Jennifer Faison, executive director of the Virginia Association of Community Services Boards, was in attendance at Tuesday’s open house.
By Daniel Sherrier
Editor
The Rappahannock Area Community Services Board has provided mental health, intellectual disability, substance abuse, prevention, and early intervention services to the counties of Caroline, King George, Spotsylvania, and Stafford and the City of Fredericksburg for nearly 45 years.
But only two types of services are mandated by the Code of Virginia—emergency services and case management—and state law governing those services has been amended as of July 1 of this year.
Jacque Kobuchi, emergency services coordinator for the RACSB, and Jane Yaun, deputy executive director for the local organization, shared those changes with community leaders during an open house at the RACSB’s Patricia K. Spaulding Building in Caroline on Oct. 28.
Kobuchi explained that the legislative changes came about in response to a tragic situation involving a state senator last November.
Gus Deeds, the son of Sen. Creigh Deeds of Bath County, was seen on an emergency custody order, which at the time allowed for individuals to be held in police custody for up to four hours for a mental health assessment, or up to six hours with the approval of a magistrate. He was found to meet the criteria for a temporary detention order due to a mental illness, but he was released because placement into a psychiatric facility could not be made. Gus Deeds then wounded his father and ended his own life.
“That precipitated a lot of change to the mental health laws that went into effect July 1,” Kobuchi said.
Now, CSBs have an eight-hour time limit for emergency custody orders.
Additionally, if the time on the emergency custody order is running out, a temporary detention order will automatically be issued to a state hospital.
“In the past, before July, we could call every private hospital in Virginia, and they could tell us, ‘We’re not able to accept that person because we don’t have a bed,’ or ‘We feel like they’re too violent and we can’t handle whatever symptoms they have or their medical issues,’ and then we could also call our state hospital, and they could tell us no, too,” Kobuchi explained. “We might be stuck at the end of that six-hour period with someone who’s not safe, and the police can’t legally hold them, so we don’t have an option for them.”
That type of situation hadn’t happened with the RACSB, but it has happened elsewhere in Virginia.
“Luckily, locally, we were really creative about what we did with those people and with partnerships with our local hospitals. We never had somebody who actually then consequently walked out the door, but that was probably the most stressful thing about our job is what do we do when that happens?” Kobuchi said.
Also, law enforcement is now required to notify the CSB as soon as possible following the issuance of an emergency custody order.
A statewide bed registry has been created as a result of the new laws. CSB staff can search this database any time of day for whatever type of placement they need, such as a temporary detention order bed for an adult female, for example. The registry will then bring up a list of facilities in Virginia that have an available bed matching the criteria.
“It’s been really helpful to have that resource,” Kobuchi said. “They’re working on making sure it’s always real-time with the private hospitals, which means they do have to go in and update it every time someone is admitted or discharged.”
The RACSB is noting every time a hospital declines a temporary detention order and the reasons given.
“The hospitals know now someone’s going in there and tracking that and looking at how often do you say no and what was the reason,” Kobuchi said, adding that now staff will “hear yes where we’ve never heard yes before.”
CSBs are required to record more data than before. In September 2014 alone, the RACSB’s nine full-time emergency services staff experienced 1,009 emergency contacts and 394 emergency face-to-face assessments. Of those assessments, 86 temporary detention orders were issued and 48 were done simultaneously with another assessment.
Among Virginia’s 40 CSBs in July 2014, staff received 29,054 emergency contacts, performed 6,161 emergency evaluations, and issued and executed 2,054 temporary detention orders.
Yaun said the General Assembly has initiated a four-year joint subcommittee to study mental health services in the Commonwealth. The subcommittee has been divided into three workgroups: crisis intervention, continuum of care, and children and other unique populations.
“It is a stressful time for CSBs and community mental health because of the scrutiny, but it’s an exciting time, too,” Yaun said. “There have been some real positive changes to come forward to helping individuals, and hopefully this work will also point out some positive changes that can occur.”
The RACSB is requesting that local governments fund two additional full-time emergency services staff. The goal is to ensure constant coverage at all hours, 365 days a year.
“We provide that anyway, but this will cover some of the shifts that are now only being covered by on-call staff,” which would continue to function as back-up, Yaun said.
“Our commitment is to an effective and efficient response to individual crisis, to your loved ones, to your family members, to your neighbors. We need to be able to respond in a timely manner,” Yaun added. “This is a mental health and a healthcare issue, but also a public safety issue.”
Alan Collins, a Caroline representative on the RACSB Board of Directors, said that for every $1 in support provided by local governments, the RACSB typically receives $33 from other sources.