Developments in Mental Health Law

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Volume 32, Issue 3, July 2013

The lead article in Volume 32, Issue 3 is authored by the DMHL Editor, who explores the domain of public policy regarding gun prohibitions for people with mental illness. This timely piece includes exposition of historical and legal issues under the topic. "Recently Decided Cases" informs of recent decisions in federal courts.

Developments in Mental Health Law

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Volume 32, Issue 2, April 2013

This issue features a helpful overview of "Mental Health Related Provisions of the Patient Protection and Affordable Care Act and the Potential Impact of Medicaid Expansion in Virginia." Other items of special interest are an "Update" from the 2013 Virginia General Assembly, and "Recently Decided Cases" in several state and federal courts.

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

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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)

Developments in Mental Health Law

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Volume 31, Issue 6, October 2012

The Issue explores the topic of Advance Directives with three pieces: (1) Promoting Use of Advance Directives by People with Serious Mental Illness under Virginia’s Health Care Decisions Act: Implementation Study Update; (2) Survey of Stakeholder Knowledge, Experience and Opinions about Mental Health Advance Directives in Virginia Published; and (3) Advance Directives: A Tool for Reducing Coercion

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

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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)

Developments in Mental Health Law

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Volume 31, Issue 5, July 2012

Topics: Affordable Care Act Upheld As Tax - Medicaid Expansion Would Significantly Impact Behavioral Health Care; Study Presented to JCHC Finds Longer Periods of Temporary Detention Lead to Reduction in Civil Commitments; Inspector General Presents “Failed TDO,” Barriers to Discharge and Forensic Services Reports to JCHC

Developments in Mental Health Law

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Volume 31, Issue 2, February 2012

Topics: Virginia Settles DOJ CRIPA/ADA Investigation; Three Virginia Jurisdictions Establish Specialized Mental Health Dockets; Recently Decided Cases: Fourth Circuit Finds Federal Commitment of Sexually Dangerous Persons Does Not Violate Equal Protection, California Supreme Court Rules Court Has Discretion Whether to Permit Competent Defendant to Represent Self, Maine Supreme Judicial Court Finds Right to Competency in Post-Conviction Proceedings

Developments in Mental Health Law

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Volume 31, Issue 1, December 2011

Topics: College Mental Health Study Measures Student Access; CMS Administrator Answers Virginia IG on Restraint Usage; AG Issues Opinion on ECO/TDO Transports for Town Police; Recently Settled and Decided Cases: DOJ/Delaware Settle ADA Investigation; Washington Court Finds No Constitutional Mandate to Represent Self; 1st Circuit Finds No Fault in Failure to Request Competency Evaluation

Virginia College Mental Health Study

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Virginia College Mental Health Study Prepared for The Joint Commission on Health Care General Assembly of the Commonwealth of Virginia
FINAL REPORT

Richard J. Bonnie, Chair
Susan M. Davis, Chair of Task Force on Legal Issues
Christopher Flynn, Chair of Task Force on Access to Services
November 2011

Prepared for the Joint Commission on Health Care, General Assembly of the Commonwealth of Virginia.