018

PRODUCED BY THE
Institute of Law, Psychiatry, and Public Policy at the University of Virginia

In recent years there have been dramatic increases in admissions to both public and private hospitals. Residential crisis stabilization units (CSUs) have been suggested as a possible solution to this problem, allowing an alternative environment where people in crisis can go instead of the hospital. This report explores the characteristics of Virginia’s adult CSUs, including the populations they work with and the features and resources that allow them to do their work. CSUs work with patients with depression, anxiety, bipolar disorder, post-traumatic stress disorder or substance use disorder, but they are not equipped to care for patients with medical complexities.

Children’s Residential Crisis Stabilization Units

S.A. Larocco
August, 2018

PRODUCED BY THE
Institute of Law, Psychiatry, and Public Policy at the University of Virginia

As psychiatric hospitalizations increase in Virginia and the census at the Commonwealth Center for Children and Adolescents is at an all-time high, advocates and policymakers look for alternatives to hospitalization to ameliorate the problem. One such alternative is the crisis stabilization unit, a therapeutic environment for people in a sub-acute state of crisis. Current approaches used in these programs are geared toward patients with depression, anxiety, post-traumatic stress disorder, substance use disorders and executive functioning deficits.

Developments in Mental Health Law

Volume 37, Issue 1, Spring 2018

 

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This issue of DMHL presents two updates on Virginia mental health law and mental health initiatives including an overview article SJ 47 Joint Subcommittee: Mental Health Initiatives at the 2018 General Assembly Session; (b) a Data Corner discussing Incidence and Characteristics of TDOs in Psychiatric Admissions to UVA Hospital in 2015; and (c ) outlines of significant recent cases in various federal and state courts.

In This Issue:

I. Article: SJ 47 Joint Subcommittee: Mental Health Initiatives at the 2018 General Assembly Session [p. 1]

II. Update: Mental Health Related Bills Introduced in the 2018 General Assembly Session [p.12]
Bills Related to Mental Health That Have Survived [p.13]
Bills Carried Over to the 2019 Session [p.23]
Bills Related to Mental Health That Did Not Survive [p.24]

IV. Case Law Developments
United States Supreme Court [p.34]
Federal Circuit Court Decisions [p.35]
State Court Decisions [p.40]

V. Institute Programs [p.47]

Increased Utilization of State Hospitals from Fiscal Year 2017 to 2018

S.A. Larocco, R.J. Bonnie
April, 2018

PRODUCED BY THE
Institute of Law, Psychiatry, and Public Policy at the University of Virginia

Over the past three years, temporary detention order (TDO) admissions to state psychiatric hospitals have been on the rise in Virginia. The current report focuses on increases in TDO admissions to state hospitals from the first half of fiscal year 2017 to the first half of fiscal year 2018. Fiscal year 2018 saw the greatest increase in TDOs to state hospitals in recent history, largely the result of reduced TDO admissions to private hospitals.

Trends in Utilization of Adult Psychiatric Beds in Virginia

R.J. Bonnie, S.A. Larocco
February 2018

PRODUCED BY THE
Institute of Law, Psychiatry, and Public Policy at the University of Virginia.

Over the past five years, admissions to state psychiatric hospitals have increased by 55%. This report looks at the changing nature of those admissions, as admissions under temporary detention orders are taking up an increasing share of hospital capacity. The greatest increase in state hospital admissions occurred in the 2016 fiscal year, and this increase was driven by temporary detention orders. Forensic admissions have been increasing steadily, but more slowly, and other civil admissions have been in sharp decline.

Development in Mental Health Law

Volume 36, Issue 3, Fall 2017

 

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This issue of DMHL presents a feature article - An Opportunity for Further Reflection on Police Encounters with People in Mental Health Crisis – by Stephen L. Braga, Professor of Law, University of Virginia School of Law. Outlines of significant recent cases in various federal and state courts are also in this DMHL including cases involving due process with violent sex offenders, Eighth Amendment rights of jail inmates, forcible administration of antipsychotic medication, and other cases.

In This Issue:

I. Article: Holloman v. Markowski: An Opportunity for Further Reflection
on Police Encounters with People in Mental Health Crisis [p. 1]

II. Editor’s Comment: Excessive Force Jurisprudence and Police Encounters
with People in Mental Health Crisis [p. 16]

III. Case Law Developments
Federal Circuit Court Decisions [p. 22]
State Court Decisions [p. 30]

IV. Institute Programs [p. 40]

Characteristics of Communities Associated with Increased Utilization of State Hospitals

S.A. Larocco, R.J. Bonnie
December 2017

PRODUCED BY THE
Institute of Law, Psychiatry, and Public Policy at the University of Virginia.

Over the past three years, temporary detention order (TDO) admissions to state psychiatric hospitals have been on the rise in Virginia. This removes patients from their communities and creates unsafe conditions as state hospital utilization rises well above 90%. A previous report has identified some of the important events associated with the increase in the number of TDOs across the Commonwealth since 20141. The current report focuses on increases in TDO admissions to state hospitals. Much of the increase in TDOs to state hospitals is driven by increases in TDOs in general, especially in the Northern Virginia Mental Health Institute (MHI), Western State and Catawba catchment areas. There was, nonetheless, a substantial part of the increase attributable to changes in private hospital acceptance of patients under a TDO, especially in the Central State and Southwestern MHI catchment Areas.

Mental Illness in Jails Supplement, FY 2016

University of Virginia Institute of Law, Psychiatry and Public Policy
S.A. Larocco
April, 2017

Virginia’s Compensation Board provided data on jail inmates with mental illness. A previous report has been written that describes that data. This analysis expands on that report, providing additional detail on diverse components of the dataset such as inmate aggression and mental health screening.

Mental Illness In Jails Supplement, FY 2015

University of Virginia Institute of Law, Psychiatry and Public Policy
S.A. Larocco
April 2017

Virginia’s Compensation Board provided data on jail inmates with mental illness. A previous report has been written that describes that data. This analysis expands on that report, providing additional detail on diverse components of the dataset such as inmate aggression and mental health screening.

Rise in Temporary Detention Orders in Virginia, 2013-2017: Possible Contributing Factors

University of Virginia Institute of Law, Psychiatry and Public Policy
S A Larocco, R J Bonnie, H Zelle
January, 2017

From 2013 through 2017, there has been a substantial increase in temporary detention orders (TDO) in Virginia. State hospitals are absorbing an increasing number of these patients. This report explores various theories put forth to explain the increase in temporary detention orders in general. Factors that appear to have contributed to the increase in temporary detention orders in general include attention to the death of Austin Deeds, the implementation of the Governor’s Access Plan, and the opening of increasing numbers of crisis intervention team assessment centers, although other factors may have had subtle effects as well.

Developments in Mental Health Law


Volume 36, Issue 2, Summer 2017

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This issue of DMHL presents two premier articles on gun violence: a.The Gun Violence Restraining Order: An Opportunity for Common Ground in the Gun Violence Debate and b. Doctors, Patients, and Guns: The First Amendment Rights of Doctors to Counsel Patients about Gun Safety and the Statutory Privacy Rights of Firearm Owners. Case Law Developments in federal and states courts are highlighted.

In This Issue:

I. Article: The Gun Violence Restraining Order: An Opportunity for Common Ground in the Gun Violence Debate [p. 1]

II. Summary Tables of Preemptive Firearm Removal Statutes [p. 23]

III. Article: Doctors, Patients, and Guns: The First Amendment Rights of Doctors to Counsel Patients about Gun Safety and the Statutory Privacy Rights of Firearm Owners [p. 29]

IV. Case Law Developments
United States Supreme Court Decision [p. 35]
Federal Circuit Court Decisions [p. 36]
State Court Decisions [p. 42]

V. Institute Programs [p. 51]
 

Telemental Health in Emergency Settings

AA Allen and KM Faris
June 2017

PRODUCED BY THE
Institute of Law, Psychiatry, and Public Policy at the University of Virginia.
PREPARED FOR
The Joint Subcommittee to Study Mental Health Services in the Commonwealth in the 21st Century
WITH SUPPORT FROM THE
Department of Behavioral Health and Developmental Services

“Smart Practices” for Community Services Boards Learned from the Field

The following report was created to support “SJ-47” – the Joint Subcommittee to Study Mental Health Services in the Commonwealth in the 21st Century, specifically, the work of the Emergency Services Expert Advisory Panel. Telemental health has been frequently discussed by the panel as a way to enhance emergency services. In order to inform the panel and Community Services Boards (CSBs) statewide on how telemental health can be used specifically to enhance emergency services, researchers from the Institute of Law, Psychiatry, and Public Policy (ILPPP) have been looking closely at existing emergency telemental health practices and their current and potential use in emergency departments and other emergency settings. Researchers interviewed five CSBs who were identified as using emergency telemental health services through ILPPP surveys of CSBs in 2016. Two hospitals that have partnered with Fairfax-Falls Church CSB were also identified during the interview process and contacted for interviews on their experiences and perspectives on their internal use of telemental health and their telemental health partnerships with Fairfax-Falls Church CSB.

This report, using the experiences and examples provided by these existing programs, provides “smart practice” recommendations for CSBs when implementing and structuring an emergency telemental health program. The recommendations were formed after speaking with the five CSBs that either currently have an operating emergency telemental health program or are in the process of implementing a program. The recommendations themselves come from researchers’ synthesis of information gained from the interviews and from recommendations offered by CSBs and CSB partners.

We would like to thank the CSBs, hospitals, and VACSB who contributed their time and expertise to this report. Your contributions are greatly appreciated.