Last year's changes to Virginia's mental health laws significantly expanded the responsibilities of clinicians charged with assessing whether people should be sent to psychiatric hospitals against their will.
But state statute holds the compensation for clinicians who make such determination at just $75 per case review.
Richard Bonnie, a law professor at the University of Virginia who spearhead the mental health overhaul, told a panel of legislators last week that the fee may be prohibitively low.
“We are concerned that people are going to say, ‘I can’t do this for $75,'” Bonnie told the panel. Before last year's changes, the law was vague on what constituted a full examination, and examiners could meet with a person for a little as five minutes immediately prior to the commitment hearing.
“Only an examination was required previously,” says Jane Hickey, a lawyer in the attorney general's office overseeing the changes. “Nothing was specifically required other than the examiner examine the person in private … [and find] probable cause to believe that the person met the commitment criteria.”
Now the examiners are required to give clinical assessments based on reviews of patients' medical, psychiatric and substance-abuse histories. Examiners must submit written reports and in some cases may have to attend commitment hearings.
The changes come in the wake of the Virginia Tech massacre in April 2007, which raised questions about the process. Mental health examiners had determined the gunman, Seung-Hui Cho, needed treatment but didn't need to be hospitalized.
Delegate Chris Peace, R-Hanover, says that last year's $42 million infusion into the mental health system combined with a stormy budget forecast make any increase in the examination fees next year unlikely.
“If it's coming out of state monies,” he says, “I don't see there being a call for increased spending.” Peace sits on the health, courts and budget committees of the House of Delegates.
Mental health advocates say the fee is important because the clinician must also discuss treatment preferences with the individual who may be committed.
Ann Benner, program director for the Virginia Organization of Consumers Asserting Leadership, a mental health advocacy group known as VOCAL, says the examiner's interview is the last chance for someone on the brink of becoming involuntarily committed to step back.
“It could move somebody in crisis on the road to recovery,” she says. “Obviously we want [clinicians] to be well-qualified and take their work very seriously. We don't want to end up with people who are just kind of desperate to make a buck.”