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.

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.

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.

Annual Statistical Report Adult Civil Commitment Proceedings in Virginia FY 2016

University of Virginia Institute of Law, Psychiatry and Public Policy
AA Allen and TM Ko
January 2017

Annual Statistical Report: Adult Civil Commitment Proceedings in Virginia, FY 2016. The report is published by Institute of Law, Psychiatry and Public Policy, and has been funded by the Virginia Department of Behavioral Health and Developmental Services in cooperation with the Office of the Executive Secretary of the Supreme Court of Virginia. For citation the report's authors are AA Allen and TM Ko (January 2017).

Annual Statistical Report Adult Civil Commitment Proceedings in Virginia FY 2015

University of Virginia Institute of Law, Psychiatry and Public Policy
AA Allen, JK Bonnie
December 2015

Annual Statistical Report: Adult Civil Commitment Proceedings in Virginia, FY 2015. The report is published by Institute of Law, Psychiatry and Public Policy, and has been funded by the Virginia Department of Behavioral Health and Developmental Services in cooperation with the Office of the Executive Secretary of the Supreme Court of Virginia. For citation the report's authors are AA Allen and JK Bonnie (December 2015).

Decisions to Initiate Involuntary Commitment: The Role of Intensive Community Services and Other Factors

Elizabeth Lloyd McGarvey, Ed.D., MaGuadalupe Leon-Verdin, M.S., Tanya Nicole Wanchek, Ph.D., J.D., and  Richard J. Bonnie, LL.B.

Objective: This study examined the predictors of actions to initiate involuntary commitment of individuals experiencing a mental health crisis. Methods: Emergency services clinicians throughout Virginia completed a questionnaire following each face-to-face evaluation of individuals experiencing a mental health crisis. Over a one-month period in 2007, a total of 2,624 adults were evaluated. Logistic hierarchical multiple regression was used to analyze the relationship between demographic, clinical, and service-related variables and outcomes of the emergency evaluations. Results: Several factors predicted 84% of the actions taken to initiate involuntary commitment. These included unavailability of alternatives to hospitalization, such as temporary housing or residential crisis stabilization; evaluation of the client in a hospital emergency room or police station or while in police custody; current enrollment in treatment; and clinical factors related to the commitment criteria, including risk of self-harm or harm to others, acuity and severity of the crisis, and current drug abuse or dependence. Conclusions: A lack of intensive communitybased treatment and support in lieu of hospitalization accounted for a significant portion of variance in actions to initiate involuntary commitment. Comprehensive community services and supports for individuals experiencing mental health crises may reduce the rate of involuntary hospitalization. There is a need to enrich intensive community mental health services and supports and to evaluate the impact of these enhancements on the frequency of involuntary mental health interventions. (Psychiatric Services 64:120–126, 2013; doi: 10.1176/ appi.ps.000692012)

Use of Longer Periods of Temporary Detention to Reduce Mental Health Civil Commitments

Tanya Nicole Wanchek, Ph.D., J.D. and Richard J. Bonnie, LL.B.

Objective: This study examined whether lengthening the holding period for an individual experiencing a mental health crisis under a temporary detention order (TDO) can reduce the number and length of postTDO involuntary hospital commitments. Methods: Data from the Virginia Court System were matched to the Commonwealth of Virginia Medicaid claims database for July 1, 2008, through March 30, 2009. The final data set included 500 Medicaid recipients who had a mental health diagnosis and at least one TDO during the study period. Covariates included sex, race, age, primary diagnosis, and Community Service Board serving the individual. Logistic and multivariate regression models were used. Results: Longer TDO periods were correlated with an increased probability of a dismissal of the commitment petition rather than hospitalization after a TDO. Among individuals who were hospitalized, longer TDO periods were correlated with an increased likelihood of voluntary hospitalization, rather than involuntary commitment, and shorter hospitalizations, although the net care time (TDO period plus post-TDO hospitalization) increased for individuals whose TDO length was greater than 24 hours. Conclusions: Longer TDO periods were correlated with shorter hospital stays and fewer involuntary commitments. These findings support previous work showing that short TDO periods provide insufficient time to stabilize and evaluate individuals. More research is needed to establish a causal link between TDO length and health outcomes. (Psychiatric Services 63:643–648, 2012; doi: 10.1176/appi.ps.201100359)

Commission on Mental Health Law Reform

Statistical Report of Mental Health Proceedings in FY 2011

In this report, the Commission estimates the numbers of ECOs, TDOs, commitment hearings and dispositions in FY 2011 and, to the extent possible, assess whether commitment practices have changed in the wake of the recent reforms.

Commission on Mental Health Law Reform

Civil Commitment Hearings: District Court Variations, July 2010 – June 2011

In this report, the Commission summarizes the disposition of commitment hearings for FY 2011. The data presented below pertain only to hearings involving adult respondents not already under a commitment order or in penal confinement at the time of the hearing. (In other words, the data exclude recommitment hearings as well as cases involving juveniles or persons in jail.) We refer to these hearings as “initial commitment hearings.”

Commission on Mental Health Law Reform

Civil Commitment Hearings: District Court Variations, July 2009 -  June 2010

In this report, the Commission summarizes the disposition of commitment hearings for FY 2010. The data presented below pertain only to hearings involving adult respondents not under a commitment order or in penal confinement at the time of the hearing. (In other words, the data exclude recommitment hearings as well as cases involving juveniles and persons in jail.) We refer to these hearings as “initial commitment hearings.”

Virginia Civil Commitment Procedure and Practice

Policy Analysis and Recommendations to Increase Voluntary Admission

What policy changes can the Virginia Commission on Mental Health Law Reform recommend and implement to reduce the number of involuntary commitments in favor of voluntary admission? The Commonwealth of Virginia Commission on Mental Health Law Reform (the Commission), is tasked with improving mental health laws, procedure, and policy to better serve people with mental illness. One of the Commission’s goals is to increase the fairness and effectiveness of the civil commitment process. All of the analysis presented in this report is the result of extensive inquiry. With the aid of quantitative data, I was able to identify and target areas of the state with large variation in involuntary commitment rates among either Community Service Boards (CSBs) or special justices. I interviewed CSB emergency services managers and special justices about their operating procedures and attitudes concerning civil commitment. I also spoke with mental health experts and hospital officials including doctors, intake coordinators, personnel managers, nurses, and social workers. While current civil commitment procedure in Virginia allows individuals suffering from mental health crises to admit themselves voluntarily, many people do not. There are several reasons beyond a lack of capacity that might influence a person’s decision not to agree to care voluntarily. Based on my research and analysis, I recommend five specific policies that the Commission could adopt or recommend to encourage the election of voluntary admission by people with mental illnesses in lieu of involuntary commitment.

A Study of Civil Commitment Hearings Held in the Commonwealth of Virginia During May 2007

The following is a summary of the key findings of the Commission on Mental Health Law Reform’s Study of Civil Commitment Hearings Held in the Commonwealth of Virginia During May 2007 (the “Commission’s Hearing Study”). The Commission’s Hearing Study was designed to examine the prehearing, hearing, and disposition phases of civil commitment proceedings in Virginia for both adults and children. Civil commitment proceedings, which can result in the involuntary inpatient hospitalization of individuals with severe mental illness, operate under a detailed statutory framework and engage law enforcement, health professionals and courts. The study was designed to provide a window into how the civil commitment process functions in Virginia. A complete description of the findings is contained in the full report.

Study of Emergency Evaluations

Conducted by Emergency Services Personnel in Community Services Boards, June 2007

A Report to the Commission on Mental Health Law Reform

The following is a summary of the key findings of the Commission on Mental Health Law Reform’s Study of Emergency Evaluations Conducted by Emergency Services Personnel in Community Services Boards, June 2007 (the “Commission’s CSB Study”). The Commission’s CSB Study was designed to examine characteristics of emergency evaluations at Community Services Boards (CSBs) across Virginia. Community Services Boards are the public entry into mental health, substance abuse and mental retardation services in Virginia. When a person experiences a mental health or substance abuse crisis, he or she may be referred to a CSB for an evaluation from a CSB clinician for an “emergency evaluation” or “assessment”. This report examines characteristics of those emergency evaluations such as CSB clinician and client characteristics, client pathways to the CSB emergency response system, clinical evaluation results, CSB recommendations for treatment, and gaps in service capacity. A complete description of the findings is contained in the full report.