2014-16 Strategic Plan
Mental Health Treatment Centers [792]

Supporting individuals by promoting recovery, self-determination, and wellness in all aspects of life

 

A life of possibilities for all Virginians

 

Focus First on Individuals Receiving Services

Our decisions and actions consider first the best interests of individuals who receive services and their families. We respect the potential and capacity of each individual who receives services. We value and support the healing and recovery process.

Responsiveness to External and Internal Customers

We seek input and involvement from our customers. We share ideas and remain open to different opinions. We listen to and respect what our customers say and respond promptly to their requests.

Partnership and Collaboration

We create opportunities for partnerships, encourage teamwork, and support each other to succeed. We accept shared ownership and seek win-win (mutually acceptable) solutions. We communicate openly and clearly. We are willing to take risks as we look for creative solutions and new ways of solving problems. We make decisions and resolve problems at the level closest to the issue.

Professionalism, Integrity, and Trust

We recognize and celebrate individual and team successes. We use valid data that reflect best practices and positive results and outcomes. We take responsibility for ourselves, for our actions, and for how these actions affect others. We develop a supportive and learning environment and work continuously to improve the quality of the services we provide. We keep our word and deliver what we promise. We incorporate our values into everyday decisions.

Stewardship

We protect the assets and interests of the entire services system. We value and take care of staff. We use the Commonwealth’s resources in the most effective and efficient manner.

 
Financial Overview

State mental health facilities operated by the Department of Behavioral Health and Developmental Services (DBHDS) are funded with 73% general fund dollars and 27% non-general fund dollars. Non-general fund dollars are derived from the collection of fees from Medicaid, Medicare, private insurance, private payments, and federal entitlement programs related to patient care.

Biennial Budget
2017
General Fund
2017
Nongeneral Fund
2018
General Fund
2018
Nongeneral Fund
Initial Appropriation for the Biennium246,716,97290,796,948248,190,73190,818,443
Changes to Initial Appropriation0000
(Changes to Initial Appropriation will be 0 when the plan is created. They will change when the plan is updated mid-biennium.)
 
Anticipated Changes to Customer Base
Current Customer List
Predefined GroupUser Defined GroupNumber Served AnnuallyPotential Number of Annual CustomersProjected Customer Trend
ConsumerIndividuals served in state hospitals4,5064,639Stable
ConsumerIndividuals served at Hiram Davis Medical Center124124Stable
 
NameDescription
Local and regional jailsState hospitals work closely with local and regional jails to transfer inmates in need of inpatient forensic services.
Community services boards and behavioral health authority (CSBs)State hospitals participate with CSBs in discharge planning.
Federal agenciesState geriatric centers and certain state hospital beds must be certified by the Centers for Medicare and Medicaid Services (CMS) to receive Medicaid reimbursement for services provided.
Pharmacy oversight agenciesState hospitals assure that its pharmacy operations meet regulatory requirements.
Individuals receiving services, family members, and advocacy organizationsState hospitals work closely with individuals receiving services and their families to assure their active and meaningful involvement in treatment and discharge planning and service provision. Peer providers and consumer-run organizations provide very valuable services and supports for individuals receiving services in state hospitals.
Private providers (for profit and non-profit organizations)State hospitals purchase inpatient medical care for individuals receiving their services.
Private providers and vendorsState hospitals purchase or contract for a variety of services from private providers and vendors.
State agenciesState hospitals work with a number of state agencies that that coordinate services or provide operational, financial, or workforce consultation and assistance to assure appropriate implementation of regulations and management requirements.
State and Local agenciesState hospitals work with a number of state agencies that provide operational, financial, or workforce consultation and assistance to assure appropriate implementation of regulations and management requirements. Hospitals work with local health departments and fire marshals to assure compliance with applicable standards.
Virginia institutions of higher education (colleges, universities, and community colleges)State hospitals collaborate with academic medical centers, academic programs of other colleges and universities, and community colleges to address workforce issues, promote the implementation of evidence-based and other promising practices, and to train the services system’s current and emerging workforce.
 
• Implement self-determination, empowerment, recovery, resilience, and person-centered core values at all levels of the behavioral health and developmental services system through policy and practices that reflect the unique circumstances of individuals receiving services and supports.
Summary and Alignment
Chapter 3 of Title 37.2 of the Code of Virginia establishes DBHDS and Chapter 7 of Title 37.2 authorizes DBHDS to perform certain functions related to the operation of state facilities. Additionally, the federal Centers for Medicare and Medicaid Services (CMS) establishes requirements for certified beds in state hospitals and the federal Individuals with Disabilities Education Act defines who receives special education services in state hospitals. DBHDS operates eight state hospitals for adults: Catawba Hospital (CH) in Catawba (near Salem), Central State Hospital (CSH) in Petersburg, Eastern State Hospital (ESH) in Williamsburg, Piedmont Geriatric Hospital (PGH) in Burkeville, Northern Virginia Mental Health Institute (NVMHI) in Falls Church, Southern Virginia Mental Health Institute (SVMHI) in Danville, Southwestern Virginia Mental Health Institute (SWVMHI) in Marion, and Western State Hospital (WSH) in Staunton. DBHDS also operates one behavioral facility for children with serious emotional disturbance: the Commonwealth Center for Children and Adolescents (CCCA) in Staunton and the Hiram Davis Medical Center (HDMC) near Petersburg, which provides medical and skilled nursing services to individuals receiving state facility services who have serious physical and medical care needs. This goal incorporates core principles of recovery and resilience into state hospital services and supports to help individuals improve their health and wellness, learn to live self-directed lives, and live productive lives in their communities.
Associated State Goal
Health & Family: Inspire and support Virginians toward healthy lives and strong and resilient families.
Associated Societal Indicator
Suicide
Objectives
No objectives currently linked to this agency goal
• Build and sustain services capacity necessary to provide person-centered services and supports when and where they are needed, in appropriate amounts, and for appropriate durations.
Summary and Alignment
This goal envisions state hospital services and supports that are flexible, are appropriately tailored to the needs of individuals receiving services, and exemplify clinical and management best and promising practices.
Associated State Goal
Health & Family: Inspire and support Virginians toward healthy lives and strong and resilient families.
Associated Societal Indicator
Suicide
Objectives
No objectives currently linked to this agency goal
• Perform the core functions of the behavioral health and developmental services system in a manner that is efficient, effective, and responsive to the needs of individuals receiving services and their families.
Summary and Alignment
This goal envisions consistent implementation of state hospital administrative and support services that support and sustain service quality and appropriateness, protect individual human rights, ensure compliance with federal and state requirements, and promote efficiency and cost-effectiveness. Affirmative actions are taken to identify and eliminate unnecessary variability in state hospital practices and procedures.
Associated State Goal
Government and Citizens: Be recognized as the best-managed state in the nation.
Associated Societal Indicator
Government Operations
Objectives
No objectives currently linked to this agency goal
 

State hospitals provide highly structured intensive inpatient services, including a range of psychiatric, psychological, psychosocial rehabilitation, nursing, support, and ancillary services. Specialized programs are provided to older adults, children and adolescents, and individuals with a forensic status.

Hospital forensic services include inpatient pretrial evaluation, competency restoration, and a variety of clinical and inpatient interventions. At CSH, a maximum security forensic unit has perimeter and internal security and security staffing equivalent to a medium security correctional center and an intermediate security unit has a medium correctional center level of perimeter security. Three hospitals have medium security units or programs, ESH, SVMHI, and WSH, with specialized staff and a minimum of two levels of locked security to prevent escape. Adults with a forensic status also receive services on state hospital civil units.

Geriatric centers at ESH, SWVMHI, CH, and PGH provide a variety of specialized clinical and inpatient interventions in areas of behavioral management, cognition, interpersonal skills, self-care, and leisure time development that are specifically designed to address the unique and complex recovery, treatment, and support needs of older adults (65 years and older).

State hospital inpatient medical services include a broad range of medical, dental, laboratory, and nursing services, but most predominantly include skilled nursing, infirmary services, and acute medical or surgical care. Services are provided in medical/surgical units and HDMC or by referral to local acute care hospitals through the DBHDS special hospitalization program.

 

 An important measure of state hospital performance is readmissions of individuals within 30 days of discharge because this measures the effectiveness of hospitals in addressing the treatment needs of admitted individuals completely, working with the individuals’ case management CSBs on discharge planning, ensuring applications for any necessary benefits (e.g., Medicaid or SSDI) have been applied for, preparing the individuals for discharge, and maintaining effective working relationships with the CSBs they serve to avoid unnecessary readmissions soon after discharge.  A measure of productivity for state mental health facilities is hospital clinical costs per patient day. Clinical costs include medical and nursing staff, psychologists, social workers, therapists, and other staff and activities that are directly associated with the provision of care to individuals receiving hospital services   This measure tracks the overall productivity of its clinical service staff and its ability to identify and address staff capacity issues across hospitals.

 
Authorized Maximum Employment Level (MEL)          0
Salaried Employees3926
Wage Employees          730
Contracted Employees          81
 

Several factors will have a significant effect on state mental health facilities over the next four years.

  • State hospitals as facilities of “last resort:”  The 2014 General Assembly amended the Code of Virginia to require state hospitals to accept civil temporary detention order (TDO) admissions if other alternatives have not been identified within the eight hour emergency custody order period.  CSBs must notify the primary state hospital serving the CSB’s area when an emergency custody evaluation is needed.  State hospitals are required to admit any individual for temporary detention who is not admitted to an alternative treatment facility prior to the expiration of the emergency custody period. Based on data to date, this legislation has already resulted in a significant increase in TDO admissions to state hospitals. Admissions to state mental health facilities increased 20% in the second half of 2014 versus the first half.  Data indicate that the need for medical treatment is the most frequent reason for delayed access to a community psychiatric bed.
  • Lack of community alternatives: Delayed discharges from state mental health facilities increase pressure on local hospital emergency rooms, law enforcement, and individuals who would benefit from state hospital services.  In FY 2014, 327 individuals who were determined by their treatment teams to be clinically ready for discharge experienced barriers to discharge that extended their hospitalization over 30 days because community supports and housing arrangements meeting their specific needs are not available. Approximately one-third of those individuals were civil patients with special needs, one-third were geriatric patients who need nursing home placements, and one-third were forensic patients who are committed as not guilty by reason of insanity and whose services need court approval.
  • Forensic pressures on state hospital bed capacity: With adult civil beds increasingly occupied by adults with a forensic status, fewer state hospital beds are available for civil patients. Even with a statutory preference for outpatient competency evaluations and competence restoration whenever possible, many persons who could be served on an outpatient basis are instead referred to state hospitals. Continued investment in community-focused forensic services such as outpatient and jail-based evaluations, restoration of competency, and treatment for persons found not guilty by reason of insanity (NGRI) and ongoing diligence and aggressive utilization management of hospital jail inmate admission waitlists are required to offset the increasing demand for state hospital beds by adults with a forensic status.
  • Geriatric pressures on state hospital bed capacity:  Virginia serves many older adults with psychiatric needs in its state hospital geriatric centers (representing 12% of total hospital bed days for FY 2014) rather than in the community.  This rate is among the highest in the nation, in large part because the Commonwealth lacks adequate community alternatives that provide specialized programs and providers trained to address the specific needs of older individuals with mental health or substance use disorders. Specialized crisis response services for older individuals with behavioral health disorders are not widely or routinely available across Virginia.  Even as demand is expected to increase as this population group increases.  DBHDS is working closely with health and long-term care partners to strengthen the availability of community services and supports for these individuals, including emergency and crisis response services.
  • Facility capital requirements: With the completion of the new WSH, the average age of state hospital buildings is nearly 50 years old. Many of these older buildings have significant physical plant problems requiring major renovation. CSH is the remaining hospital that needs to be replaced. A recent survey found that the deferred maintenance needs at state mental health facilities exceeded $ 294,573,930 million.
  • Inadequate technical support capacity: As the mental health treatment centers expand use of electronic health records, implement health care reforms, improve performance through technology improvements, and replace aging, expensive technologies with more cost effective solutions, reliance on technical support will increase. An increasing number of mission critical clinical and financial processes rely on technology provided by a limited number of facility and central office information technology staff.
 
General Information About Ongoing Status of Agency

State hospitals have made significant progress in changing their cultures to support recovery, self-determination, and empowerment. Recovery-oriented and person-centered principles are now increasing the recovery experience for individuals receiving services through peer-to-peer supports, treatment planning partnerships, and educational and career development and job training opportunities.

State hospitals continue to focus on improving bed utilization through aggressive monitoring of service plans and discharge efforts that reduce hospital lengths of stay and enable individuals to be integrated more quickly into the community.  In addition, Discharge Assistance Program (DAP) funds are supporting creation of of individualized services and supports for individuals residing in state hospitals who are clinically ready for discharge but have significant barriers to their discharge.  Local Inpatient Purchase of Service (LIPOS) funds are being used by CSBs to ensure treatment is provided in the community rather than in more restrictive settings. Both programs received additional funds from the 2014 General Assembly.

To offset the increasing demand for state hospital beds by individuals with a forensic status, ongoing efforts continue to improve forensic patient management, review, and oversight processes and to safely and appropriately divert forensic admissions when possible.  Although the Code of Virginia expresses a preference for outpatient competency evaluations and restoration whenever possible, many persons who could be served on an outpatient basis are instead referred to state hospitals.  DBHDS is working to develop community-focused forensic services, including jail evaluations and treatment and outpatient competency restoration services in either the community or jail, to safely and appropriately divert forensic admissions to community alternatives.

DBHDS has implemented annual consultative audits (ACAs) to improve state hospital service delivery. ACAs use a peer-review process involving colleagues from other state hospitals, individuals receiving services, and central office staff to review and provide feedback on facility operations and compliance with oversight and accreditation requirements and offer consultative suggestions to improve service delivery. ACA results are being used to facilitate adoption of best practices and operational efficiencies; standardize procedures, as appropriate; and reduce duplication.  Operational efficiencies also should result from the implementation of the electronic health record system (EHRS) clinical treatment/medical record, pharmacy, ancillary, and accounts payable modules. 

With increasingly complex caseloads, state hospitals must maintain sufficient numbers of staff trained in best practice guidelines and evidence-based approaches in the treatment and care of individuals receiving state hospital services. Hospitals are working to improve staff cultural and linguistic competence so they can better address the recovery and communication needs of individuals and families in a culturally relevant manner.

Information Technology

Mental health treatment centers maintain small teams of information technology (IT) staff to support locally developed application systems and their local information technology infrastructure environments. The DBHDS central office Information Services and Technology (IS&T) office provides coordination, guidance, oversight, and support to ensure that these local systems comport to Commonwealth of Virginia (COV) security requirements and to enable required data integration with central office provided systems. 

Implementation of a single electronic health record system (EHRS) to serve all mental health treatment centers will materially affect the demands for local information technology support at the hospitals. Infrastructure modernization, normalization of independently developed local applications, and rapid response end-user device (desktop) support requirements will all increase dramatically as health care delivery processes become wholly dependent on EHRS access.

Estimate of Technology Funding Needs
Workforce Development

State hospitals operate 24 hours a day, seven days a week and depend on a cadre of skilled and dedicated employees in a wide variety of classifications. Most provide direct care or support facility infrastructure. Among the human resource challenges hospitals face are workforce aging; competition for psychiatrists, occupational and physical therapists, nurses, pharmacists, and direct care staff; and turnover due to the difficult nature of the work.

The hospital workforce average age is 47.2 years old and average work tenure is 11.5 years. The direct care separation rate is 23.9% and the turnover rate for security positions is 19.6%.  During the next 5 years, 21.3% will be eligible to retire with unreduced benefits.

The new EHRS and increasing service demands will require skilled staff with cultural and linguistic competence to serve an increasingly diverse population. Technical or clinical expertise, communication and analytic skills, ability to create and apply sophisticated new technologies, and reasoning and problem-solving capabilities will be needed. A variety of classes in performance management, computer skills, linguistics, and use of interpreters are provided to enhance workforce competence.

Physical Plant

DBHDS is responsible for the operation of 10 state-owned mental health facilities.  The state hospitals, along with HDMC, have approximately 3,000,000 square feet of building with an average age of nearly 50 years. Lack of adequate maintenance reserve funding continues to present problems with reference to these older structures.

These facilities consist of over 200 individual buildings served by a variety of mechanical heating and cooling systems ranging from central plant distribution systems to individual package heating and cooling units and in some instances makeshift systems.  Replacement of these systems based on age and physical condition has typically been deferred due to an uncertainty of the long-range need for continued use of the buildings.  Many buildings are anticipated to remain in use for a defined duration have reached the point of requiring an investment to maintain reliable systems for the remaining duration of their use.  Buildings that may reach surplus status require conditioned environments to prevent deterioration, therefore enhancing possible future utilization.  Although substantial critical system improvements have been achieved in recent years, a substantial backlog of potential system failures and system inefficiencies remain.

More than 400 acres of the current ESH campus have been declared surplus and will be advertised for sale by the Department of General Services.  WSH construction is completed and the building is fully occupied.  The old WSH campus has been sold.

The DBHDS six-year Capital Outlay Plan includes the following:

  • Replacement of CSH,
  • Expansion of WSH,
  • Renovation of PGH,
  • Improvements at ESH to create a safe adult mental health environment,
  • Major system renovations for greater security, and
  • Major renovation projects for roofs, infrastructure, abatement of hazardous materials, and HVAC/boilers repairs and replacement.

DBHDS is assessing ways to make facilities more efficient. This includes an examination of food service and laundry operations.

 

Note:  This is one of five DBHDS Executive Progress Reports. See Department of Behavioral Health and Developmental Services (720); Grants to Localities (790); Intellectual Disabilities Training Centers (793); and Virginia Center for Behavioral Rehabilitation (794).

 
TitleFile Type
 

Facility-Based Education and Skills Training [19708]

Facility-Based Education and Skills Training Services consist of educational services provided to individuals receiving state facility services who are 22 years of age or younger and covered by the federal Individuals with Disabilities Education Act (IDEA).

 

Facility-Based Education and Skills Training Services enable individuals to continue to make academic progress during their hospitalization and to improve their person-centered work skills, thereby promoting choice, self-worth, and satisfaction.

 
Description of Major Products and Services

Facility education and skills training include functional academics required to implement the Individual Education Plan (for individuals 22 years of age and under).

Anticipated Changes

No major changes in state hospital education and training services are anticipated.

Factors Impacting

Provision of educational services is affected by the challenging behaviors and physical needs of children and adolescents receiving services in state hospitals.

 

This service area is funded with 94% general fund and 6% non-general fund dollars. Non-general fund dollars are derived from the collection of fees from Medicaid, Medicare, private insurance, private payments, and federal entitlement programs related to patient care.

Biennial Budget
2017
General Fund
2017
Nongeneral Fund
2018
General Fund
2018
Nongeneral Fund
Initial Appropriation for the Biennium2,025,418137,2862,025,418137,286
Changes to Initial Appropriation0000
 
TitleFile Type
 

Forensic and Behavioral Rehabilitation Security [35707]

State hospitals consist of inpatient pretrial evaluation, competency restoration, and a variety of clinical services and inpatient interventions to individuals who are involved with the criminal justice system in Virginia.  The most secure forensic treatment location is the Maximum Security Forensic Unit at Central State Hospital (CSH) near Petersburg, which has levels of perimeter and internal security and security personnel that are equivalent to a medium security correctional center.  An Intermediate Security Unit at CSH has a medium correctional security level of perimeter security, with less restricted internal milieu and security staffing.  Three hospitals have medium security units or programs, Eastern State Hospital (ESH) in Williamsburg, Southern Virginia Mental Health Institute (SVMHI) in Danville, and Western State Hospital (WSH) in Staunton, with specialized staff and a minimum of two levels of locked security to prevent escape.

 

DBHDS must, by statute, provide secure confinement of individuals under criminal charge who are admitted directly from law enforcement custody. Chapter 11 of Title 16.1 of the Code of Virginia sets out the provisions of juvenile and domestic relations court law.  Section 16.1-356 of the Code of Virginia authorizes DBHDS to conduct evaluations of the competency of juvenile defendants to stand trial; and Chapters 11 and 11.1 of Title 19.2 of the Code of Virginia authorize DBHDS to provide forensic services to individuals in the criminal justice system, including evaluations of competency, determinations of sanity, restoration to competency services, and treatment services for individuals adjudicated not guilty by reason of insanity.

 
Description of Major Products and Services

Forensic Services include inpatient pretrial evaluation, competency restoration, and inpatient treatment to individuals who are involved with the criminal justice system.

Anticipated Changes

No major changes in state hospital forensic services are anticipated.

Factors Impacting

Although the Code expresses a preference that evaluations of competency to stand trial be conducted on an outpatient basis whenever possible, courts regularly issue orders for inpatient services even when clinical assessment indicates that an inpatient level of care is not needed, and some regions experience a shortage of qualified or willing evaluators.

After undergoing an initial evaluation of competence to stand trial, some defendants are adjudicated incompetent and ordered to undergo treatment to restore competence. Even with the Code’s preference for outpatient competence restoration whenever possible, reliance on state hospitals to provide competence restoration has resulted in unnecessary admissions. At ESH and CSH, especially, jails inmates are waiting for admission to a state hospital for restoration of competency because no alternative exists. Not all of those persons would be appropriate for diversion to outpatient services, but many would.

Mandatory parolees are admitted directly to the CSH maximum security unit from the Department of Corrections as civilly committed persons upon the expiration of their sentences. Although they can then be transferred to civil units after an initial period of assessment, many do not appear to require maximum security.  Often they are former patients of state civil units that are very familiar with them.

After commitment, NGRI acquittees can gradually obtain privileges that integrate increasing levels of community access until they are considered appropriate for conditional release.  However, acquittees remain under the jurisdiction of the original trial court, which makes the decision regarding conditional release and supervises the acquittee while on release.

 

This service area is funded with 98% general fund and 2% non-general fund dollars. Non-general fund dollars are derived from the collection of fees from Medicaid, Medicare, private insurance, private payments, and federal entitlement programs related to patient care.

Biennial Budget
2017
General Fund
2017
Nongeneral Fund
2018
General Fund
2018
Nongeneral Fund
Initial Appropriation for the Biennium12,922,941308,09812,922,941308,098
Changes to Initial Appropriation0000
 
TitleFile Type
 

Inpatient Pharmacy Services [42102]

Inpatient Pharmacy Services consist of medication selection and procurement, storage, ordering and prescribing, preparation and dispensing, administration, and monitoring.  Medication orders are prepared, packaged, compounded (if needed), labeled and then sent directly to the individual's unit for administration by nursing staff.

 

State hospitals provide medications that appropriately alleviate the symptoms of and distress associated with an individual’s illness or medical condition, or both.

 
Description of Major Products and Services

Inpatient pharmacy services include medication selection, procurement, preparation, dispensing; management, and education, and pharmacy service oversight and cost containment.

Anticipated Changes

No major changes in state hospital pharmacy services are anticipated.

Factors Impacting

Inpatient pharmacies will continue to experience increasing medication costs. These costs may be offset somewhat as patents for certain medications expire and generic medications become available.  The pharmacist shortage in Virginia and nationally will continue to make recruitment and retention of pharmacists extremely difficult.

 

This service area is funded with 25% general fund and 75% non-general fund dollars. Non-general fund dollars are derived from the collection of fees from Medicaid, Medicare, private insurance, private payments, and federal entitlement programs related to patient care.

Biennial Budget
2017
General Fund
2017
Nongeneral Fund
2018
General Fund
2018
Nongeneral Fund
Initial Appropriation for the Biennium4,935,28714,541,6634,935,28714,541,663
Changes to Initial Appropriation0000
 
TitleFile Type
 

Geriatric Care Services [43006]

Geriatric Care Services consist of a variety of clinical services and inpatient interventions that promote optimal performance in areas of behavioral management, cognition, interpersonal skills, self-care, and leisure time development and are specifically designed to address the unique and complex recovery, treatment, and support needs of older adults (65 years of age and older).  Specialized inpatient geriatric care services are provided by Eastern State Hospital (ESH) in Williamsburg, Southwestern Virginia Mental Health Institute (SWVMHI) in Marion, Catawba Hospital (CAT) near Salem, and Piedmont Geriatric Hospital (PGH) in Burkeville.

 

Inpatient geriatric services are provided to older adults (65 years of age and older) who are in crisis or who present with acute or complex conditions, or both, and who require the highly intense and structured environments of care that currently is available only in an inpatient setting.  Inpatient geriatric services are person-centered, flexible, and sensitive to the cultural and age-related needs of individuals.

 
Description of Major Products and Services

Inpatient geriatric care services include inpatient psychiatric and medical assessment; psychology, nursing, and social work services; recreational, physical and occupational therapies; and medication management and rehabilitation.

Anticipated Changes

Partnerships with nursing facilities are increasingly focusing geriatric centers' services on transitioning individuals residing in state geriatric centers to the community. To support successful transitions, the agency expects that centers will respond to increasing demands for geriatric education and consultation from local nursing and assisted living facilities.

Factors Impacting

Virginia lacks adequate community behavioral health services infrastructure to meet the needs of older adults. The provision of services to older adults is complicated by the limited number of specialized community-based programs and lack of providers trained to serve this population.  Additionally, the reluctance of many older adults and family caregivers to seek behavioral health services often results in a more complicated clinical picture when an individual finally does present for services.

A shift in cultural perspectives on aging, which once assumed that older adults required no more than custodial or end-of-life care, has increased demand for new service models and more treatment choices for individuals who need services.  State geriatric centers are working with CSBs and other stakeholders to develop innovative services for older adults in their home communities and improve and sustain access to community providers with the goal of intervening earlier and reducing the need for psychiatric hospitalization. Partnerships with community psychiatric hospitals are enabling acute care to be increasingly provided in community hospitals.

The increasingly complex needs of individuals receiving care in state hospitals will require a well-trained workforce skilled in evidence-based person-centered practices.  Compliance with standards set by CMS will require heightened vigilance and resources.

 

This service area is funded with 7% general fund and 93% non-general fund dollars. Non-general fund dollars are derived from the collection of fees from Medicaid, Medicare, private insurance, private payments, and federal entitlement programs related to patient care.

Biennial Budget
2017
General Fund
2017
Nongeneral Fund
2018
General Fund
2018
Nongeneral Fund
Initial Appropriation for the Biennium2,786,18034,626,3032,786,18034,626,303
Changes to Initial Appropriation0000
 
TitleFile Type
 

Inpatient Medical Services [43007]

Inpatient Medical Services consist of a broad range of medical, dental, laboratory, and nursing services, but most predominantly include skilled nursing, infirmary services, and acute medical or surgical care provided in state hospital medical/surgical units or by referral to local acute care hospitals through the DBHDS special hospitalization program.

 

Inpatient medical services focus on alleviating the symptoms and distress associated with an illness or medical condition.  Acute symptom resolution or management is a prerequisite for active and meaningful individual involvement and participation in services that enable individuals to develop skills and supports.

 
Description of Major Products and Services

Inpatient medical services include physician, nursing, and dental services; skilled nursing care; speech and audiology; physical, occupational, and recreational therapy; and special hospitalization (purchase of medical care from local hospitals).

Anticipated Changes

DBHDS will monitor bed utilization to determine the most cost effective means of providing medical and skilled nursing services.

Factors Impacting

Growth in the number of individuals with forensic involvement, who typically have more medical conditions associated with poor health care prior to admission and iatrogenic disorders, will increase demand on state hospitals to provide or purchase medical services. Compliance with standards set by CMS and the Joint Commission will require heightened vigilance and resources.

 

This service area is funded with 94% non-general fund dollars and 6% general fund dollars. Non-general fund dollars are derived from the collection of fees from Medicaid, Medicare, private insurance, private payments, and federal entitlement programs related to indirect services costs of patient care.

Biennial Budget
2017
General Fund
2017
Nongeneral Fund
2018
General Fund
2018
Nongeneral Fund
Initial Appropriation for the Biennium1,138,85019,262,7501,138,85019,262,750
Changes to Initial Appropriation0000
 
TitleFile Type
 

State Mental Health Facility Services [43014]

State Mental Health Facility Services consist of a variety of intensive inpatient clinical services and supports to adults with serious mental illnesses and children and adolescents with serious emotional disturbances who are in crisis, who present with acute or complex conditions, or both, and who require the highly intensive and structured environments of care provided in an inpatient setting.  Services include psychiatric assessment and stabilization and a range of psychiatric, psychological, psychosocial rehabilitation, nursing, and ancillary services, and, in collaboration with the CSBs, discharge planning.

State hospitals include Catawba Hospital (CAT) near Salem, Central State Hospital (CSH) near Petersburg, Commonwealth Center for Children and Adolescents (CCCA) in Staunton, Eastern State Hospital (ESH) in Williamsburg, Northern Virginia Mental Health Institute (NVMHI) in Falls Church, Southern Virginia Mental Health Institute (SVMHI) in Danville, Southwestern Virginia Mental Health Institute (SWVMHI) in Marion, and Western State Hospital (WSH) in Staunton.

 

State hospital services are person-centered and individualized to meet each individual’s goals for recovery. They focus on stabilizing acute psychiatric symptoms, developing skills needed for successful community living, and enhancing other fundamental life skills, such as identifying and developing positive community supports, increasing hope, motivation, and confidence, and making informed choices.

 
Description of Major Products and Services

State hospital services include psychiatric assessment, stabilization, and medication management; psychosocial rehabilitation programming; psychology, nursing, and social work services; and recreational, physical, and occupational therapies. State hospital services are further specialized by the age groups and legal status served at a facility.

Anticipated Changes

State hospitals will continue to improve their ability to provide integrated care for those with co-occurring mental illness and substance use disorders and provide services that demonstrate competence in trauma-informed care.  Hospitals will increasingly use peer support specialists to advance the concept of recovery.

Factors Impacting

Demand for state hospital beds will increase as facilities receive referrals to serve individuals because beds in an alternative hospital cannot be found for a temporary detention order (TDO) within the 8-hour emergency custody order (ECO) period.

Increasingly, state hospital beds are being used by individuals with a forensic status.  Without additional community-focused forensic services, the proportion of state hospital civil beds will continue to decline.

The lack of a comprehensive array of community-based services has caused an over-reliance on inpatient and residential treatment models for these children and adolescents.  Inpatient services provided by the CCCA will continue to be needed until alternative community-based services are available.

A number of state hospitals have significant physical plant problems that require immediate attention.  Older buildings and large multi-building campuses are inappropriately designed to safely meet the needs of individuals and have inherent inefficiencies for staff, utilities, and support services.

The increasingly complex needs of individuals receiving care in state hospitals will require a well-trained workforce skilled in evidence-based person-centered practices. Compliance with standards set by CMS and the Joint Commission will require heightened vigilance and resources.

 

This service area is funded with 95% general fund and 5% non-general fund dollars. Non-general fund dollars are derived from the collection of fees from Medicaid, Medicare, private insurance, private payments, and federal entitlement programs related to indirect services costs of patient care.

Biennial Budget
2017
General Fund
2017
Nongeneral Fund
2018
General Fund
2018
Nongeneral Fund
Initial Appropriation for the Biennium144,526,6657,863,885145,969,2367,863,885
Changes to Initial Appropriation0000
 
TitleFile Type
 

Facility Administrative and Support Services [498]

Facility Administrative and Support Services consist of general management and direction, computer services, food and dietary services, housekeeping services, linen and laundry services, physical plant services, power plant operations, and training and education services. These functions are essential for state hospital provision of services and supports.

 

Facility Administrative and Support Services provides the administrative framework so state hospitals can provide quality care in a safe and clean environment and comply with administrative and financial requirements.

 
Description of Major Products and Services

Facility administrative and support services include administrative leadership and regulatory compliance; information technology support; food, housekeeping, linen and laundry, and physical plant services; and employee training and education services.

Anticipated Changes

No major changes in state hospital administrative and support services are anticipated.

Factors Impacting

Retention of the state hospital workforce will be a challenge as the average employee aging increases. This is particularly true for facilities in rural areas where staff turnover is less than in more urban areas.

New Governor’s Executive Orders and changes in requirements of external agencies such as the Department of Accounts (DOA), Department of Human Resources Management (DHRM), Department of Planning and Budget (DPB), Department of General Services (DGS), and Virginia Information Technologies Agency (VITA) could affect performance of state mental health facility administrative and support services.

Administration and support needs will change as state hospital capacities change or they undergo major renovations.  Increased costs associated with the implementation of EHR clinical treatment/medical records and for medications, energy, and other goods and services are likely.

 

This service area is funded with 85% general fund and 15% non-general fund dollars. Non-general fund dollars are derived from the collection of fees from Medicaid, Medicare, private insurance, private payments, and federal entitlement programs related to indirect services costs of patient care. Less than one-half percent of total non-general fund dollars are federal grant funds for the National School Lunch, National School Breakfast, and the Virginia Department of Agriculture and Consumer Services' Federal Food Distribution programs.

Biennial Budget
2017
General Fund
2017
Nongeneral Fund
2018
General Fund
2018
Nongeneral Fund
Initial Appropriation for the Biennium78,381,63114,056,96378,412,81914,078,458
Changes to Initial Appropriation0000
 
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SP - Run Date: 08/29/2015 05:18:57