THE UNITED STATES VIRGIN ISLANDS OFFICE OF THE GOVERNOR GOVERNMENT HOUSE Charlotte Amalie, V.I. 00802 340-774-0001 January 13, 2020 The Honorable Novelle E. Francis, Jr. President Thirty-Third Legislature of the Virgin Islands Capitol Building St. Thomas, VI 00802 Re: Proposed Bill; Request to Legislature to Enact and Establish First Behavioral Health and Developmental Disability Act Dear Mr. President: I am pleased to forward to you the enclosed Bill proposed by the Governor, establishing the first Behavioral Health and Developmental Disability Act (“Act”). The Act amends restructures and reclassifies sections and chapters of Title 19 that addressed public health and mental health services, and combines and expands these provisions into one Act. The Act also repeals certain sections or chapters within Title 19 to update the law, services and programs that are currently available in these areas to serve adults and children in the Virgin Islands community who suffer from behavioral health challenges, mental health disorders, intellectual or developmental disabilities, alcoholism, and drug dependency. Additionally, the Act establishes the first Behavioral Health, Mental Health, Developmental Disability, Alcohol or Substance Abuse Facility to serve the public’s need for services and treatment here in the Virgin Islands. The Act is also enforced through the coordination and participation of multiple agencies and organizations and is structured to use territorial, out-of-state, private, public, and community resources to comprehensively treat individuals that face multiple health challenges. As has become keenly evident in the aftermath of Hurricanes Irma and Maria, there is a pressing need in the community to comprehensively deal with mental health, developmental and intellectual disabilities and drug and alcoho! dependency and abuse. This Act seeks to accomplish that. The Act expands public health and mental health services in the Virgin Islands by adding the following additional programs and services: 1. Community Behavioral Health Services 2. New Divisions, Programs, Treatments, and Patient Rights: Memorandum Re: Letter to the Legislature to Enact and Establish First Behavioral Health and Developmental Disability Act Page| 2 a. Division of Behavioral Health, Mental Health, Developmental Disability, Alcoholism, and Drug Dependency Services; b. Director of Behavioral Health, Mental Health, Developmental Disability, Alcoholism, and Drug Dependency Services; c. dInterdepartmental Coordinating Committee; Emergency and Involuntary Commitment; and e. Care of persons diagnosed with behavioral health challenges, mental health disorders, developmental disabilities, and alcohol or drug dependency by relative or friend; bond. 3. Behavioral Health, Mental Health, Developmental Disability, Alcohol or Substance Abuse Facility 4. New Types of Commitments, Examinations, and Reports: a. Behavioral Health Examiners; b. Mental Competency Determination and Hearings; ¢. Hospitalization of a Person Found Not Guilty by Reason of Insanity; d. Hospitalization of a Convicted Person Suffering From Behavioral Disorder, Mental Disease, or Defect; e. Hospitalization of an Imprisoned Person Suffering from Behavioral Health Challenge, Mental, Disease, or Defect; f Hospitalization of a Person Due for Release but Suffering from Behavioral Health Challenges; and g. Civil commitment of a sexually dangerous person. Expansion of Civil Commitment and Rehabilitation of Narcotic Addicts Expansion of Civil Commitment of Persons Not Charged with Any Criminal Offense Treatment of the Above By Telepsychology or Telehealth Expansion of Intellectual and Developmental Disabilities Services and Programs Expansion of Behavioral Health for children and young adults Co POnnu The Act repeals or reclassifies the following provision in the Virgin Islands code to expand public health and mental health services to comprehensive behavioral health, mental disorders, developmental disabilities, alcoholism, and drug dependency services: e Part I. Chapter 7. Maternal, Child Health, Physical Disability and Intellectual Disability Children's Services (§§ 151 — 153); Reclassified and moved into new Behavioral Health Act e Chapter 29. Subchapters IV. Civil Commitment and Rehabilitation of Narcotic Addicts (§§ 661 — 666) and Subchapter V. Civil Commitment of Persons Not Charged with Any Criminal Offense (§§ 681 — 696); o Reclassified and moved into new Behavioral Health Act e Chapter 30 Virgin Islands Commission on Alcoholism and Narcotics (§§ 701 — 704) © §701 is repealed © §702 is repealed © §703 is repealed Memorandum Re: Letter to the Legislature to Enact and Establish First Behavioral Health and Developmental Disability Act Page |3 © §704 is repealed e Chapter 31. Behavioral Health, Alcoholism and Drug Dependency (§§ 710 — 729); © §716 is repealed © §717 is repealed © §726 is repealed © §746 is repealed e Part V. Subchapters I - V (§§ 1101-1204 §1101 is repealed §1111 is repealed §1112 is repealed §1113 is repealed §1114 is repealed §1130 is repealed §1131 is repealed §1131 is repealed §1132 is repealed §1133 is repealed §1134 is repealed §1135 is repealed §1136 is repealed §1137 is repealed §1138 is repealed §1139 is repealed §1140 is repealed §1141 is repealed §1142 is repealed §1143 is repealed §1171 is repealed §1172 is repealed §1173 is repealed §1174 is repealed §1174(a) is repealed §1175 is repealed §1176 is repealed §1177 is repealed 1201 is repealed 1202 is repealed 1204 is repealed e Part VIII. Mental Retardation Facilities and Community Health Centers Construction Act (Chs. 73 —- 74) © Reclassified and moved into new Behavioral Health Act os © as © as © as © mE © EE © DE © UE © EE © 2 © 2 © EE © © EE © EE © 2 © 2 © 2 © TE © EE © SE © I © 2 @ © EE © EE © EEE © EL © EL © EEC) Memorandum Re: Letter to the Legislature to Enact and Establish First Behavioral Health and Developmental Disability Act Page| 4 e Title 5 Section 3637 of the Virgin Islands Code o Is repealed and Reclassified and moved into new Behavioral Health Act I am asking the Legislature to give this proposed Bill prompt attention in light of the Virgin Islands need to restructure and update the provisions of Virgin Islands Law to address the difficulties that exist in providing comprehensive behavioral health and developmental health services. Your assistance in bringing these measures before the Thirty-Third Legislature for prompt and favorable consideration will be greatly appreciated. Respectfully Yours, Governor Sor A vA WN = NNN ND — &— ee Be ee ee ee RRRSRBVPSSSWUIRBDEBDHAS © BILL NO. - THIRTY-THIRD LEGISLATURE OF THE UNITED STATES VIRGIN ISLANDS REGULAR SESSION 2019 A Bill amending, restructuring, reclassifying and adopting the first comprehensive Virgin Islands Behavioral Health and Developmental Disability Act. The Act addresses services and interdepartmental agencies and organizations coordination of a structure to address providing support to individuals throughout the Virgin Islands who suffer from behavioral health challenges, mental health disorders, developmental disabilities, alcoholism, or drug dependency. The Act establishes community behavioral health, alcoholism, drug dependency, and developmental health and disability services, as well as provides for the first comprehensive public Behavioral Health and Developmental Disability Facility to treat individuals voluntarily and involuntarily who face behavioral health or developmental health challenges. PROPOSED BY: The Governor WHEREAS, gaps continue to exist in comprehensive behavioral health and developmental health service systems; WHEREAS, provisions for a comprehensive behavioral health and developmental health service system have not yet been adopted within the Virgin Islands Code; WHEREAS, there is a need in the Virgin Islands for a coordinated structure to build a new comprehensive behavioral health and developmental health service system to address gaps in services to those in the community who suffer from behavioral health challenges, mental health disorders, developmental disabilities, alcoholism, or drug dependency; WHEREAS, there is a lack of provisions to address the urgent need for supervision and oversight by the courts, behavioral health professionals, and institutions, dealing with persons within the Virgin Islands in need of services who suffer from behavioral health challenges, mental health disorders, developmental disabilities, alcoholism, or drug dependency; WHEREAS, it is necessary to restructure and update the provisions of Virgin Islands Law to address the difficulties that exist in the Virgin Islands with providing comprehensive behavioral health and developmental health service and developing a comprehensive behavioral health and developmental health service system; WHEREAS, creating a “Behavioral Health and Developmental Disability Act” will allow a comprehensive behavioral health and developmental health service system to be established; Page I of 110 on Am &wWN — £4 SPR HF HWW WWW Wwe WW weN NNN NNN WN DY — — — == SH Se eS eS eS me Aun wWN KK COU WAH MNFwWN S| Cw KOA NUN WH KH SH ems KHUWU PWN | Ow WHEREAS, the Act will allow for interdepartmental coordination between the court, government agencies, private and public facilities, health professionals, and non-profit organizations to respond to and address the needs of the Virgin Islands community; WHEREAS, the interdepartmental coordination and comprehensive Act will facilitate establishing and expanding all of the following in the Virgin Islands: 1) residential psychiatric facilities, 2) community-based crisis services, 3) residential and outpatient behavioral health services with case management, 4) medication-assisted treatment and associated recovery supports, 5) adequate workforce, 6) detoxification services, and 7) affordable supportive housing; WHEREAS, the purpose of this Act is to enact a plan that will support consistent, comprehensive, and ongoing partnerships that seek to improve behavioral health treatment by strengthening guardianship and community attachment in the Virgin Islands now and in the future; Be it enacted by the Legislature of the Virgin Islands: SECTION 1. Title 32, Chapter 21, Section 517, subsection “(c)” is amended by striking the following: “Fifteen (15%) percent to hospitals and health”, “One (1%) percent for gambling addiction and education programs”, and “Five (5%) percent to the University of the Virgin Islands” and replacing them with “Twenty-one (21%) percent to the Behavioral Health and Developmental Disability Treatment Facility”. SECTION 2. Title 19, Chapters 47 and 48 (§§ 1251-1267) are being removed from Part V. Mental Health and reclassified under Part I. Chapter 7. which is to be renamed “Cancer and Autoimmune Disease Registry” and renumbered. Title 19, Chapter 75. Fluoridation of Water (§§ 4201-4204) is to be removed and reclassified under Part VI. Regulatory Provisions Concerning Public Health (Chs. 51 62) as “Chapter SIA. Fluoridation of Water” and renumbered. SECTION 3. Title 19, Part V. Mental Health, is to be renamed the “Behavioral Health and Developmental Disability Act”, and provisions — Part I. Chapter 7. Maternal, Child Health, Physical Disability and Intellectual Disability Children's Services (§§ 151 — 153), Chapter 29. Subchapters IV. Civil Commitment and Rehabilitation of Narcotic Addicts (§§ 661 —. 666) and Subchapter V. Civil Commitment of Persons Not Charged with Any Criminal Offense (§§ 681 — 696); Chapter 31. Behavioral Health, Alcoholism and Drug Dependency (§§ 710 — 729), and Part VIII. Mental Retardation Facilities and Community Health Centers Construction Act (Chs. 73 — 74) are to be renumbered and reclassified into the newly entitled “Part V. Behavioral Health and Developmental Disability Act of 2020” as follows: Page 2 of 110 or DA wh WN — 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 Part V. Behavioral Health and Developmental Disability Act (Chs. 45 - 48) Chapter 45. Behavioral Health, Mental Health Disorders, Developmental Disabilities, and Alcohol or Drug Dependency (Subchs. 1 — IID) Subchapter I. Community Behavioral Health Services (§§ 1000-1009) 1000. Purpose 1001. Definitions 1002. Commissioner’s Duties Regarding Behavioral Health Services 1003. Cooperative Planning Required; Grant Recipients and Bureau of Correction Authorities 1004. Community Service Networks 1005. Crisis Intervention Program 1006. Crisis Intervention Team 1007. Behavioral Health Training 1008. Protective Custody 1009. Sexual Activity with Recipient of Services Prohibited Subchapter II. Divisions, Programs, Treatment, Patient Rights (38 1010- 1040) 1010. Declaration of Policy 1011. Division of Behavioral Health, Mental Health, Developmental Disability, Alcoholism, and Drug Dependency Services; Director; Bureaus; Bureau Chiefs 1012. Powers of the Division 1013. Duties of Division 1014. Interdepartmental Coordinating Committee 1015. Citizens Advisory Council on Behavioral Health, Alcoholism and Drug Dependency, and Developmental Disabilities 1016. Standards for public and private treatment facilities; enforcement procedures; penalties 1017. Acceptance for treatment; rules 1018. Voluntary treatment for persons who suffer from behavioral health challenges or mental health disorders, alcoholism, intoxication and developmental disabilities 1019. Treatment and services for persons who suffer from behavioral health challenges or mental health disorders, alcoholism, intoxication, drug dependency, and developmental disabilities 1020. Emergency commitment 1021. Involuntary Commitment of Persons Diagnosed with Behavioral Health Challenges or Mental Health Disorders, Alcoholic and Drug Dependency, and Developmental Disability, or Dual Diagnose into a Behavioral Health Treatment Facility or Hospital 1022. Involuntary treatment with Medication 1023. Transfer to other Facilities 1024. Hospitalization Outside of the Territory 1025. Protective Custody Page 3 of 110 on Nm Rh WN — 33 1026. 1027. 1028. 1029. 1030. 1031. 1032. 1033. 1034. 1035. 1036. 1037. 1038. 1039. 1040. Expense of transportation Maintenance of patients Care of persons diagnosed with behavioral health challenges, mental health disorders, developmental disabilities, and alcohol or drug dependency by relative or friend; bond Conditional Release Return from Unauthorized Absence Patient’s Rights Visitation and communication of patients Progressive Treatment Program Support of person adjudged behaviorally challenged or diagnosed with mental health disorders Discharge Notification to Bureau of Corrections and Police Commissioner Records of persons who suffer from behavioral, mental, or developmental disability health disorders and alcoholism, intoxication and drug dependents Prohibitive Act: Penalty Criminal laws limitations Severability; inconsistency with other provisions Subchapter III. Behavioral Health, Mental Health, Developmental Disability, Alcohol or Substance Abuse Facility (§§ 1041-1044) 1041. 1042. 1043. 1044. Establishment of a Behavioral Health, Mental Health, Developmental Disability, Alcohol or Substance Abuse Treatment Facility Persons who may be admitted into the Behavioral Health, Mental Health, Developmental Disability, Alcohol or Substance Abuse Treatment Facility Rules and Regulation Funding Source Chapter 46. Mental Health (Subchs. I — X) Subchapter I. Commitment, Examination, and Reports (§§ 1045 — 1053) 1045. 1046. 1047. 1048. 1049. 1050. 1051. 1052. 1053. Definitions Authority and Responsibility of the Commissioner of Health Behavioral Health Examiners Psychiatric or Psychological Reports Periodic Report and Information Requirements Videotape Record Return of Escaped Patients Duty to Report Prisoner’s Release to Police Commissioner Habeas Corpus Unimpaired Page 4 of 110 on Aum ff WN — hp HHL Hh HS WwW WW WH WW Www N NNN NN NNN DH — — Se Me eee eK MP WN — OO RWAIARMH PWN | COO PAD PWN | SO KOA DA PWN => OO Subchapter II. Mental Competency (§§ 1054 — 1059) 1054. 1055. 1056. 1057. 1058. 1059. Determination of mental competency to stand trial or to undergo post- release Hearing Admissibility of Finding of Competency Determination and Disposition Request for Discharge Discharge Subchapter III. Not Guilty by Reason of Insanity (§§ 1060 - 1067) 1060. 1061. 1062. 1063. 1064. 1065. 1066. 1067. Determination of the Existence of Insanity at the Time of the Offense Hospitalization of a Person Found Not Guilty by Reason of Insanity Hearing on the Release The Burden of Proof Psychiatric or Psychological Examination and Report Determination and Disposition Conditional Release Discharge Subchapter [V. Hospitalization of an Imprisoned person _(§§ 1068 - 1072) 1068. 1069. 1070. 1071. 1072. 1073. Hospitalization of a Convicted Person Suffering from Behavioral Disorder, Mental Disease, or Defect Hearing Psychiatric and Psychological Examination and Report Determination and Disposition Discharge Subchapter V. Hospitalization of Person Due for Release (§§ 1073 — 1077) 1074. 1075. 1076. 1077. 1078. Hospitalization of an Imprisoned Person Suffering from Behavioral Health Challenge, Mental, Disease, or Defect Psychiatric or Psychological Examination and Report Hearing Determination and Disposition Discharge Subchapter VI. Hospitalization of a Person Due for Release but Suffering from Behavioral Health Challenges or Mental Health Disorders (§§ 1078 — 1083) 1079. 1080. 1081. 1082. 1083. 1084. Hospitalization of a Person Due for Release but Suffering from Behavioral Health Challenges, Mental Health Disorders, Or Defects Psychiatric or Psychological Examination and Report Hearing Determination and Disposition Discharge Release to State of Certain Other Persons Page 5 of 110 wer nA Ua WN — ha SS hh hWWWW WwW YW WDWwWNY NNN NN NN YN NN — — SR eS ee ee ee = wm hwWN S| TOO WAI KHDHN PWN S| OO RPI AANA PWN —|§ CVU Bra HAW ah WN | OO Subchapter VII. Civil Commitment of a Sexually Dangerous Person (§§ 1084 — 1089) 1085. 1086. 1087. 1088. 1089. 1090. Civil commitment of a sexually dangerous person Psychiatric or Psychological Examination and Report Hearing Determination and Disposition Discharge Revocation of Conditional Discharge Subchapter VIII. Civil Commitment and Rehabilitation of Individuals Suffering from Addiction or Alcohol Use Disorder (§§ 1090 — 1095) 1091. 1092. 1093. 1094. 1095. 1096. Definitions Discretionary authority of court; examination, report, and determination by court; termination of civil commitment Authority and responsibilities of the Commissioner of Health; institutional custody; aftercare; maximum period of civil commitment; credit toward sentence Civil commitment not a conviction; use of test results Delegation of functions by Commissioner of Health; use of Federal, territorial, state and private facilities Absence of offer by the court to a defendant of an election or any determination as to civil commitment, not reviewable on appeal or otherwise Subchapter IX. Civil Commitment of Persons Not Charged with Any Criminal Offense (§§ 1096 — 1111) 1097. 1098. 1099. 1100. 1101. 1102. 1103. 1104. Definitions Preliminary proceedings—Petition for Treatment Judicial proceedings; advisement of patient, counsel retained physician's authority, treatment program of commitment, withdrawal, duration, confinement, post-confinement, and recommitment; examination of patient; appointment of physicians, order of commitment, conduct and report of examination, and copies to patient and counsel; return of patient for further proceedings Hearings—Discharge of patient and dismissal of proceedings; notice of time and place; service; issues of fact; demand for jury or judicial determination Order of commitment for treatment to care and custody of Commissioner of Health; reports of Commissioner of Health Period of commitment to care and custody of Commissioner of Health; patient subject to Post-hospitalization program; release from confinement Release from confinement—Notice and return to committing court; placing patient under care and custody of Commissioner of Health for post- hospitalization treatment; recommendations of Commissioner of Health Petition for inquiry into health and general condition and necessity for Page 6 of 110 om HUM PWN — WWW WWW W WNN NYDN NNN NN Ne ee em me Se Se eRe ee SNDUF WN S| OD wMAIANAUN WN | OO WAH FWHM — OO WwW we Oo 0 a P~ - Qo aN N continuation of confinement; order for release from confinement and return to court; placing patient under post-hospitalization treatment 1105. Criminal conviction or criminal appellation from determination of being narcotic addict; criminal proceedings prohibited from using information gained in addiction inquiry 1106. Evidence; examining physician a competent and compellable witness; physician-patient privilege 1107. Subchapter inapplicable to persons with criminal charge pending, on probation or with sentence unserved; consent to commitment of such persons by authority with power over their custody 1108. Commitment to hospital of the Service dependent upon certification of availability of facilities or personnel for treatment 1109. Compensation of physicians and counsel; source of funds 1110. Authority of Commissioner of Health—Delegation of functions 11. Penalties; escape or rescue from custody 1112. Same; false statements Subchapter X. Telepsychology or Telehealth (§§1112-1113) 1113. Telehealth, Telemedicine, and Telepsychology Defined 1114. Permission to Practice and Authorization Chapter 47. Intellectual and Developmental Disabilities (§§1114 —1119) 1115. Purpose 1116. Territorial Protections for Individuals with Intellectual and Developmental Disabilities 1117. Establishing Federal Policies and Initiatives for Services and Programs for Individuals with Intellectual and Developmental Disabilities 1118. General powers and duties 1119. Administrative appropriations 1120. Standards for maintenance and operation Chapter 48. Behavioral Health for Children and Young Adults (§§ 1120 — 1123) 1121. Maternal and child health services 1122. Services for children with physical disabilities 1123. Education of children with intellectual disabilities 1124. Application of the Children’s Policy Page 7 of 110 Part V. Behavioral Health and Developmental Disability Act (Chs. 45 - 48) Chapter 45. Behavioral Health, Mental Health Disorders, Developmental Disabilities, and Alcohol or Drug Dependency (Subchs. I — III) Subchapter I. Community Behavioral Health Services (§§ 1000-1009) 1000. Purpose (a) The purpose of this subchapter is to expand community behavioral health services, encourage local participation in programs provided by community behavioral health providers, obtain a better understanding of the need for community behavioral health services and encourage implantation of community behavioral health services. To promote and support the development and implementation of comprehensive community support systems to ensure community integration and the maintenance of a decent quality of life for persons who suffer from behavioral health challenges or mental health disorders in each of the service areas in the Territory; and to strengthen the capacity of families, natural networks, self-help groups, and other community resources in order to improve the support for persons who suffer from behavioral health challenges or mental health disorders. 1001. Definitions (a) For purposes of this chapter and related chapters, unless the context otherwise indicates: (1) Act: means the Virgin Islands Behavioral Health and Developmental Disability Act of 2020; (2) Alcoholic: means a person who habitually lacks self-control as to the use of alcoholic beverages, or uses alcoholic beverages to the extent that his health is substantially impaired or endangered or his social or economic function is substantially disrupted; (3) “Alcohol Use Disorder (AUD) or Alcoholism”: means problem drinking that becomes severe and is a chronic relapsing brain disease characterized by compulsive alcohol use, loss of control over alcohol intake, and a negative emotional state when not using. To be diagnosed with AUD, individuals must meet certain criteria outlined in the Diagnostic and Statistical Manual of Mental Page 8 of 110 eon AM fh wWN — bh HS HLH fF LWW WHY WW YH WWW wWNnYNN NN NN DY NN See ee Be Be Se eK Rn kWNK OO DOA AUYN FP WN KK Sv BAAN AWN — OO MATA UN RWN = OO Disorders (DSM). To be diagnosed with alcoholism, individuals must meet any two of the below criteria within the same 12-month period: i. Using alcohol in higher amounts or for a longer time than originally intended. ii. Being unable to cut down on alcohol use despite a desire to do so. iii. Spending a lot of time obtaining, using, and recovering from the effects of alcohol. iv. Cravings, or a strong desire to use alcohol. v. Being unable to fulfill major obligations at home, work, or school because of alcohol use. vi. Continuing to abuse alcohol despite negative interpersonal or social problems that are likely due to alcohol use. vii. Giving up previously enjoyed social, occupational, or recreational activities because of alcohol use. viii. Using alcohol in physically dangerous situations (such as driving or operating machinery). ix. Continuing to abuse alcohol despite the presence of a psychological or physical problem that is probably due to alcohol use. x. Having a tolerance (i.e. needing to drink increasingly large or more frequent amounts of alcohol to achieve the desired effect). xi. Developing symptoms of withdrawal when efforts are made to stop using alcohol. (4) Agency: means a governmental or non-governmental person, firm, association or corporation, and department; (5) Approved private treatment facility: means a private agency meeting the standards prescribed in section 1016 of this title and approved under section 1017 of this title, which can cover or provide services for behavioral challenges, mental health, developmental disabilities, alcoholism, and drug dependency; (6) Approved public treatment facility: means a treatment agency operating under the direction and control of the Department of Health or providing treatment under this chapter through a contract with the Division under section 1046 of this title and meeting the standards prescribed in section 1016 of this title and approved under section 1017 of this title, which can cover or provide services for behavioral challenges, mental health, developmental disabilities, alcoholism, and drug dependency; (7) Behavioral health: means the promotion of mental health, resilience and wellbeing; the treatment of mental and substance use disorders; and the support of those who experience and/or are in recovery from these conditions, along with their families and communities. Behavioral health is the scientific study of the emotions, behaviors, and biology relating to a person’s mental well-being, their ability to function in everyday life and their concept of self. A person struggling with his or her behavioral health may face stress, depression, anxiety, relationship problems, Page 9 of 110 or~l A wr kRWN = fh Hf P HLwWW WWW WH WwW WNNN HNN NNN NS — KH Se Re ee eK = RUOBEBHDZASSCRZARZGRESORVNZSSSSUILSRSHSESOCHRVSSRNUARAGTETDHALDS © grief, addiction, ADHD or learning disabilities, mood disorders, or other psychological concerns. Counselors, therapists, life coaches, psychologists, nurse practitioners or physicians can help manage behavioral health concerns with treatments such as therapy, counseling, or medication. (8) Behavioral healthcare hospital: means a public or private facility or a behavioral health center which is equipped to provide patient care and treatment for persons who suffer from behavioral health challenges or mental health disorders; (9) Behavioral health professional: means a licensed psychologist, psychiatrist, psychiatric nurse, behavioral health counselor, or behavioral health or psychiatric social worker, or in their absence, an emergency medical technician (EMT); (10)Behavioral health services: means patient counseling, other psychological, psychiatric, diagnostic or therapeutic services and other allied services; (11) Case management services: means those services which assist an individual in gaining access to and making effective use of the range of medical, psychological and other related services available to them; (12) Commissioner: means the Commissioner of the Department of Health; (13) Community support system: means the entire complex of behavioral health, rehabilitative, residential and other support services in the community to ensure community integration and the maintenance of a decent quality of life for persons who suffer from behavioral health challenges or mental health disorders; (14) Department: means the Department of Health; (15) Developmental Disability: means for the purposes of this chapter a severe, chronic disability of an individual that can require behavioral, mental health, or other similar service and is any of the following: a. Is attributable to a mental or physical impairment or combination of mental and physical impairments; b. Results in functional limitations in three or more of the following areas of major life activity; i. Self-care; li. Receptive and expressive language; ili. Learning; iv. Mobility; v. Self-direction; vi. Capacity for independent living; and vii. Economic self-sufficiency. Page 10 of 110 om NM & WN — Shh hf Lh HWW WWW WwW WwW WwWN NN NN WYNN WN — H— KH Ke KP Ke kK eS SS Am F&F WN KK CO WO WAI KHUN fFWNY— TKO WAI A UM FWN KH COTO AA KHDU LP WHY —|— OY c. Reflects the individual's need for a combination and sequence of special, interdisciplinary, or generic services, supports, or other assistance that is of lifelong or extended duration and is individually planned and coordinated, except that such term, when applied to infants and young children means individuals from birth to age 5, inclusive, who have developmental delay or specific congenital or acquired conditions with a high probability of resulting in developmental disabilities if services are not provided. (16) Director: means the Director of the Division of Behavioral Health, Alcoholism, and Drug Dependency Services; (17) Division: means the Division of Behavioral Health, Alcoholism, and Drug Dependency Services established under section 1011 of this title; (18) Drug dependence or Drug Dependency: means a state of psychic or physical dependence, or both, on a drug, arising in a person following administration of that drug on a periodic or continuous basis. The characteristics of such a state will vary with the agent involved, and these characteristics must always be made clear, designating the particular type of drug dependence in each specific case, for example, drug dependence of the alcohol type, morphine type, of the barbiturate type or of the amphetamine-type; or the opioid type. (19) Emergency service patrol: means a patrol established to transport a person during Emergency Commitment under section 1020 or under any of the conditions established by the Commissioner of Health; (20) Forensic Services: means evaluating an individual's competency to stand trial and mental state at the time of the offense; (21) Homeless: means an individual or family who lacks a fix regular and adequate nighttime residence, or if an individual or family sleeps in a shelter designated for temporary living accommodations or in a place not adequate for human habitation; (22) Incapacitated by alcohol: means a condition of intoxication caused by the use of alcohol in which the person is unconscious or unable to speak coherently or unable to control body movements in a coordinated and effective manner; (23) Incompetent person: means a person who has been adjudged incompetent by the Superior Court; (24) Intellectually disabled: means having a disorder characterized by significantly impaired intellectual and adaptive functioning as diagnosed by a qualified and licensed mental health specialist; (25) Intoxicated person: means a person whose mental or physical functioning is substantially impaired as a result of the use of alcohol; Page I1 of 110 on NA Ph WH — hw WwW WwW WwW HB wd NN NN NNN WY Nm mm me mm mee eS eS (26) Least restrictive form of transportation: means the vehicle used for transportation and any restraining devices that may be used during transportation that impose the least amount of restriction, taking into consideration the stigmatizing impact upon the individual being transported; (27) Licensed medical practitioner: means a person licensed under the laws of Virgin Islands to practice medicine; (28) Licensed clinical psychologist: means a person licensed under the laws of the Virgin Islands as a psychologist and who practices clinical psychology; (29) Likelihood of harm: means - a. b. A risk of physical harm to the person as manifested by recent threats of, or attempts at, suicide or serious self-inflicted harm; A risk of physical harm to other persons as manifested by recent homicidal or violent behavior or by recent conduct placing others in reasonable fear of serious physical harm; A reasonable certainty that the person will suffer severe physical or mental harm as manifested by recent behavior demonstrating an inability to avoid risk or to protect the person adequately from impairment or injury; or If a person suffers from severe and persistent behavioral health challenges or mental health disorders, in view of the person's treatment history, current behavior and inability to make an informed decision, a reasonable likelihood that the person's behavioral health will deteriorate and that the person will in the foreseeable future pose a likelihood of serious harm as defined in paragraphs (a), (b) or (c); (30) Long-term behavioral health challenges or mental health disorders: means persons who suffer certain mental or emotional disorders, such as organic brain syndrome, schizophrenia, recurrent depressive and manic-depressive disorders, paranoid and other psychoses, plus other disorders which may become chronic, that erode or prevent the capacities in relation to 3 or more of the primary aspects of daily life, such as personal hygiene and self-care, self-direction, interpersonal relationships, social transactions, learning, recreation, and economic self-sufficiency. While these persons may be at risk of facilitization, there is no requirement that these persons are or have been residents of facilities providing behavioral health services; (31) Medical practitioner or practitioner: means a licensed medical practitioner, registered physician assistant, certified psychiatric clinical nurse specialist, certified nurse practitioner or licensed clinical psychologist; (32) Network: means organizations providing behavioral health services which were awarded governmental funds or Medicaid; Page 12 of 110 r- CO OHHH PWN — (33) Patient: means a person under observation, care or treatment in a psychiatric facility or residential care facility pursuant to this subchapter, a person receiving services from an assertive community treatment team, a person receiving intensive behavioral health management services from the Department or a person being evaluated for emergency admission in a hospital; (34) Persons who suffer from behavioral health challenges or mental health disorders: means a person whose mental functions are impaired to interfere with his capacity to meet the ordinary demands of life, the result of which is that such person's thinking, mood, and behavior have become irrational or distorted from reality, whether such condition has been caused by organic brain tissue damage or by psychological causes. This includes, but not limited to those who are dually diagnosed; (35) Peace officer: means law enforcement officer, and shall include, but not limited to, police officers, parole officers, correction officers, warden, prison guard, marshals, pursuant to Title 5 V.I.C. § 3561 and 23 V.I.C. § 3; (36) A person suffering from behavioral health challenges or mental health disorders: means an individual having a psychiatric or other diseases that substantially impairs that person's behavioral or mental health or creates a risk of suicide. A person with developmental disabilities or a person diagnosed as a sociopath is not for those reasons alone a person with a diagnosed behavioral health challenge or mental health disorder. This includes those who are dually diagnosed; (37) Private Facility: means a facility privately funded and not under the supervision of the Virgin Islands Government which is equipped to provide inpatient and outpatient care and treatment for the mentally ill; (38) Progressive treatment program or programs; means a program of court-ordered services provided to participants under the Progressive Treatment Program as expressed in the Act (section 1033); (39) Psychiatric facility: means public or private behavioral health facilities; or any section of any public hospital designated for behavioral health/psychiatric care; (40) Public Facility: means a facility funded by the Government of the Virgin Islands and under the supervision of the Virgin Islands Government which is equipped to provide inpatient care and treatment for persons who suffer from behavioral health challenges, mental health disorders, substance use, and are in need of developmental disability services; (41) Residential care facility: means a licensed or approved boarding care, nursing care or foster care facility which supplies supportive residential care to individuals due to their chronic behavioral health challenge or mental health disorder; Page 13 of 110 woonna UV fb Wwe HN — oS wW No (42) Severe and persistent behavioral health challenges or mental health disorders: means a diagnosis of one or more qualifying mental health disorders or illnesses plus a listed disability or functional impairment that has persisted continuously or intermittently or is expected to persist for at least one year as a result of that disease or disorder. The qualifying mental health disorders are schizophrenia, schizoaffective disorder or other psychotic disorder, major depressive disorder, bipolar disorder or a combination of mental disorders sufficiently disabling to meet the criteria of functional disability. The listed disabilities or functional impairments, which must result from a diagnosed qualifying mental health disorder, include inability to adequately manage one's own finances, inability to perform activities of daily living and inability to behave in ways that do not bring the attention of law enforcement for dangerous acts or for acts that manifest the person's inability to protect the person from harm; (43) Sexual Act: means any act that results in sexual contact as defined in Title 14 V.L.C. §1699 (d); (44) Sexual Conduct: means conduct as defined Title 14 V.I.C. §1027(b) and Title 14 V.L.C. §1699 (c); (45) A Student in Crisis: means a student who is suffering from anxiety or fear because of the student experience or perceives a threat to their self-esteem or significant relationship or role mastery; (46) Treatment: means the broad range of emergency, outpatient, intermediate and inpatient services and care, including diagnostic evaluation, medical, psychiatric, psychological and social service care, vocational rehabilitation and career counseling, which may be extended to persons; 1002. Commissioner’s Duties Regarding Community Behavioral Health Services (a) The Commissioner of Health shall be responsible for providing all-inclusive services for people who suffer from behavioral health challenges or mental health disorders who otherwise cannot be served by the community service networks. The Department may develop contracts to deliver safety net services if the Department determines contracts to be appropriate and cost-effective. The governmentally operated safety net must include, but is not limited to: 1) Emergency hospital beds for people requiring medical stabilization, assessment or treatment; 2) Intermediate and long-term treatment for people who need long-term structured care; 3) Forensic services; 4) Intensive case management; 5) Residential Facility Services; and 6) Other necessary services as determined by the Commissioner. Page 14 of 110 oon HW PWN — Ww WW WwW WwW Ww WwW HNN DY NY KY HN NK NY NK = KS Se eS Ke eK eS (b) The Commissioner of Health shall be responsible for providing technical assistance for program development, promoting effective coordination with the Department of Health, Department of Education, Bureau of Corrections, Police Department, Judiciary, and Department of Human Services and other relevant departments or agencies to develop new resources to improve the availability and accessibility of comprehensive community support services to persons who suffer from behavioral health challenges or mental health disorders. The Commissioner of Health shall also responsible for ensuring the following: 1) Assessing service needs, monitoring service delivery related to these needs and evaluating the outcomes of programs designed to meet these needs in order to enhance the quality and effectiveness of community support services; 2) Preparing a report that describes the system of community support services in the Territory. This report must include: 1. ii. ili. iv. both existing service resources and deficiencies in the system of services; assessment of the roles and responsibilities of behavioral health agencies, human services agencies, health agencies and similar departments of the government, in order to suggest ways in which these agencies and departments can better cooperate to improve the service system for persons who suffer from behavioral health challenges, mental health, or developmental disorders; be prepared annually, and must be submitted to the joint standing committee of the Legislature having jurisdiction over behavioral health by December 15th of every even-numbered year; interdepartmental coordination, including review by _ the Commissioner of Health, the Department of Health, Department of Education, Bureau of Corrections, Police Department, Judiciary, and Department of Human Services, of the report to ensure recommendations with respect to administrative and funding improvements in the system of community support services to persons who suffer from behavioral health challenges, mental health, or developmental disorders are made; A. Participate with school administrative units in transition planning for each student with a behavioral health challenge, mental health, or developmental disorder; and B. assign appropriate staff as a transition contact person and as a member of the transition planning team for each student, who is receiving special education services, and who is a minor or young adult, if it is determined appropriate by the student's individualized education program team. 1003. Cooperative planning required; grant recipients and Bureau of Correction Authorities (a) Providers of Community Behavioral Health Services Cooperative Plan with Bureau of Corrections: Page 15 of 110 on NU fh Ww NY — As a condition for receipt of behavioral health funding pursuant to this Chapter, providers of community behavioral health services to persons who suffer from behavioral health challenges or mental health disorders must develop, with the Bureau of Correction authorities, cooperative plans for the provision of services to those persons under the custody and care of the Bureau of Corrections. These plans must include at least the following: 1) Procedures for timely referral of persons who suffer from behavioral health challenges or mental health disorders to community-based behavioral health services; 2) Provision for the treatment and support of persons who suffer from behavioral health challenges or mental health disorders at the correctional facilities and commitment of funds within available resources; and 3) Procedures for referrals of individuals suffering from behavioral health challenges or mental health disorders to local providers of comprehensive behavioral health services following release from correctional facilities, including mechanisms for developing comprehensive treatment plans before the release, from correctional facilities, of persons who suffer from behavioral health challenges or mental health disorders. (b) Ineligibility for Governmental Funds: Providers of community behavioral health services and other public providers of comprehensive services to persons who suffer from behavioral health challenges or mental health disorders that fail to participate in the development of plans to serve this population, or to provide services to serve this population, are not eligible for governmental funding. (c) Exclusion: A person or entity that applies for the award or renewal of a grant or contract for the provision of behavioral health services must be a participating member of the community service network, as established in §1004 Community Service Networks of this Act. 1004. Community Service Networks (a) The Commissioner of Health Shall Establish and Oversee Community Service Networks: Community Service Networks will be established on each island with the collective responsibility to coordinate and ensure continuity of care within the delivery of behavioral health services to behavioral health consumers under the authority of the Department of Health. The community service networks must be established and operated in accordance with standards adopted by the Department of Health to establish and operate networks. Departmental oversight includes, but is not limited to, establishing and overseeing protocols, quality assurance, writing and monitoring contracts for service, establishing outcome measures and ensuring that each network provides an integrated system of care. The Department of Health may adopt rules to carry out this section. Rules adopted pursuant to this section are mandatory rules. Page 16 of 110 Son AM WN — WWW Wwe wwe NN NN DY NN YN NY = = HS Se Se eS eS eS aA MN WN —- OD tna NU WN | CO wWrx~A KDHUN BwWNK CO OO vs) Oo bh Ww oOo 6 4l 42 43 44 45 46 (b) Each network shall: ) 2) 7) Ensure 24-hour access to a client’s community support services records for better continuity of care during a psychiatric crisis; Ensure continuity, accountability, and coordination regarding service delivery; Participate in the collection of uniform data pertaining to services; In conjunction with the Department, conduct planning activities based on data and client outcomes; Develop techniques for identifying and providing services to clients at risk; Enable, among other things, the sharing of confidential client information to the extent necessary to protect the client’s health and safety when it is determined the client has an urgent need for behavioral health services. i. The network members shall share confidential client information, even without a client’s consent, to the extent necessary to protect the client’s health and safety in a period of urgent need for behavioral health services when the client lacks the capacity to give consent for the information sharing or when an exigency exists so that the client’s health and safety is better protected if the information is shared without a delay to obtain consent. A person or entity participating in good faith in sharing information under this paragraph is immune from civil liability that might otherwise result from these actions, including, but not limited to, a civil liability that might otherwise arise under local or federal laws or rules regarding confidentiality of information. The Department shall adopt rules to identify the limits and requirements to be implemented; and Provide consolidated behavioral health crisis services for children and adults through a memorandum of understanding among providers of behavioral health services in the network that must include provisions to ensure coordination, eliminate duplication, and provide a level of crisis services established by the Department. (c) Data collection: The Commissioner of Health shall collect data to assess the capacity of the community service networks, including, but not limited to, analyses of the utilization of mental health services and the unmet needs of persons receiving publicly funded behavioral health services. 1006. Crisis Intervention Program (a) Crisis Intervention Program Established: The Department of Health shall establish Crisis Intervention and Prevention services, a community-based program to provide counseling, consultation, evaluation, treatment and referral, education and training services, delivered by a crisis intervention team. The program will be designed for persons with behavioral challenges, mental health disorders, developmental disabilities, or alcohol and drug dependency who experience Page 17 of 110 a behavioral crisis that threatens their ability to live a full productive life due to | 2 hospitalizations, law enforcement involvement, or placement in restrictive settings. 3 Persons will be supported by the Department of Health in the development of 4 behavioral assessments, individualized behavior treatment plans, and intensive 5 intervention with a focus on family coaching. The program shall provide the following 6 services: 7 1) Emergency room services. Crisis intervention and psychiatric emergency 8 services based in a hospital emergency room; 9 2) Outreach services. Outreach services and crisis intervention beyond the 10 hospital setting; 11 3) Telephone hot-line services. A community-based telephone crisis 12 intervention hot-line offering 24-hour, 7-days-a-week counseling, 13 consultation, evaluation, treatment and referral services. 14 4) Telehealth Services. delivery of health care services, through the use of 15 interactive real-time visual and audio or other electronic media for the 16 purpose of consultation and education concerning and diagnosis, treatment, 17 care management and self-management of an enrollee's physical and mental 18 health, and includes real-time interaction between the enrollee and the 19 telehealth provider, synchronous encounters, asynchronous encounters, 20 store, and forward transfers and telemonitoring. 21 22 (b) Suicide Prevention and Other School Counseling Program: 23 The Department of Health, shall, in cooperation with the Department of Education, 24 Department of Human Service, and the Police Department shall develop a suicide 25 prevention strategy and a model suicide prevention program, counseling for bullying, 26 cyberbullying, and peer pressure counseling to be presented in the elementary, junior, 27 and high schools in the Territory. The development of such a program must include the 28 preparation of relevant educational materials that must be distributed in the schools. 29 30 31 1006. Crisis Intervention Team 32 33. (a) Established: 34 A community-based crisis intervention team shall be established to provide crisis 35 intervention on a 24-hour, 7-days-a-week basis to persons who suffer from behavioral 36 health challenges or mental health disorders and to provide crisis intervention training 37 for emergency room personnel. 38 39 = (b) Qualifications: 40 The team shall be comprised of qualified behavioral health professionals with training 4l and experience in assessment and intervention with persons who suffer from behavioral 42 health challenges or mental health disorders in a crisis. The team members shall have 43 a working knowledge of intake, case management, behavioral and mental health 44 systems, and local resources. 45 46 47 Page 18 of 110 1007. Behavioral Health Training l 2 3 (a) Purpose: 4 Law enforcement officers are most often the first responders in a behavioral health 5 emergency, and as such, it is essential that law enforcement officers recognize the signs 6 and symptoms of behavioral health challenges or mental health disorders and respond 7 more effectively and appropriately to individuals in crisis. 8 9 (b) Law Enforcement Training: 10 The Virgin Islands Police Department in conjunction with the Division of Behavioral 11 Health shall train law enforcement officers on how to address calls involving 12 behavioral or mental health crises. Law enforcement officers shall perform their regular 13 duties but shall be trained on how to respond more effectively and appropriately to 14 individuals in crisis. Law enforcement officers shall receive a minimum of forty (40) 15 hours of specialized training in psychiatric diagnoses, suicide intervention, substance 16 abuse issues, behavioral de-escalation, the role of the family in behavioral health 17 challenges or mental health disorders, behavioral health, and substance abuse laws, and 18 local resources and procedures for individuals in crisis. 19 20 ~=(e) Training for Education Personnel: 21 Teachers, school psychologists, social workers, guidance counselors, and other school 22 personnel will be trained on early identification of potential behavioral health 23 challenges or mental health disorders. 24 25 1008. Protective Custody 26 27. = (a) Law Enforcement Officer's Power: 28 If a law enforcement officer has probable cause to believe that a person may be 29 suffering from a behavioral health challenge or mental health disorder and that due to 30 that condition the person presents a threat of imminent and physical harm to that person 31 or to other persons or to property, law enforcement has the following authority: 32 1) The law enforcement officer shall take the person into protective custody; and 33 i. When formulating probable cause, the law enforcement officer may rely 34 upon information provided by a third-party informant if the officer 35 confirms that the informant has reason to believe, based upon the 36 informant's recent personal observations of or conversations with a 37 person, that the person may suffer from a behavioral health challenge or 38 mental health disorder and that due to that condition the person presents 39 a threat of imminent and physical harm to that person or to other persons 40 or property. 4] 2) Shall deliver the person immediately for examination by a medical practitioner 42 as provided in sections 1020, 1021 and 1022 of this chapter for examination to 43 determine the individual's capacity. 44 45 46 Page 19 of 110 (b) Certification Not Required for Treatment: l 2 Pursuant to sections 1020, 1021 and 1022 of this chapter, if it is determined that the 3 person poses a danger of harm or injury to himself or others and that he is in need of 4 emergency treatment or may be committed to the custody of the Department of Health 5 by the Superior Court for observation, diagnosis, care, and treatment upon petition, the 6 psychiatrist shall so certify by filing a written certification to that effect. However, if a 7 certificate is not executed under sections 1020, 1021 and 1022, the medical practitioner 8 shall still treat the person, and if he/she feels that person is not a threat to himself or 9 others or property, the medical practitioner may release the person. 10 1) Notwithstanding the above and the discretion of the medical practitioner to 1] determine whether a certificate is required and executed, no person shall be 12 released who may be a threat to themselves or others or property. 13 14 (¢) Executed Certificate: 15 If a certificate is filed and executed by the examiner under sections 1020, 1021 and 16 1022 of this chapter, the officer shall undertake forthwith to secure the endorsement of 17 a Superior Court judge under §1021 and 1022 and may detain the person for a period 18 of time not to exceed 72 hours as may be necessary to obtain that endorsement. 19 20 =(d) Detention Pending Judicial Determination: 21 Notwithstanding any other provisions of this subchapter, a person, with respect to 22 whom an application for the issuance of an order for hospitalization has been filed, may 23 not be released or discharged during the pendency of the proceedings, unless: 24 1) The Superior Court orders release or discharge upon the request of the patient 25 or the patient's guardian, parent, spouse, next of kin, or attorney; 26 2) The Superior Court orders release or discharge upon the report of the applicant 27 that the person may be discharged with safety; 28 3) The Superior Court orders release or discharge upon a writ of habeas corpus 29 under 5 V.I.C. § 3810; or 30 4) Upon request of the Commissioner, the Superior Court orders the transfer of a 31 patient in need of more specialized treatment to another psychiatric facility. 32 33 (e) When Release is Authorized Law Officers or Peace Officers Shall: 34 1) Release the person from protective custody and, with the person's permission, 35 return the person forthwith to the person's place of residence; 36 2) Release the person from protective custody and, with the person's permission, 37 return the person forthwith to the place where the person was taken into 38 protective custody; or 39 3) Ifthe person is also under arrest for a violation of the law, retain the person in 40 custody until the person is released in accordance with the law. 41 42 1009. Sexual Activity with Recipient of Services Prohibited 43 44 (a) A person who owns, operates or is an employee of any public or private facility, 45 residence, organization, or program that is operated, administered, licensed or funded 46 by the Department of Health shall not engage in any sexual act, with another person Page 20 of 110 40 4\ 42 43 44 45 or subject another person to sexual contact, if the other person, not the actor's spouse, is a recipient or person being treated for behavioral health challenges or mental health disorders, and who receives therapeutic, residential or habilitative services from that entity or employee. Any person who violates this section shall be charged with committing a felony. Subchapter II. Divisions, Programs, Treatment, Patient Rights (§§ 1010-1040) 1010. Declaration of Policy (a) In conformity with the purpose of the Virgin Islands Behavioral Health and Developmental Disability Act of 2020, the Department of Health is responsible for the direction of behavioral health and certain developmental disability programs in public facilities and for the promotion and guidance of behavioral health, mental health, and developmental disability programs within the Territory. (b) The Act establishes policies and procedures by which persons with behavioral health challenges, mental health disorders, or developmental disabilities may receive services. The procedures are to be applied consistently with the principles of due process to make voluntary and involuntary treatment available where the need is great and where the absence of treatment could result in serious harm to the individual or to others. (c) This Act applies to all involuntary treatment of persons who suffer from behavioral health challenges or mental health disorders, whether inpatient or outpatient and for all voluntary inpatient treatment of persons who suffer from behavioral health challenges or mental health disorders. Persons who are developmentally or intellectually disabled, senile, alcohol-dependent or drug dependent shall be afforded behavioral health examinations or treatment if they are also diagnosed as suffering from behavioral health challenges or mental health disorders, or if there is a reasonable probability that upon examination such diagnosis will be established. Persons in treatment under the Act shall be afforded necessary diagnostic or treatment procedures as defined in their treatment plan for conditions of developmental or intellectual disability, senility, alcohol, or drug abuse when it is determined that the absence of such procedures will be detrimental to the progress of the person accomplishing the goals of treatment. 1011. Division of Behavioral Health, Mental Health, Developmental Disability, Alcoholism, and Drug Dependency Services; Director; Bureaus; Bureau chiefs (a) A Division of Behavioral Health, Mental Health, Developmental Disability, Alcoholism, and Drug Dependency Services is established within the Department. The Division shall be under the supervision of the Commissioner. The Division shall be headed by a Director. The Director shall be a licensed medical practitioner in the field of behavioral health or mental health or a qualified professional who has had a minimum of five (5) years training and experience in handling medical-social problems or the organization or administration of treatment services for persons who suffer from Page 21 of 110 on Ain RW HN — 10 11 12 13 14 15 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 medical-social challenges including, behavioral health challenges, mental health disorders, alcoholism, drug dependency, and developmental disabilities. (b) The Commissioner may establish such bureaus and appoint such chiefs to head such bureaus as deemed appropriate for the efficient and effective functioning of the Division. 1012. Powers of the Director (a) The Director Shall with the Advice and Consent of the Commissioner: 1) 2) 3) 4) 5) 6) 7) Plan, establish and maintain treatment, education, training and prevention programs as necessary or desirable in relation to Behavioral Health, Mental Health, Developmental Disability, Alcoholism, and Drug Dependency; Make contracts necessary or incidental to the performance of its duties and the execution of its powers, including contracts with public and private agencies, organizations and individuals to pay them for services rendered and furnished to persons who suffer from behavioral health challenges, mental health disorders, developmental disabilities, alcoholism, intoxication or drug dependency; Solicit and accept for use any gift of money or property made by will or otherwise, and any grant of money, services, or property from the Federal Government or the Territory or any private source, and do all things necessary to cooperate with the Federal Government or any of its agencies in making an application for any grant for services in any area concerning behavioral health challenges, mental health disorders, developmental disabilities, alcoholism, intoxication or drug dependency; Administer or supervise the administration of provisions relating to persons who suffer from behavioral health challenges, mental health disorders, developmental disabilities, alcoholism, intoxication or drug dependency in any Territorial plan submitted for Federal funding pursuant to Federal health, welfare or treatment legislation; Coordinate its activities and cooperate with behavioral health challenges, mental health disorders, developmental disabilities, alcoholism, intoxication or drug dependency in this Territory and other states or territories, and make contracts and other joint or cooperative arrangements with Territorial, local, or private agencies in this and other states for the treatment of persons who suffer from behavioral health challenges, mental health disorders, developmental disabilities, alcoholism, intoxication or drug dependency and for the common advancement of behavioral health, mental health, developmental disabilities, alcoholism, intoxication or drug dependency; Do other acts and things necessary or convenient to execute the authority expressly granted to it; Provide treatment facilities for persons who suffer from behavioral health challenges, mental health disorders, developmental disabilities, alcoholism, intoxication or drug dependency; and Page 22 of 110 on A nA WwW nN = 26 hh Lh LHW WwW Ww WWW wn NNN NY KY NNN N= — = = B= BS Se eS = DRDmfwndDs—- OO WMAIADNfFWNYM — OO WAIAUNRWN HH OO WAIT A URW N —|— OO 8) Establish health programs for the purpose of research into and aid of methods of prevention, diagnosis, and treatment of behavioral health challenges, mental health disorders, developmental disabilities, alcoholism, intoxication or drug dependency; The programs shall include: i. Emergency treatment provided by a facility affiliated with or part of the medical service of a general hospital; il. Inpatient treatment; ili. Intermediate treatment; and iv. Outpatient and follow-up treatment. 9) Shall establish comprehensive and coordinate programs for the treatment of the persons who suffer from behavioral health challenges, mental health disorders, developmental disabilities, alcoholism, intoxication or drug dependency; 10) Supervise the administration of those services included in programs which are not administered directly; 11)Provide such methods of administration as are necessary for the effective operation of the program; 12) Extend and improve local health services for behavioral health challenges, mental health disorders, developmental disabilities, alcoholism, intoxication or drug dependency throughout the Virgin Islands; 13) Cooperate with the Federal Government through its appropriate agency or instrumentality in developing, extending and improving behavioral health challenges, mental health disorders, developmental disabilities, alcoholism, intoxication or drug dependency services; 14) Investigate, by personal visit, complaints made by any patient or by any person on behalf of patient suffering from behavioral health challenges, mental health disorders, developmental disabilities, alcoholism, intoxication or drug dependency; 15) Visit each behavioral health, mental health, developmental disabilities, alcoholism, intoxication or drug dependency treatment facility regularly to review the commitment procedures of all new patients admitted between visits, and review protocols and procedures related to certification of patients under §1020, 1021 and 1022; 16) Keeps records and engage in research and the gathering of relevant statistics; 17) Require reports from the Director of any hospital or residential care facility relating to the admission, examination, diagnosis, release or discharge of any patient; 18) Prescribe the form of applications, records, reports, and medical certificates provided for under this subchapter and prescribe the information required to be contained in them; and 19) Become a member of the National Association of County Behavioral Health & Developmental Disability Directors ““NACBHDD”) i. NACBHDD is an active partner in efforts to improve access to, funding for, and quality of behavioral health services. Directors of the Virgin Islands that are members of NACBHDD receive national assistance in collaboration with other state partners on key issues including protecting Medicaid coverage, ending the stigma of mental illness, Page 23 of 110 on A tA Rw N — hwWwWwW WW WwW WwW WwW eH N YN NY WYN YN DN we wm Be eS Se Be Se eS eS eS better treatment for veterans, achieving parity in insurance coverage for behavioral health care, affordable housing and vocational training for those with mental illness or developmental disabilities, and more. 1013. Duties of the Division (a) The Division shall: 1) 2) 3) 4) 5) Develop, encourage and foster Territory-wide, regional and local plans and programs for persons who suffer from behavioral health challenges or mental health disorders, alcoholism and drug dependency, developmental disabilities, and for the treatment of persons who suffer from behavioral health challenges or mental health disorders, alcoholism, intoxication, and drug dependency, and developmental disabilities in cooperation with public and private agencies, organizations, and individuals and provide technical assistance and consultation services for these purposes; Coordinate the efforts and enlist the assistance of all public and private agencies, organizations, and individuals interested in prevention of behavioral health challenges or mental health disorders, alcoholism and drug dependency, and developmental disabilities, and in the treatment of behavioral health challenges or mental health disorders, alcoholic, intoxicated and drug dependency, and developmental disabilities; Cooperate and coordinate with the U.S. Virgin Islands Police Department (V.I.P.D.), Bureau of Corrections, and Board of Parole in establishing and conducting programs to provide treatment for persons in or on parole from correctional institutions who suffer from behavioral health challenges or mental health disorders, alcoholism, intoxication, and drug dependency, and developmental disabilities; Cooperate and coordinate with the Department of Education, the Board of Education, schools, the courts, and other public and private agencies, organizations and individuals in establishing programs for persons who suffer from behavioral health challenges or mental health disorders, alcoholism and drug dependency, and developmental disabilities, and for the treatment of persons who suffer from behavioral health challenges or mental health disorders, alcoholism, intoxication and drug dependency, developmental disabilities, as well as preparing curriculum materials for students in crisis at all levels in the schools of this Territory, (as defined in §1001(42)); Prepare, publish, evaluate and disseminate educational materials dealing with the nature and effects of behavioral health challenges or mental health disorders, alcohol, and drugs; Page 24 of 110 on NAW BW NY — +. hk HWW WWW HWW we WN DH NY NNN YY WYN eS Se Se ee Se Se eS 6) Develop and implement, as an integral part of treatment programs, educational programs for use in the treatment of behavioral health challenges or mental health disorders, alcoholism, intoxication, and drug dependency, and developmental disabilities, which programs shall include the dissemination of information concerning the nature and effects of behavioral health challenges, mental health disorders, alcohol and drug dependency, and developmental disabilities; 7) Organize and foster training programs for all persons engaged in the treatment of persons who suffer from behavioral health challenges or mental health disorders, alcoholism, intoxication and drug dependency, and developmental disabilities; 8) Sponsor and encourage research into the causes and nature of behavioral health, alcoholism, drug dependency, and developmental disabilities, and treatment of persons who suffer from behavioral health challenges or mental health disorders, alcoholism, intoxication, drug dependency, and developmental disabilities, and serve as a clearinghouse for information relating to behavioral health, mental health disorders, alcoholism and drugs, and developmental disabilities; 9) Specify uniform methods for keeping statistical information by public and private agencies, organizations, and individuals, and collect and make available relevant statistical information, including the number of persons treated, frequency of admission and readmission, and frequency and duration of treatment; 10) Advise the Health Planning and Resource Development Agency, in the preparation of a comprehensive health plan for treatment of persons who suffer from behavioral health challenges or mental health disorders, alcoholism, intoxication, drug dependency, and developmental disabilities; 11) Review all Territorial health, welfare, and treatment plans to be submitted for Federal legislation, and advise the Health Planning and Resource Development Agency on provisions to be included relating to behavioral health challenges or mental health disorders, alcoholism, intoxication, drug dependency, and developmental disabilities; 12) Assist, in the development of and coordination with alcoholic and drug education and treatment programs for employees of the Government of the United States Virgin Islands and businesses and industries in this Territory, and shall include occupational and employee assistance programs; 13) Utilize the support and assistance of interested persons in the community, particularly recovered alcoholics and drug dependent persons, to encourage alcoholics and drug dependent persons voluntarily to undergo treatment; Page 25 of 110 oon Ar BRWN — $B Hh FH HKwWwHY WW H WwW WW WsNN NNN NN NNN — &— = = HK HK mw = Se DRAauhwWN — CU WPA AUN BWN | OO DAI AUN WN KH OO MOAT ANA UN hw NH = © 14) Cooperate with the Attorney General, Director of the Office of Highway Safety, the Superior Court and the Police Commissioner in establishing and conducting programs designed to deal with the problems of persons operating motor vehicles while intoxicated or under the influence of drugs; 15) Encourage general hospitals and other appropriate health facilities to admit without discrimination persons who suffer from behavioral health challenges or mental health disorders, alcoholism, intoxication, drug dependency, and developmental disabilities, to provide them with adequate and appropriate treatments; 16) Encourage all health and disability insurance programs to include alcoholism and drug dependency as a covered illness; and 17) Submit to the Commissioner, the Governor and the Legislature not later than January 15 of each year, an annual report covering the activities of the Division. 18) Shall provide for adequate and appropriate treatment for persons admitted under sections §1019 through 1022 of this title who suffer from behavioral health challenges, or mental health disorders, alcoholism, intoxication, drug dependency, and developmental disabilities. Treatment may not be provided at a correctional institution except for inmates. 19) Shall maintain, supervise and control all facilities operated by or subject to policies of the Department. The Administrator/Director of each facility shall make an annual report of its activities to the Director in the form and manner the Director specifies. 20) Coordinate all appropriate public and private resources to utilize in all programs. 21)Shall prepare, publish and distribute annually a current list of all approved public and private treatment facilities. 22) May contract for the use of any facility as an approved public treatment facility if the Director, subject to the approval of the Commissioner, considers this to be an effective and economical course to follow. 1014. Interdepartmental Coordinating Committee (a) An Interdepartmental Coordinating Committee is hereby established and shall be composed of the Commissioners of Health, Education, Human Services, Police Commissioner, Director of Vocational Rehabilitation and other appropriate agencies and the Director as the Governor deems appropriate. The Committee shall meet at least twice annually at the call of the Commissioner of Health, who shall be its Chairman. Page 26 of 110 The Committee shall provide for the coordination of, and exchange of information on, I 2 all programs relating to behavioral health disorders, alcoholism, drug dependency, 3 homelessness, and developmental disabilities, and shall act as a permanent liaison 4 among the departments engaged in activities affecting behavioral health disorders, 5 alcoholism, drug dependency, homelessness, and developmental disabilities. The 6 Committee shall assist the Commissioner and Director in formulating a comprehensive 7 plan for the prevention of behavioral health disorders, alcoholism, drug dependency, 8 homelessness, developmental disabilities, and for treatment of persons who suffer from 9 behavioral health challenges or mental health disorders, alcoholism, intoxication, drug 10 dependency, homelessness, and developmental disabilities. 11 12 (b) In exercising its coordinating functions, the Committee shall assure that: 13 14 1) The appropriate governmental agencies provide all necessary medical, 15 social, treatment and educational services for persons who suffer from 16 behavioral health challenges or mental health disorders, alcoholics, 17 intoxication, drug dependency, homelessness, and developmental 18 disabilities; 19 20 2) The several governmental agencies shall cooperate in the use of facilities 21 and in the treatment of persons who suffer from behavioral health 22 challenges or mental health disorders, alcoholics, intoxication, drug 23 dependency, homelessness, and developmental disabilities; and 24 25 3) All governmental agencies shall adopt approaches, such as employee 26 assistance programs, to prevent and treat behavioral health challenges or 27 mental health disorders, alcoholics, intoxication, drug dependency, 28 homelessness, and developmental disabilities, consistent with the policies 29 of this chapter. 30 31 4) Shall coordinate all private agencies that receive federal or local funds to 32 make certain that there is no duplication of services. 33 34 5) Shall set the rules, regulations, and purpose of private agencies that receive 35 federal or local funds. 36 37 38 ©1015. Citizens Advisory Council on Behavioral Health, Alcoholism, Drug 39 Dependency, and Developmental Disabilities 40 41. (a) Behavioral Health Council of the Virgin Islands: 42 In order to promote high-quality adult behavioral health services, this section 43 establishes the Behavioral Health and Development Disabilities Council of the Virgin 44 Islands (referred to henceforth as “the Council”) to provide an effective, independent 45 consumer voice in an advisory capacity in the development of public policy and 46 resource allocation. The council will consist of a total of seven members appointed by 47 the Commissioner with the consent of the Governor, composed of - three members Page 27 of 110 Sa Hw WN — RON -—S0o 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 appointed from the island of St. Croix, three members appointed from the island of St. Thomas, and one member from the island of St. John. A chairperson shall be chosen from among the seven members. Each shall serve for a term of two years; however, the Governor may reappoint the members or remove them for cause. (b) The Council exists as an independent public instrumentality to provide guidance and advice from consumers of behavioral health and development disability services provided or funded by the Government, including guidance and advice regarding the delivery of effective and appropriate behavioral health and developmental disability services consistent with the Territory’s comprehensive behavioral health and developmental disability services plan. (c) Exercise of the powers conferred by this section is an essential governmental function. The Council must be considered as a public entity for the purpose of completing its task. However, the Council is not considered an agency of the Government for the purposes of budgeting, accounts, control, auditing, contracting, and purchasing. (d) As it pertains to the delivery of behavioral health services the Council shall: ii. ili. iv. Vi. Vii. Viii. Advise the Department, the Governor and other executive branch Departments. 1. This duty includes advising the Department on the review, analysis, and evaluation of behavioral health programs, homelessness policies, developmental disability treatment, procedures, and service delivery systems administered or funded by the Government including unmet needs, quality assurance, and quality improvements. Assist the Department in program design and implementation, including assessment of the quality of services, delivery systems, and the prioritization of programming; Provide consumers with a recognized mechanism for collaboration with the Government, including addressing issues with persons and entities that provide services through contracts with the Department; Provide input regarding programs, evaluations, public policies and resource allocation, and address issues and concerns that arise territory-wide; Identify, research and respond to issues of importance to consumers, including requesting information and data to facilitate informed decision making; Interact with other Government Departments, community entities and other organizations; Provide budget requests to fund the Council to the Department for each biennial budget and each supplemental budget; and Make annual and interim recommendations to the Government and provide by May 31st of each year a report to the Governor. The report must include analysis of public programs, policies and procedures, legislative and regulatory proposals and recommendations for action by the Government. Page 28 of 110 l 2 (e) Council Criteria: 3 i. Employees of the Council are not Government employees; however, they 4 are immune from civil liability for acts that they perform in good faith within 5 the scope of their duties for the Council; 6 ii. Members of the Council will be paid a stipend for participating in Council 7 meetings from the Council’s budget in an amount consistent with that of 8 other Boards of the Virgin Islands Government. Council members may be 9 reimbursed for reasonable and necessary expenses actually incurred, 10 including but not limited to costs incurred for travel upon approval by the 11 Commissioner; 12 iii. Council members may engage in advocacy regarding legislative and 13 regulatory initiatives; and 14 iv. Provide interim reports to the Governor and respond to written responses 15 from the Department. 16 17 (f) No later than September 30th of each year, the Commissioner shall provide a written 18 response to the Council’s annual report to the chair of the Council and the Governor. 19 The response must: 20 i. Address the actions that the Department plans to take or proposes to 21 implement with regard to the recommendations contained in the Council’s 22 annual report and any interim reports, address the reasons for declining to 23 take or propose action; and 24 ii. Include a report on progress in implementing actions detailed in prior 25 Department written reports under this subsection. 26 27. (g) Funding for the Council shall be included as part of the Governor's proposed budget 28 for the Department. The Commissioner may accept on behalf of the Council; gifts, 29 grants and other funds and contributions for use in performing the duties of the Council 30 as long as such gifts, grants, funds, and contributions are in accordance with local and 31 federal laws prohibiting conflicts of interest. 32 33 1016. Standards for Public and Private Treatment Facilities; Enforcement 34 Procedures; Penalties 35 36 (a) The Division shall utilize standards established by the Joint Commission on 37 accreditation for approved treatment facilities that must be met for a treatment facility 38 to be approved as a public or private treatment facility, and establish the fees to be 39 charged by the Division for the required inspections of such facilities. The standards to 40 be applied shall only be for the health standards to be met and standards of treatment 41 to be afforded, patients. 42 43 (b) The Division periodically shall inspect approved public and private treatment facilities 44 at reasonable times and in a reasonable manner. 45 Page 29 of 110 won Au WN — - hb PPh HP PW WwW WW WW WW WN NN NN NNN NN & &— = SB Be eS we me ee Bub WwW HN K- COD wMHAAUNHPWN— DUO SADA PWN K— DO WHA AU WH HH OO (c) Each approved public and private treatment facility shall file with the Division, on request, data, statistics, schedules and information the Division reasonably requires. An approved public or private treatment facility that without good cause fails to furnish any data, statistics, schedules, or information as requested, or files fraudulent return thereof, shall be removed from the list of approved treatment facilities by the Commissioner upon certification by the Director. (d) After holding a hearing, the Commissioner may suspend, revoke, limit, or restrict approval, or refuse to grant approval, for failure to meet its standards. (e) The Superior Court may restrain any violation of this section, review any denial, (f) restriction, or revocation of approval, and grant other relief required to enforce its provisions. Upon petition of the Division and after a hearing held upon reasonable notice to the facility, the Superior Court may issue a warrant to an officer or employee of the Division authorizing him to enter and inspect at reasonable times and examine the books and accounts of, any approved public or private treatment facility refusing to consent to inspection or examination by the Division, or which the Division has reasonable cause to believe is operating in violation of this chapter. (g) Persons diagnosed with behavioral health challenges, mental health disorders, or developmental disabilities in private behavioral health facilities that contract with the Department under this subsection are entitled to the same rights and remedies as patients in public behavioral health facilities as conferred by the constitution, laws, regulations, and rules of the Virgin Islands and of the United States. i. Before contracting with and approving the admission of involuntary patients to a private behavioral health treatment facility, the Department shall require the facility to: 1. Comply with all applicable regulations; 2. Demonstrate the ability of the facility to comply with judicial decrees related to services already being provided by the facility; and 3. Coordinate and integrate care with other community-based services. ii. The Director of a private behavioral health treatment facility shall provide notice to the Department and such additional information that may be requested by the Department when a person who was involuntarily admitted to the facility has died, attempted suicide or sustained a serious injury resulting in significant impairment of physical condition. For the purposes of this paragraph, “significant impairment” includes serious injuries resulting from burns, lacerations, bone fractures, hematoma and injuries to internal organs whether self-inflicted or inflicted by another person. The notice must be provided within 24 hours of occurrence and must include the name of the person; the name, address and telephone number of that person's legal guardian, conservator or legal representative and parents if that person is a minor; a detailed description of the occurrence and any injuries or impairments sustained; the date and time of the occurrence; the name, street address, mailing address and telephone Page 30 of 110 on Au kh WN — WwW WW WwW Ww WwW WNW NY NY YN YN NN = = SS Se Se eK eK number of the facility; and the name and job title of the person providing the notice. 1017. Acceptance for Treatment; Rules (a) The Commissioner shall adopt and may amend and repeal rules for acceptance of persons into the treatment program, considering available treatment resources and facilities, for the purpose of early and effective treatment of behavioral health challenges, mental health disorders, alcoholism, intoxication, drug dependency, and developmental disabilities. In establishing the rules, the Commissioner shall be guided by the following standards: i. If possible, a patient shall be treated on a voluntary rather than an involuntary basis; ii. A patient shall be initially assigned or transferred to outpatient or intermediate treatment unless he is found to require inpatient treatment; iii. | A person shall not be denied treatment solely because he has withdrawn from treatment against medical advice on a prior occasion or because he has relapsed after earlier treatment; iv. An individualized treatment plan shall be prepared and maintained ona current basis for each patient; and v. Provision shall be made for a continuum of coordinated treatment services so that a person who leaves a facility or a form of treatment will have and utilize other appropriate treatments. 1018. Voluntary Treatment of Person Suffering from Behavioral Health Challenges, Mental Health Disorders, Alcoholism, Intoxication, Drug Dependency, and Developmental Disabilities (a) Any persons suffering from alcoholism, or persons suffering from behavioral health challenges or mental health disorders, drug dependency, and developmental disabilities may apply for voluntary treatment directly to an approved public treatment facility or hospital. If the proposed patient is a minor or an incompetent person, a parent, a legal guardian, or another legal representative may make the application. A minor may apply; however, the facility must notify the parents or guardians within 8 hours of application. (b) Subject to rules adopted by the Commissioner, the Administrator/Director in charge of an approved public treatment facility may determine who shall be admitted for treatment. Ifa person is refused admission to an approved public treatment facility, the Administrator, subject to rules adopted by the Commissioner, shall refer the person to another approved public treatment facility for treatment if possible and appropriate. The Administrator/Director cannot refuse treatment to a person who is a danger to themselves or others or to property. (c) If a patient receiving inpatient care leaves an approved public treatment facility, he shall be encouraged to consent to appropriate outpatient or intermediate treatment. If it Page 31 of 110 on NN RW NHN — Wi Wh WW Ww WW ww nN NN NNN NNN — mM Me eK RM er Ree CC = appears to the Administrator/Director in charge of the treatment facility that the patient is diagnosed with alcoholism, behavioral health challenges, any mental health disorders, drug dependency, or developmental disabilities, and requires help, the Division shall arrange for assistance in obtaining supportive services and residential facilities. (d) If a patient leaves an approved public treatment facility, with or against the advice of the Administrator/Director in charge of the facility, the Division may make reasonable provision for transportation to another facility or to the patient’s home. If no home exists, the patient shall be referred to the Department of Human Services. If the patient is a minor or incompetent, the request for discharge from an inpatient facility shall be made by a parent, legal guardian or another legal representative. (e) A patient admitted is free to leave the psychiatric facility at any time after admission within 24 hours of the patient's request unless an application for admission of the person under sections 1021 or 1022 is initiated within that time. i. At the time of admission, the Director of the psychiatric facility shall cause every patient admitted under §1020 to be informed of: 1. The patient's status as an informally admitted patient; and 2. The patient's freedom to leave the psychiatric facility under this section. (f) If in the opinion of the treating medical practitioner, the person appears to be a threat to himself or others or to property, the person will not be allowed to leave the hospital or facility, and the person will be treated pursuant to 1021. 1019. Treatment and services for behavioral health challenges or mental health disorders, intoxicated, drug dependency, and developmental disabilities (a) A person suffering from behavioral health challenges, mental health disorders, intoxication, drug dependency, or developmental disabilities may come voluntarily to an approved public treatment facility or hospital for emergency treatment. A person in need of help who is diagnosed with behavioral health challenges, any developmental disability, mental health disorder, or found to be intoxicated or under the influence of drugs in a public place, can receive assistance if the patient consents to the proffered help. The patient may be assisted by law enforcement officers, hospitals or any behavioral health personnel, in a private home, an approved public treatment facility, an approved private treatment facility, or other health facilities. (b) A person who comes voluntary and appears to be a threat to themselves or others or to property or to be incapacitated by alcohol or drugs shall be taken into protective custody by the hospital or an appropriate facility and shall be subject to the provision of sections 1021 or 1022. Page 32 of 110