Virginia is NOT for Lovers of Mental Health Courts…

Virginia is for lovers

Virginia’s history of the implementation and maintenance of mental health courts (MHC), is as dismal as most other states. This isn’t to say that we should take comfort in our universal ineptness, but it should serve as a warning sign as to the abundance of hurdles, lack of oversight, and gap in funding for having truly effective mental health dockets.

Virginia currently has 32 general district courts which typically act as the primary entry point any person has with the judicial system due to it generally covering all traffic cases and other misdemeanor and civil cases involving amounts of under $25,000. Out of those 32 courts, only 2 have mental health dockets –  the cities of Richmond and Petersburg. As for circuit courts, Virginia currently has 120 courts that handle civil cases over $25,000, felony charges, and serve as an appellate jurisdiction for any cases originated in the General District Courts. Virginia has only one, Norfolk, which utilizes a mental health docket.

Court Flow Chart

Now let’s take a closer look at the history of Norfolk’s MHC. After over 2 years of trying to implement this specialized docket, it was officially established in 2008. Since that time, approximately 30 participants have been involved with the diversional program at any given time, and typically remain active for at least a year (obviously this number doesn’t even come close to addressing the disproportionate number of incarcerated individuals with serious mental illness, but its a start). With the Virginia Commission on Mental Health Law Reform  increasing focus on MHCs, Norfolk’s program became the prototype for all others in the sate to follow. This also put it under a high level of scrutiny from legislators and people within the judicial system. Old Dominion University was commissioned to completed a comprehensive study and issued a report on the MHC’s measurable outcomes. Due to this and other studies being conducted across the nation, the Commission was forced to acknowledge the substantially higher rate of access to services, less time spent incarcerated, better collaboration of services, improved mental health and engagement in treatment, and lower recidivism rates that came with the effective use of MHCs. Most important to legislators was the significant savings in jail costs, with $1.63 million being saved during the ODU study period of 18 months in Norfolk’s jurisdiction! One could assume that for this reason alone, more courts would quickly be following in step with Norfolk’s MHC.

money-grow

In 2005, both Richmond City and Petersburg City began to work towards the creation of a MHC through grants and subsidies from the federal government, yet it wasn’t until April/May 2011 that the dockets became active. Even after that long stretch of time to iron out the wrinkles, Richmond City’s docket was met with dissension from within its own judicial ranks. By November 2011, the Virginia Supreme Court issued a memo that stated the creation of any “problem-solving courts” was legislatively unauthorized. The memo sent by Chief Justice Cynthia D. Kinser to over 400 statewide judges, specifically warned that the creation of any specialized docket would need General Assembly approval before being implemented. This one memo created a level of fear in many judges across the state (even those who serve on other specialized dockets like “Drug-Courts”) to temporary suspend services until substantial research and collaboration with the General Assembly could be worked out (and we all know the speed at which the GA works!). Concurrently, Petersburg City was facing additional issues of their own. For example, they recognized that they were missing a critical factor: a position of a coordinator that could work with all of the necessary agencies since there was no precedent for inter-agency collaboration prior to the MHC creation. <Insert eyeroll> Luckily the Cameron Foundation provided funds for the position… for approximately 1 1/2 months! (Le sigh). It was after this rocky start that from a media standpoint, information on Richmond’s and Petersburg’s MHC dissolved into oblivion.

GA

With no general information available on the  interwebs, I was left cold-calling each General District Court for information. Both courts stated that their MH dockets are “active;” however, trying to get more specific information on its use, effectiveness, and evaluation proved almost impossible. After leaving numerous voice mail messages, I finally received a call back from Petersburg’s General District Court clerk’s office. Again, most of my specific questions were met with “Oh geez, I really don’t know,” but I was able to get some generic information. For instance, the process of a defendant’s inclusion on a mental health docket is a little different than in other jurisdictions. Petersburg police officers responding to a call can “fill out a form and report” to submit along with the other charge documents “if it appears that the defendant has a history of mental illness” (Leave it up to untrained and overworked police to fill out a form!?) From there, the paperwork is “routed” to the current Mental Health Docket Coordinator for review (The coordinator has evidently been in flux, because it took 4 attempts to find this person’s name and transfer me to their voice mail). A “through” case review is conducted and eligibility is determined based off of “prior police reports and additional information.” From there, District 19 conducts a mental health exam if one already hasn’t been completed to screen for Axis I diagnoses. (I’ll save my complete and utter disdain for District 19 and their unethical/ineffective services for a later post.)

I don’t think it takes a PhD in research to see the numerous shenanigans of Virginia’s Mental Health Courts. After a rocky start, contempt from naysayers, and general funding and logistical concerns, one can easily see where program access, effectiveness, and outcomes can be called into questions. Even with the totality of these chronic issues, it does not signify a need to scrape the whole idea of mental health courts – as research shows them to be overwhelmingly beneficial to consumers, the judicial system, communities, and tax payers. Instead I believe it shines a spotlight on the necessity to establish funding streams and subsidiaries to encourage the creation of specialized dockets, provide technical assistance  to negotiate inter-agency collaboration and fast-track MHC creation,  and have a regulatory body provide oversight and adherence to evidence-based practices that serve the consumer above all else.

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From “Old Dominion State” to “New & Improved Dominion State”

Born and raised a proud Virginian, I’ve unfortunately come to know that my state has a checkered history of making legislative decisions that are most definitely not for the “common wealth” of it’s constituents.

While doing research on the state of mental health treatment in Virginia, I have come across numerous statistics that corroborate what we as social workers see all too often.

The National Alliance on Mental Illness (NAMI) currently gives Virginia a grade of “C” (on an A – F scale), in its treatment of the mentally ill. See the breakdown below:

NAMI Score Card VIRGINIA

On a good note, Virginia was able to improve from it’s 2006 rank of “D” and is currently offering more services to the mentally ill than many states with dismal numbers like Arkansas, Kentucky, Mississippi, South Dakota, Wyoming, and our dear ol’ neighbors, West Virginia.  Virginia now is on the positive side of the national average; however, there still is a great amount of room for improvement.

Currently Virginia’s urgent needs towards mental health include:

  • Expand community services, including case management and crisis services
  • More housing options
  • Health care coverage for uninsured persons that includes mental health care

In recent years, the Treatment Advocacy Center has also identified another crucial barrier to treatment of mental illness. They specifically looked at the disproportionate number of mentally ill incarcerated within each of the 50 states. Regarding the odds of a seriously mentally ill individual being in jail or prison compared to a hospital, the odds in Virginia was 3.6 to 1 that they would be incarcerated. This means that in 2004–2005, throughout the state, there were almost four times more individuals with serious mental illnesses in jails and prisons than in hospitals. Virginia was ranked #32! Ouch.

In 2008 a Virginia state mental health commission estimated that “15 percent of all inmates in states prisons and jails are seriously mentally ill.” Roanoke County Sheriff Gerald Holt said it was 25 to 30 percent in his jail. In Virginia Beach, Sheriff Paul Lanteigne “estimated that it typically takes at least six months to find an available bed for a deranged inmate at Eastern State Hospital or a nearby psychiatric center. Scores of people are sitting in his jail today, long after they would normally have been released on minor charges, because they are too sick to be freed.”

In summary, national surveys and state reports both suggest that at least 15–20 percent of jail and prison inmates are seriously mentally ill. We have thus effectively returned to conditions that last existed in the United States in the 1840s:

Mentally Ill Incarceration Over Time
It is imperative that we as dedicated Virginians, work to stop the “frequent flyer” cycle of mentally ill being incarcerated versus receiving necessary treatment. This will come from utilizing assisted outpatient treatment, implementing mental health courts, maintain critical assessments and evaluations of state and local policies and programs, shift state and federal funding to address current service gaps, and work on reliable prevention and intervention services to address mental health before an individual is deemed dangerous.

The Requisite American Ritual…

Superbowl
Football fanatics and apathetic viewers all seem to be able to unite for one single day throughout the year… Super Bowl!

I’ve seen Super Bowl parties big and small, but usually full of the the quintessential attendees: the “Walking-Football-Almanacs,” the “Nobody-Loves-This-Team-More-Than-Me,” the “Just-Jumped-On-The-Bandwagon,” the “I’m-Here-For-The-Free-Beer-And-Food,” and most importantly… the “Shhh-The-Commercials-Are-On.”

Now don’t get me wrong, I was born and raised in a family that indoctrinated the religion of football. Perhaps my first tantrum can be traced back to a poor call from a referee and my first football chant involved shouting “piss poor coaching” at the TV in melodic harmony with rest of my family.  Growing up in a rural town in Appalachia only solidified the importance of football, as my hometown would resemble Varsity Blues during the rivalry game (albeit we only had two teams).  As a kid and teenager, my favorite memories revolved around football games:  from being a majorette and cheerleader, to captain of the color guard, to a bonafide marching band geek.

Now here is where two roads diverge in a wood…

Over the years, my die-hard passion has mellowed to lukewarm. For no single reason, I no longer plan my Sunday and Monday nights around the game  schedules of my favorite teams, or save up ludicris amounts of money to sit in a small seat, with 7 layers of clothes, sipping on $12 beers, just to see the action in person. I have become that apathetic viewer, but just don’t tell my family.

SuperbowlStadium

Super Bowl 2013 is like every other year for me, as I planned to continue my role of apathetic viewer to watch the game with the rest of the world…  yes, world. It is estimated that 71% of every home with a TV in the United States was tuned into the Superbowl. My own brother stationed in Europe sat camped around with hoards of other military service men to participate in the obligatory celebration.

Think about this: Super Bowl has the ultimate platform. In between watching men violently pummel each other to run a small ball back and forth across a well manicured lawn, we are elated to watch 30-90 second commercials (you know, the very thing we pay our high-dollar DVRs to skip on a day-to-day basis.) I’ll admit, the commercials are great. They are well researched and planned by the most influential marketing firms, sometimes over a year in advance. By May 2012, over half of all the commercial slots had already been sold. Super Bowl XLVII (2013) continued the trend in commercial cost, by setting a new record average of $4,000,000 per 30 seconds of marketing (“average,” as in many paid more!).

Superbowlcost

So here is my food for thought → Just imagine! Imagine what our country could do with all of that money. Think about how many underfunded but necessary services could be bolstered to new heights. What if we all gathered around like crazed fanatics around a topic with true “give back” potential?  Could you imagine if the Super Bowl commercial battle was not about who could pay the most, but who could change the most? What if our very own class video project could be viewed by millions and millions around the world, all at the same time? A Super Bowl commercial featuring (my secret, and not so secret obsession) of Ted Talks, or innovative ideas to help poverty, secure human rights, or provide sustainable food for the hungry? What about helping to reform our broken criminal justice system, election system, or education system for that matter? The possibilities are endless and the latent consequences of positive change are astounding.

Sigh. End rant. I need to get back to my Super Bowl party and give a good “piss poor coaching” yell on behalf of my dad.  ;o)