RICHMOND, Va. – 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 stop, transport and hospitalize people in barking of a mental health crisis.
Clair’s 21-member Marion Police Department officers criss-cross the state to deliver patients for court-ordered treatment, sometimes only to find that the hospital they were taken to has no beds available. Patients end up boarding waiting rooms or emergency rooms, sometimes for days at a time, while under the supervision of Clair’s officers.
It’s a problem for law enforcement agencies around Virginia, one that attorneys, advocates and leaders like Clair say ties up police resources and contributes to poor patient outcomes. In 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 and did so last month on a roughly 15-hour round trip to a coastal town on the other side. of the state.
The problem underscores a widespread consensus that Virginia’s mental health care system is in urgent need of reform, due to what Gov. Glenn Youngkin’s administration says is an overreliance on hospitalization at a time of growing need.
About a year ago, Youngkin, a Republican, 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 community rather than necessarily in the confines of a hospital, easing the burden on both patients and law enforcement.
While Virginia’s struggles may be particularly poignant, Youngkin is not alone in his focus on the matter. Improving mental health care became a priority in the US like never before, as the pandemic brought new levels of isolation, fear and grief, in addition to pre-existing crises such as rising drug overdose deaths and struggles weighing on teenage girls. Survey data from the US Substance Abuse and Mental Health Services Administration found that in 2022, about half of adults with a mental illness did not receive treatment.
“We know there’s a lot of partisan divide across the country, but what we’ve found is whether it’s red states or blue states, there’s a lot of support for behavioral health at this point,” said Brian Hepburn, executive director of the National Association of State Mental Health Program Directors.
Youngkin’s emphasis on mental health developed during his 2021 campaign, when person after person — from doctors to local officials to police — pleaded with 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,” Littel said.
Youngkin has since 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 crossing key points — cannot seek a second consecutive term and is out of office in two years.
The initiative’s broad goals include building the behavioral health care workforce and working to stem the tide of overdose deaths, which claimed the lives of an average of seven Virginians per day by 2022. Youngkin has signed dozens of related bills into law and has 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 help to individuals in crisis, which should also ease some of the burden on police departments like Clair’s that are tasked with transporting most patients. the court considers him a danger to himself or others.
The Youngkin administration hopes to create 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 the need to turn those hours away. all away from their homes for care.
A recent report from the state’s legislative watchdog highlighted the need.
Virginia had more than 20,000 temporary restraining orders in fiscal year 2023, according to a recent presentation to lawmakers. About 8,538 of those individuals experienced delays in receiving psychiatric treatment after being deemed an immediate danger to themselves or others, the report said.
The report also raised concerns about law enforcement “breakouts,” where sheriff’s officers or deputies drop off patients before they are admitted to a hospital or other facility. Recent testimony at a legislative hearing suggested that the dropouts put some of those patients at risk of death.
Elsewhere in the US, policy concerns and states’ approaches to improving mental health care have varied.
States have used federal coronavirus pandemic relief funds to bolster access to care, and most governors have talked about mental health in their State of the Union addresses in recent years. Mental health was ranked as a budget priority in most states in an analysis by the National Association of State Budget Officials.
Will this emphasis continue?
“It’s a marathon, it’s not a sprint,” said Katherine McGuire, chief advocacy officer for the American Psychological Association, “and our daily hope is that states, especially after the public health emergency is lifted, will understand that they need to stay in it. they should stay with it.”
Virginia lawmakers are considering bills to combine law enforcement and mental health this year.
Clair said he hoped that speaking candidly about his department’s experiences would help them understand the urgency of the problem. But he worries that the part-time General Assembly, also grappling with controversial gambling and sports arena deals, could rush to accomplish something that isn’t so necessary.
The patient Clair 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 estimates. One involved a suicide attempt.
The patient left a handwritten thank you note to the boss after their long journey. A short time later, she was returned to the custody of his department.
Clair said both police and needy patients — whose seizures can be exacerbated by time spent in custody in the back of a police car — deserve better.
“We’re just preparing for tragedy all the time,” he said.