2014 Virginia Mental Health Law Changes, Jim Martinez at live session of May 20, 2014: http://worldeventsforum.blogspot.com/p/l-ive-event-to-be-held-tuesday-may-20.html

1. 2014 VIRGINIA MENTAL HEALTH LAW CHANGES
AND
CASE STUDIES/NAVIGATING NEW ROUTES TO
IMPROVED MENTAL HEALTH CARE
FOR OLDER ADULTS

2. GOALS FOR WEBINAR
Part 1
Brief review
Background on
Virginia’s involuntary
admission process
Major changes for
2014 in Virginia law
governing involuntary
admissions
Part 2
Case Examples
Review selected
cases
Practice applying
clinical knowledge and
Virginia law

3. PART 1
2014 CHANGES IN VIRGINIA’S STATUTES
FOR
INVOLUNTARY ADMISSION
JAMES M. MARTINEZ, JR.
DIRECTOR, OFFICE OF MENTAL HEALTH SERVICES
VIRGINIA DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES

4. VIRGINIA AND OTHER STATES’ LAWS
 This presentation [Part 1] includes material about Virginia’s
involuntary treatment process for people with mental illness,
which is based on Virginia law.
 Individual states all have their own involuntary treatment
laws.
 State laws in this area are rooted in the Constitution and
Supreme Court decisions. They share many similarities but
are rarely identical. Standards and procedures can also be
very different from state to state.
 The situations discussed here are relevant anywhere, so it’s
important to know the laws of your state.

5. THE INVOLUNTARY ADMISSION PROCESS
• INVOLUNTARY ADMISSION IS THE CIVIL COURT PROCESS BY
WHICH A PETITION IS FILED TO INITIATE INVOLUNTARY
PSYCHIATRIC TREATMENT FOR A PERSON WHO NEEDS CARE BUT
WHO IS UNWILLING, OR INCAPABLE OF VOLUNTEERING FOR
TREATMENT (CODE OF VIRGINIA, §37.2-808, ET. SEQ)
• The petition is adjudicated by a judge or special justice at a formal court hearing.
• Due process protections are important, but balancing rights of individuals with
community interests and public safety can often be difficult. Treatment
resources are limited and controversies abound.
• Procedures seem simple, but effective implementation is a complex task under
best of circumstances.

6. *Operational procedures vary considerably by locality
VIRGINIA’S INVOLUNTARY ADMISSION PROCESS
Basic Steps*CSB Crisis
Contact
Court Hearing
on Petition
Emergency
Custody
Temporary
Detention
Release
or
Dismissal
Mandatory
Outpatient
Treatment
Voluntary
Inpatient
Involuntary
Inpatient

7. 2014 CHANGES IN VIRGINIA LAW
• Mental health legislation and studies were driven by
Sen. Deeds’ family experience
• Over 35 bills related to involuntary treatment
process filed by legislators
• The most significant changes were in the
emergency custody and temporary detention
procedures.

8. VIRGINIA’S INVOLUNTARY ADMISSION PROCESS
Most significant 2014 legislative changes
were in ECO and TDO process
CSB Crisis
Contact
Court Hearing
on Petition
Emergency
Custody
Temporary
Detention
Release
or
Dismissal
Mandatory
Outpatient
Treatment
Voluntary
Inpatient
Involuntary
Inpatient

9. Emergency custody
and temporary
detention
are not required for
every involuntary
admission
i.e.,
- ECO is not required for
temporary detention
- TDO is not required for
commitment hearing
BUT
Both procedures are
needed for due
process, practical and
clinical reasons:
• Emergency custody allows a
safe, in-person exam to
confirm clinical condition and
need for temporary detention
or possible involuntary
hospitalization.
• Temporary detention keeps
the person safe, enables
treatment to start, and allows
time to prepare for a fair court
hearing.
PURPOSE OF
EMERGENCY CUSTODY AND TEMPORARY DETENTION

10. EMERGENCY CUSTODY
SB260/HB478
ECO valid up to 8 hours
from time of execution
• 8-hour period applies to ECOs
issued by magistrate and
“paperless” ECOs (or “officer-
initiated” ECOs)
• Old law was 4 hours, with one
possible 2-hour extension
• No extension provision in new law
ECO must be executed
within
8 hours of issuance
(ECO becomes void if not executed)
• Old law was 6 hours
0 8 hrs

11. EMERGENCY CUSTODY
SB260/HB478
Law enforcement agency
that executes an ECO must
notify the CSB responsible
for conducting the
evaluation as soon as
practicable after taking the
person into custody
Notification requirement
applies to paper ECOs and
“paperless” ECOs
The person taken into
emergency custody must be
given a written summary of
the emergency custody
procedures and the statutory
protections associated with
those procedures
Written summary will be
available from the courts for
law officers (and others) to
print and hand out.

12. DETERMINING TEMPORARY DETENTION FACILITY
SB260/HB293
Upon receiving notification of
the need for an evaluation, the
CSB must contact the primary
state facility and notify the
facility that the individual will be
transported to that facility upon
the issuance of a TDO if an
alternative facility cannot be
identified by the expiration of
the 8 hour emergency custody
period
Upon completion of the
evaluation, CSB must provide
information about the individual
to the state facility to help the
state facility determine the
services the individual will need
if admitted.
Once notified, the state facility
may search for an alternative
facility
State facility may contact
another state facility if it is
unable to provide temporary
detention and appropriate care
If state facility finds an
alternative facility, it shall notify
the CSB and the CSB shall
designate the alternative facility
on the preadmission screening
report
A state facility shall not fail or
refuse to admit an individual
who meets the criteria for a
TDO unless an alternative
facility agrees to accept the
individual
An individual who meets the
criteria for a TDO shall not be
released
If a facility of temporary
detention cannot be identified
by the expiration of the 8-hour
emergency custody period, the
individual shall be detained in
the state facility
State facility shall be indicated
on the TDO

13. CHANGE OF TEMPORARY DETENTION FACILITY
HB 1172
CSB may change the facility of
temporary detention and designate
an alternative facility at any point
during the period of temporary
detention
• CSB must determine that the
alternative facility is a more
appropriate facility given the specific
security, medical, or behavioral needs
of the person
• CSB must provide notice to the clerk
of the court of the name and address
of the alternative facility
If temporary detention facility
is changed, then transportation is
provided in accordance with
§ 37.2-810
• If law enforcement or an alternative
transportation provider has custody of
the person when the change is made,
individual shall be transported to
alternative facility
• If individual has already been
transported to initial TDO facility, CSB
shall request an order from the
magistrate specifying an alternative
transportation provider or (if no
alternative provider is available), the
local law enforcement agency where
the person resides or is located, if 50-
mile rule is applicable

14. TEMPORARY DETENTION
S260/HB478
• The person detained shall
be given a written
summary of the temporary
detention procedures and
the statutory protections
associated with those
procedures
• Written summary will be
on back of temporary
detention order
SB260/HB574
• Commitment hearing shall
be held within 72 hours of
execution of the TDO. [If
72-hour period ends on a
Saturday, Sunday, legal
holiday, or day on which
the court is lawfully
closed, person may be
detained until COB on the
next business day when
the court is open]
• Old law was 48 hours
maximum before hearing

15. IMPLICATIONS OF ECO AND TDO LAW CHANGES
TO SYSTEM
• No individual will be released from emergency custody who
needs involuntary treatment
• State hospitals will be the “facility of last resort”, and cannot
refuse an admission when no other facility can be found
• Changes may alter decision–making paradigm of emergency
departments, community psych hospitals, community
services boards, law officers, and others when evaluating
risk and response to individuals experiencing mental health
crises
• State hospital capacity likely to be stretched or strained

16. IMPLICATIONS OF ECO AND TDO LAW CHANGES
TO PRACTICE
• Effective utilization of limited state hospital resources will be
important (managing the front-door and the back door).
• Minimize use of involuntary or judicial intervention whenever
possible. Use advance planning strategies (e.g., advance
directives, WRAP) to help prevent and manage crises, and reduce
coercive care.
• Careful screening and assessment will be critically important,
especially medical screening and medical assessment.
• Good collaboration with safety net partners is essential to deliver
effective care for individuals and families. Build and sustain these
relationships actively.
• Be proactive is dealing with safety net “glitches.”

17. VIRGINIA PSYCHIATRIC BED REGISTRY
SB260/HB1232
DBHDS to develop and administer a web-based acute psychiatric
bed registry to show available acute beds in public and private
inpatient psychiatric facilities and residential crisis stabilization units,
Registry intended to help identify willing and available facilities for
temporary detention of individuals who meet the TDO criteria
Registry in operation as of March 3, 2014 (Legislation was effective
upon signing by Governor)

18. Bed registry
includes:
Descriptive information
about each inpatient
facility or crisis
stabilization unit
Contact information
Real-time information
about
Number of beds
curently available
Type of patients that
may be admitted
Level of security
provided
Other information to
help identify
appropriateness for
temporary detention

19. BED REGISTRY
Required facility
listings are:
• State facilities
• CSBs residential crisis
stabilization units
• Private inpatient
providers licensed by
DBHDS
Registry allows
searches by:
• CSBs
• Inpatient psychiatric
facilities
• Residential crisis
stabilization units
• Health care providers
working in an ER or
other facility rendering
emergency medical
care

20. CSB EVALUATORS – STUDY
SB261/HB1216
• DBHDS to review the required qualifications, training, and
oversight of individuals performing preadmission screening
evaluations
• Make recommendations for increasing qualifications,
training, and oversight
• Report findings to the Governor and General Assembly by
December 1, 2014