Commission on Mental Health Law Reform

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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

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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.”

Developments in Mental Health Law

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Volume 30, Issue 6, July 2011

Topics: Mental Health Law Reform Commission Legislative Proposals; Proposed Rules of Court on Invol. Commitment Proceedings; Inspect Gen Equates OAG Advice on Restraints to Abuse and Neglect; Recently Decided Cases: DOJ loses AK CRIPA/ADA case, DE Settles DOJ ADA Investigation, Prior Negative Sex Offender Determination No Bar to SVP Commitment, Counsel Failure to Seek Mental Health Exam Does Not Overturn Capital Sentence, Burden on Defendant to Prove Incompetence at Retrospective Compet. Hearing

Developments in Mental Health Law

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Volume 30, Issue 5, June 2011

Topics: Study on Reducing Mental Health Civil Commitments through Longer TDO Periods; VA College Mental Health Survey; Recently Decided Cases:US Sup Ct-CA Failure to Provide Treatmt Inmates w/SMI, 9th Circ-NGRI Acquittee Appeal Crim Proceedings, 9th Circ-Test for Mental Impairment for Fed Habeas, TN Sup Ct Expert Testimony for Capital Defendant-Cognitive Ability/IQ Scores

Developments in Mental Health Law

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Volume 30, Issue 4, May 2011

Topics:MH Law Reform Comm Final Mtg; US Sup Ct Allows VOPA Sue DBHDS; VA Gen Assem Budget Update; Recently Decided Cases:US Sup Ct Declines Rev 7th Circ Decis IN Sue-Obtain Records, US Sup Ct Upholds Death Penalty-Defend Atty Did Not Present Bipolar Mood Disorder Evid, US Sup Ct Declines Hear MO Sup Ct Find Ineffec Counsel-Failure Call MH Expert, AK Denies Insan Acquit Appeal, US Sup Ct Declines Hear Appeal 5th Circ Dismiss Suit State Endangermt-Death Police Detain Man w/MI, VT ExParte Communic

Developments in Mental Health Law

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Volume 30, Issue 3, April 2011

Topics: National Healthcare Decisions Day-April 16, 2011; Behavioral Health and Criminal Justice Transformation Update; 2011 VA General Assembly Session; Recently Decided/Pending Cases: Class Action Filed Alleging TX Violates ADA in Failing to Provide Community-based Svcs, Government Fails to Carry Burden to Forcibly Medicate Incompetent Defendant, SVP Petition Cannot Be Filed in NY When Respondent Not in Custody for Sex Offense, Hospital Not Liable for Counselor's Sexual Harrassment of Patients

Developments in Mental Health Law

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Volume 30, Issue 2, March 2011

Topics: VA Use of Mandatory Outpt Treatment(MOT) & Step-Down MOT; Draft Rules of Court-Invol Civil Commitment Proceedings; DOJ Finds VA Violates ADA/Olmstead; Recently Decided Cases: VA Sup Ct Permits SVP Rescind Refusal to Cooperate--Gen Assem Estab Procedure, Ct Authorizes Lay Testimony-Defendants Behavior Since Iraq Return to Support Insanity Defense, Civil Rights Complaint Alleging 4th Amendmt Violation-Death of Man w/Bipolar Disorder Dismissed, TN Dismisses EMTALA Complaint-Suicide Case

Developments in Mental Health Law

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Volume 30, Issue 1, March 2011

Topics: Alternative Transportation; Update on Implementation Plan for Advance Directives in VA; Advance Directive Websites; Recently Decided and Pending Cases: US v. Georgia (ADA settlement agreement), VOPA v. Stewart (State P&A suits against state officials), US v. Tennessee (Arlington Dev. Center consent decree), US v. White (application of Sell criteria), Moore v. Superior Court of Los Angeles County, CA (SVP); Frequently Asked Questions on Virginia’s Civil Commitment Process

The Effect of Community Mental Health Services on Hospitalization Rates in Virginia

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

This study examined the relationship between the availability of mental health outpatient services provided by 40 publicly funded community service boards (CSBs) and the use of inpatient mental health treatment among Medicaid recipients. Methods: Three-year data were obtained for Medicaid recipients aged 18–64 from the Medicaid claims database for the Commonwealth of Virginia. Medicaid recipients who had a mental disorder diagnosis and who had received at least one community mental health service were included in the sample. A multivariate regression model was used for the analyses. Results: Of the 11,107 individuals included, 27% had schizophrenia-related disorders and 32% had affective psychoses; 60% were white and 37% were black; and the average age was 40.1±13.1 years. In this sample, greater use of outpatient mental health services, but not greater variety of services available, was correlated with fewer inpatient hospital days for mental health treatment (–1.0±.2 days of hospitalization). Conclusions: Virginia’s CSBs provide a range of outpatient mental health services that are designed to enable individuals to remain in their community. The availability of community-based mental health services was correlated with lower rates of inpatient hospitalization for mental illness. More research, however, is needed to establish causality and to determine which services are most effective at reducing the need for inpatient care. (Psychiatric Services 62:194–199, 2011)

Use of Mandatory Outpatient Treatment in Virginia

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A Preliminary Report on the First Two Years

Prepared for the Commission on Mental Health Law Reform

This report reviews the frequency and circumstances under which MOT was ordered from July 1, 2008 through October 31, 2010. Additionally, we have conducted interviews and a survey of Virginia community services boards (CSBs) to help us understand the CSBs‟ perspectives on MOTs. The report also provides a general description and sample of treatment plans and conditions.

Virginia College Mental Health Study

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Report on the Virginia College Mental Health Survey

The Joint Commission on Health Care of the Virginia General Assembly, in coordination with The Commission on Mental Health Law Reform, conducted a survey to gather comprehensive empirical information from colleges in Virginia regarding the adequacy of students' access to mental health services and the ways in which colleges respond to students' mental health crises.

Commission on Mental Health Law Reform

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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

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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.

Mental Health System Transformation After The Virginia Tech Tragedy

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Richard J. Bonnie, James S. Reinhard, Phillip Hamilton and Elizabeth L. McGarvey

Health Affairs 28, no.3 (2009):793-804
doi: 10.1377/hlthaff.28.3.793

ABSTRACT: On 16 April 2007, a deeply disturbed Virginia Tech student murdered thirty-two fellow students and faculty and then shot himself. Less than one year later, the Virginia legislature improved the emergency evaluation process, modified the criteria for involuntary commitment, tightened procedures for mandatory outpatient treatment, and increased state funding for community mental health services. The unanswered question, however, is whether the necessary political momentum can be sustained for the long-term investment in community services and the fundamental legal changes needed to transform a system focused on managing access to scarce hospital beds to a community-based system of accessible voluntary services. [Health Affairs 28, no. 3 (2009): 793–804; 10.1377/ hlthaff.28.3.793]

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

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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.