RICHMOND, Va. — John Clair, the police chief of a small Appalachian town in southwestern Virginia, spends his days dealing with a growing problem: the frequency with which his officers are deployed to detain, transport, and wait in hospitals with people who being in the grip of a mental health crisis. .
Officers from Clair’s 21-person Marion Police Department crisscross the state delivering patients for court-ordered treatment, sometimes only to find that the hospital they’re sent to has no available beds. Patients sometimes end up in waiting rooms or emergency rooms for days while under the supervision of Clair’s agents.
It’s a problem for law enforcement agencies in Virginia, one that advocates, advocates and leaders like Clair say consumes police resources and contributes to poor patient outcomes. Over the past five years, these types of transports have become the largest category of cases handled by the Marion department.
“We’re up against the wall,” said Clair, an Army veteran and former lay pastor who sometimes transports patients himself, which he did last month during a nearly 15-hour round trip to a coastal city on the other side of the state.
The problem underscores a widespread consensus that Virginia’s mental health system is in dire need of reform because of what Gov. Glenn Youngkin’s administration says is an overreliance on hospitalization at a time of growing need.
About a year ago, Republican Youngkin launched an ambitious initiative that aims to transform the way psychiatric care is delivered by creating a system that allows people to get the treatment they need without delay, in their own communities and not necessarily in one’s own community. confines of a hospital, easing the burden on both patients and law enforcement.
While the battle in Virginia may be particularly acute, Youngkin is not alone in his attention to this issue. Improving mental health care became a priority like never before in the US as the pandemic brought new levels of isolation, fear and grief, on top of pre-existing crises like the rising number of drug overdose deaths and the struggles faced by teenage girls had. Survey data from the U.S. Substance Abuse and Mental Health Services Administration found that about half of adults with mental illness were not receiving treatment in 2022.
“We know there’s a lot of partisan divide across the country, but what we’ve found is that whether it’s red states or blue states, there’s a lot of support for behavioral health right now,” said Brian Hepburn, executive director of the National Association of Mental Health Program Directors.
Youngkin’s emphasis on mental health developed during his 2021 campaign, as person after person — from doctors to local officials to police — implored him to make it a priority, according to John Littel, the Cabinet secretary overseeing the Virginia initiative .
“It was so clear that people were really struggling,” Litel said.
Youngkin has since received bipartisan support for his “Right Help, Right Now” initiative and praise from advocates, though some are concerned about the pace at which things are developing. The governor – whose press office says the initiative exceeds important milestones – cannot seek a second consecutive term and will leave office within two years.
The initiative’s broad goals include building a behavioral health workforce and stemming the tide of overdose deaths, which will kill an average of seven Virginians by 2022. Youngkin has signed dozens of related bills into law and secured hundreds of millions in new funding, with more proposed.
The “fundamental” part of the plan, as Littel describes it, is creating a system that delivers same-day assistance to individuals in crisis, which should also ease some of the burden on police departments like Clair’s, which involve transporting most patients to another location. the judge considers a risk to himself or others.
Youngkin’s administration hopes to build that continuum of care by increasing the number of mobile crisis teams staffed by doctors to respond to mental health emergencies and creating more short-term stabilization centers for patients to avoid having to spend hours away from home are taken for care. .
A recent report from the state’s legislative watchdog highlighted the need.
Virginia had more than 20,000 temporary detention orders in fiscal year 2023, according to a recent presentation to lawmakers. About 8,538 of these individuals experienced delays in receiving psychiatric treatment after being deemed an immediate risk to themselves or others, the report found.
The report also raised concerns about law enforcement “drop-offs,” in which sheriff’s officers or deputies abandon patients before they are accepted by a hospital or other facility. Recent testimony at a legislative hearing suggested that dropping out put some of these patients at risk of death.
Elsewhere in the US, states’ policy interests and approaches to improving mental health care vary.
States have used federal coronavirus pandemic relief funds to improve access to care, and most governors have talked about mental health in their State of the State addresses in recent years. Mental health was listed as a budget priority in most states in an analysis by the National Association of State Budget Officers.
Will that emphasis continue?
“It’s a marathon, it’s not a sprint,” said Katherine McGuire, chief advocacy officer of the American Psychological Association, “and our daily hope is that states, especially after the public health emergency is lifted, will realize that they should stick with it. they must adhere to it.”
Virginia lawmakers are considering bills this year at the intersection of law enforcement and mental health care.
Clair said he hoped speaking candidly about his department’s experiences would help them understand the urgency of the problem. But he worries the part-time General Assembly, which is also grappling with controversial gambling and sports arena deals, will rush through something that falls short of what’s needed.
The patient Clair transported across the state, costing his department thousands of dollars, had about 15 mental health encounters with his facility in a year and a half, he estimates. One of these involved a suicide attempt.
The patient dropped off a handwritten thank you note for the supervisor after their long drive. A short time later she was back in the care of his department.
Clair said both police and patients in need — whose crises can be exacerbated by time spent held in the back of a police car — deserve better.
“We prepare ourselves for tragedy again and again,” he said.
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Geoff Mulvihill contributed to this report from Cherry Hill, New Jersey.