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Tragedies pave the way to mental health legislation reform

Legislative reforms follow Virginia Tech shooting, Deeds stabbing

	<p>Virginia Senater Creigh Deeds, D-Charlottesville, is a leader in mental health care reform in the state.</p>

Virginia Senater Creigh Deeds, D-Charlottesville, is a leader in mental health care reform in the state.

The state of Virginia has reformed the legal procedures surrounding mental health care twice in the past several years — first in the wake of the 2007 Virginia Tech tragedy, and then again following the stabbing of Sen. Creigh Deeds, D-Charlottesville.

Beginnings of change

Back in October 2006, however, Chief Justice Leroy Rountree Hassell, Sr. of the Supreme Court of Virginia initiated the Commission on Mental Health Law Reform. The commission aimed to analyze Virginia’s mental health laws to improve their efficiency for both psychiatric patients and their families. Law Prof. Richard Bonnie chaired the commission, which produced reports through 2009 and concluded work in 2011.

“I chaired [the] Commission created by the Supreme Court from 2006-2011 and we were able to make substantial reforms,” Bonnie said in an email. “Important changes were also made this session.”

A 2007 preliminary report of the Commission outlined the initial plan to conduct intensive studies in 2007, hold public hearings in the spring of 2008 and distribute a final report in the fall of 2008.

After Virginia Tech, an expanded effort

The mass shooting at Virginia Tech in April 2007 changed many of the initial plans, however.

“The Panel charged with investigating the Virginia Tech shootings found that an aborted episode of involuntary treatment in December of 2005 was one of several missed opportunities to uncover Seung Hui Cho’s deepening emotional disorder and distress before it exploded into horrifying violence,” Bonnie said in a Commission report. “The compelling need for change — long recognized by people within the mental health system — now became evident.”

The Commission accelerated its schedule and presented a Blueprint for Comprehensive Reform in Dec. 2007.

The report was followed by a series of policy changes during 2008 and 2009, which, according to a 2009 progress report on the Commission, included reforms to “the length of the emergency hospitalization period and the possible expansion of mandatory outpatient treatment.” The Commission also attempted to improve access to and integration of services.

New regulations were imposed on local mental health authorities in Virginia, known as community service boards — as well as on magistrates, judges and examiners — to improve the decision-making process during psychiatric proceedings. The reform package also mandated more “detailed procedures for issuing, reviewing, and terminating mandatory outpatient treatment orders,” as well as authorizing law enforcement officers to take a person with “apparent mental illness” to a mental health facility instead of jail. The General Assembly additionally allocated $42 million in state funds to support and expand CSB service capacity for the 2009-10 fiscal year.

Bonnie also led a study published in 2009 titled “Mental Health System: Transformation After the Virginia Tech Tragedy.” The study — which sought to gauge the effects of heightened political attention to mental health reform following the Virginia Tech shooting — found the reforms in 2008 had “already had some positive effects,” and that the Commission “developed a vision of comprehensive reform that would transform Virginia’s mental health services.”

A final report on the Commission was never issued, though Bonnie did release a progress report in 2010 which found the focus in the General Assembly had largely switched to refining existing policies rather than enacting new ones.

Following Deeds, recent reforms

In its 2014 session, the General Assembly passed a bill aimed at reforming Virginia’s mental health laws. SB 260 passed the Senate and House of Delegates in March and was signed by Gov. Terry McAuliffe in April. The bill was introduced by Deeds, who was stabbed by his son in November, who suffered from mental illness.

The day before the stabbing, Deeds’ son Gus underwent an emergency mental health evaluation, but was released from Bath Community Hospital because a psychiatric bed was not available in the facility. Three hospitals, which are located within two hours of Bath County, later said they had available psychiatric beds but were never contacted.

The final version of the bill increases the time a person may be held following an emergency custody order from four hour — with a possible two-hour extension — to 12 hours, down from the 24 hours Deeds and the Senate initially proposed. It also dictates that a state facility cannot refuse or fail to admit a patient “who meets the criteria for temporary detention” unless an alternative plan can be enacted.

Furthermore, the bill mandates the Department of Behavioral Health and Developmental Services institute an online psychiatric bed registry to “provide real-time information about the number of beds available” in psychiatric facilities.

The General Assembly also passed a joint resolution this session which will create a subcommittee, which will examine mental health services across the commonwealth.

“Unfortunately, tragedy creates opportunity,” Bonnie said. “I expect additional improvements over the next few years from the governor’s task force and from a legislative study led by Senator Deeds.”


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