Report of Visit to MCES (Montgomery County Emergency Services)

1. Report of Visit to MCES(Montgomery County Emergency Services) Presentation to House Health, Welfare and Institutions General Assembly Building September 6, 2007

2. MCES • Established in Feb. 1974 • Developed at the request of the law enforcement and criminal justice communities in Montgomery County, PA following the suicides of 2 mentally ill detainees • Is now a 73 bed acute care facility that provides emergency psychiatric and an array of crisis support services

3. MCES • FY2006/07 Budget- $14,090 Million • Licensed by The Pennsylvania Department of Public Welfare • Accredited by JCAHO • Other licenses include outpatient, crisis intervention, and drug and alcohol services

4. FY 2006 3,095 Evaluations Conducted Voluntary Evaluations – 1,771 1,283 (72.4%) admitted Involuntary Evaluations – 1,324 1,172 (88.5%) admitted FY 2007 3,060 Evaluations Conducted Voluntary Evaluations – 1,558 897 (57.6%) admitted Involuntary Evaluations – 1,502 1,268 (84.4%) admitted MCES – Evaluation Outcomes

5. MCES Services • Wide Array Of Services • (MH, MR, D&A, Co-Occurring) • Inpatient & Outpatient Services • Mobile Crisis Intervention Service 24/7 • Forensic Services • Linkages to other rehab services • Crisis Residential services

6. Mandated Services in PA50 P.S. § 4301 • Short term inpatient (other than state provided) • Outpatient services • Emergency services 24 hours a day • Partial Hospitalization • Consultation and education services to professional personnel and community agencies • Aftercare services for persons discharged from state and county facilities • Specialized rehab and training services • Unified procedures for intake for all county services and a central place providing referral services and info

7. Mandated Services in VAVa. Code § 37.2-500; 37.2-601 • Emergency services • Case management (subject to availability of funds)

8. Pennsylvania Delegate (county administrator) issues a warrant requiring a person authorized by him or police officer to take person to facility for emergency examination Exam conducted w/i 2 hours of arrival by physician If physician finds person meets criteria, person is admitted for tx for up to 5 days Virginia Magistrate issues ECO – 4 hours Magistrate issues TDO – 48 hours Law enforcement transport Commitment Law Detention Process

9. Pennsylvania Confinement beyond 5 days requires hearing Judge or mental health officer If meets criteria, commitment for up to 20 days At end of 20 days, another hearing is held. Up to 90 days At end of 90 days, another hearing is held. Up to 180 days Virginia Confinement beyond 48 hours requires hearing Judge or special justice If meets criteria, commitment for up to 180 days Commitment Law After Detention

10. Best Practices of MCES Access • Single point of entry into the system and a centralized location for law enforcement to refer individuals in psychiatric crisis • Access to emergency psychiatric treatment twenty-four hours a day, which includes mobile crisis services • Psychiatrist available 24/7 • Aggressive and comprehensive mental health evaluations

11. Best Practices of MCES Access • No refusal policy for: • law enforcement referrals including those suffering from a co-occurring disorder • mental health screening with psychiatric assessments if needed, including walk ins • Psychiatric treatment regardless of one’s ability to pay or legal status (i.e. prisoner, voluntary, involuntary, etc.)

12. Best Practices of MCES Transport • Use of MCES operated ambulances and EMTs fortransport of persons in crisis • Direct transfer of calls from 911 operator to MCES for dispatch • EMTs have extensive clinical training in MH and de-escalation techniques • Additional assessment of presenting needs is conducted during transport

13. Best Practices of MCES Strong Linkages • Extensive planning and implementation of formal MOUs with other relevant agencies • Police and criminal justice system • Rehab facilities for substance abuse and other related services • Hospital ERs for medical clearance • Extensive CIS* training (during implementation and on-going) for police, staff, magistrates, probation and parole, judges, etc. • Full time Criminal Justice Director to develop curriculum and training *CIS – Crisis Intervention Specialist similar to CIT

14. Benefits of MCES Best Practices • Reduces incarceration of individuals with mental illness • 2% of individuals in Montgomery County Jail have mental illness • 2005 Jail Survey found that 16% of individuals in Virginia jails have mental illness

15. Benefits of MCES Best Practices • Rapid police turnaround time • 15 minutes on average in Montgomery Co. • 4 hours or longer in Virginia

16. Benefits of MCES Best Practices • Organizational and Cultural Change • Consistent “marketing” of the values of MCES throughout Montgomery County has changed the way MH crises are dealt with • MCES has become the “single point of entry” for people in MH crisis in the county

17. Benefits of MCES Best Practices • Rapid stabilization of individuals in crisis in a safe, secure environment • A continuum of crisis stabilization services and an array of mental health services reduces the need for inpatient hospitalization

18. Questions? Contact Info: Allyson K. Tysinger, Assistant Attorney General Office of the Attorney General atysinger@oag.state.va.us Phone: (804) 225-4205