John Clare, the police chief in a small Appalachian town in southwest Virginia, spends his days consumed with a growing problem: the frequency with which his officers take advantage of detaining, transporting and waiting in hospitals with people in the throes of a mental health crisis. .
Officers from the 21-member Marion Police Department in Clare travel across the state to deliver patients for court-ordered treatment, sometimes discovering that the hospital they are sent to does not have available beds. Patients end up in waiting rooms or emergency rooms, sometimes for days on end, under the supervision of CLEAR officers.
It’s a problem for law enforcement agencies across Virginia, and one that advocates, attorneys and leaders like Clare say ties up police resources and contributes to poor patient outcomes. In the past five years, these types of transportation have become the largest class of cases handled by the Marion Department.
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“We’re against the wall,” said Clare, an Army veteran and former lay priest who sometimes transports patients himself, doing so last month on a roughly 15-hour round trip to a coastal city on the other side of the state.
The problem highlights a broad consensus that Virginia’s mental health care system is in dire need of reform, because of what Gov. Glenn Youngkin’s administration says is an overreliance on hospital treatment at a time of heightened need.
About a year ago, Youngkin, a Republican, launched an ambitious initiative aimed at changing the way psychiatric 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 in the United States. Hospital boundaries, reducing the burden on patients and law enforcement officials.
While Virginia’s struggles may be particularly acute, Youngkin is not alone in his focus on this issue. Improving mental health care has become a priority in the United States like never before as the pandemic has brought new levels of isolation, fear and grief, on top of pre-existing crises such as rising drug overdose deaths and struggles burdening teenage girls. Survey data from the U.S. Substance Abuse and Mental Health Services Administration found that in 2022, about half of adults with any mental illness did not receive treatment.
“We know there’s a huge 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 at this point,” said Brian Hepburn, the foundation’s executive director. National Association of State Mental Health Program Directors.
Youngkin’s focus on mental health evolved 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 Little, the Cabinet secretary overseeing the Virginia initiative.
“It was very clear that people were really suffering,” Little said.
Youngkin has since won bipartisan support for his “Right Help, Right Now” initiative and praise from advocates, though some are concerned about the pace at which things are moving. The governor — whose press office says the initiative crosses major milestones — cannot seek a second consecutive term and leave office within two years.
The initiative’s broad goals include building the behavioral health care workforce and working to stem the tide of overdose deaths, which have claimed an average of seven Virginians per day in 2022. Youngkin has signed dozens of related bills into law and has It has secured hundreds of millions in new funding, with more proposed.
The “foundational” part of the plan, as Littell describes it, is to create a system that provides same-day assistance to individuals in crisis, which should also take some of the burden off police departments like Clair’s who are tasked with transporting most patients if a court deems there is a danger to themselves or On others.
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The Yongkin administration hopes to build this continuum of care by increasing the number of mobile crisis teams with doctors to respond to mental health emergencies and creating more short-term stabilization centers for patients to avoid the need to take them hours away from their homes for care. .
A recent report from the state legislative oversight body emphasized the need.
Virginia had more than 20,000 temporary detention orders in fiscal year 2023, according to a recent presentation to lawmakers. The report found that about 8,538 of these individuals experienced a delay in receiving psychological treatment after they were considered an imminent danger to themselves or others.
The report also raised concerns about law enforcement “drop-offs,” where officers or deputy sheriffs leave patients before they are admitted to a hospital or other facility. Recent testimony at a legislative hearing indicated that patient interruptions put some of those patients at risk of death.
Elsewhere in the United States, concerns about state policies and approaches to improving mental health care vary.
States have used federal coronavirus pandemic relief funds to boost access to care, and most governors have spoken about mental health in their state addresses in the past few years. Mental health was listed as a budget priority in most states in an analysis by the National Association of State Budget Officers.
Will this focus continue?
“It’s a marathon, not a sprint, and our daily hope is that states, especially after a public health emergency is lifted, realize they have to stay in it,” said Katherine McGuire, chief advocacy officer at the American Psychological Association. They have to stick to it.”
Virginia lawmakers are considering bills related to the intersection of law enforcement and mental health this year.
Clare said he hopes talking openly about his department’s experiences 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 and sports deals, might rush into something that falls short.
He estimates that the patient Clair transported across the state, costing his department thousands of dollars, had about 15 mental health encounters with his agency in a year and a half. One involved a suicide attempt.
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The patient delivered a handwritten letter of thanks to the president after his long flight. A short time later, it returned to his administration.
Clare said police officers and patients in need — whose crises can be exacerbated by time spent confined to the back of a police car — deserve better.
“We are bracing ourselves for tragedy over and over again,” he added.