John Clair, the police chief of a small Appalachian town in southwest Virginia, spends his days consumed by a growing problem: the frequency with which his officers are being tapped to detain, transport and wait in hospitals with people in mental health crisis.
Officers from the 21-member Clare Police Department in Marion criss-cross the state to deliver patients for court-ordered treatment, sometimes only to find that the hospital they are sent to has no beds available. Patients end up in waiting rooms or emergency rooms, sometimes for days, while under the care of Clair staff.
It’s a problem for law enforcement in Virginia that advocates, attorneys and leaders like Clair say ties up police resources and contributes to poor patient outcomes. Over the past five years, these modes of transportation have become the largest single category of cases handled by Marion’s department.
“We’re up against the wall,” said Clair, an Army veteran and former lay pastor who sometimes transports patients himself and did so last month during a nearly 15-hour round trip to a coastal town on the other side of the state.
The issue underscores the widespread consensus that Virginia’s mental health care system is in urgent need of reform because of what Gov. Glenn Youngkin’s administration says is an overreliance on hospitalization at a time of growing need.
A deadly, 11th-hour crime spree in D.C. and Maryland is sparking conversations about mental health, how police handle someone in crisis and how to prevent a mental health crisis from escalating. News4’s Joseph Olmo reports.
“People really struggled”
About a year ago, Youngkin, a Republican, launched an ambitious initiative that aims to transform the way mental health care is delivered by creating a system that allows people to get the treatment they need without delay in their own community , and not necessarily within the confines of a hospital, which eases the burden on both patients and law enforcement.
While Virginia’s struggles may be particularly acute, Youngkin is not alone in his focus on the issue. Improving mental health care has become a priority in the US like never before, as the pandemic has brought new levels of isolation, fear and grief, on top of already existing crises like rising drug overdose deaths and the struggles of teenage girls. Data from a study by the US Office of Substance Abuse and Mental Health Services found that in 2022, about half of adults with any mental illness did not receive treatment.
“We know there’s a big 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 State Directors of Mental Health Programs.
Youngkin’s emphasis on mental health developed during his 2021 campaign, when person after person — from doctors to local officials to police — implored him to make it a priority, according to John Littell, the cabinet secretary overseeing the initiative. in Virginia.
“It was so clear that people were really struggling,” Littel said.
“The right help, right now”
Since then, Youngkin has won bipartisan support for his “Right Help, Right Now” initiative and praise from advocates, though some worry about the pace at which things are moving. The governor, whose press office says the initiative is passing key milestones, is ineligible for a second consecutive term and is leaving office after two years.
The initiative’s broad goals include building a behavioral health workforce and working to stem the tide of overdose deaths that claimed an average of seven Virginians a day by 2022. Youngkin has signed dozens of related bills and secured hundreds of millions in new funding, with more proposed.
The “core” part of the plan, as Littel describes it, is creating a system that provides same-day care to individuals in crisis, which should also ease some of the burden on police departments like Clair, which are tasked with transporting most patients until the court deems him a risk to himself or others.
The Youngkin administration hopes to build that continuum of care by increasing the number of mobile crisis teams with clinicians to respond to mental health emergencies and creating more short-term stabilization centers for patients to avoid having to take them for hours away from their care homes.
A recent report by the state’s legislative watchdog highlighted the need.
Virginia has more than 20,000 temporary detention orders in fiscal year 2023, according to a recent presentation to lawmakers. About 8,538 of those individuals had delays in receiving psychiatric treatment after they were deemed an imminent risk to themselves or others, the report said.
The report also raised concerns about law enforcement “drop-offs,” where officers or sheriff’s deputies drop off patients before they are admitted to a hospital or other facility. Recent testimony at a legislative hearing suggested that the dropout puts some of these patients at risk of death.
Elsewhere in the US, states’ policy concerns and approaches to improving mental health care vary.
States have used federal funds to ease the coronavirus pandemic to increase access to care, and most governors have talked about mental health in their addresses over the past few years. Mental health is listed as a budget priority in most states in an analysis by the National Association of State Budget Officials.
Will this emphasis continue?
“This is a marathon, not a sprint,” said Kathryn McGuire, chief advocate for the American Psychological Association, “and our daily hope is that states, especially after the public health emergency is lifted, will realize that they have to stay at it , they should stick to it.
Virginia lawmakers are considering bills to intersect law enforcement and mental health this year.
Clair said he hopes speaking candidly about his department’s experience will help them see the urgency of the problem. But he worries that the part-time General Assembly, which is also grappling with controversial gambling deals and sports arenas, could rush into something that doesn’t fit the bill.
The patient Clare transported across the state, costing his department thousands of dollars, had about 15 mental health appointments with his agency in a year and a half, he said. One involves a suicide attempt.
The patient left a handwritten thank you note for the boss after their long journey. A little later she was again in the custody of his department.
Clare said both police and patients in need – whose crises can be exacerbated by time spent detained in the back of a police car – deserve more.
“We’re just setting ourselves up for tragedy over and over again,” he said.
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Jeff Mulvihill contributed to this report from Cherry Hill, New Jersey.
