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 called to detain, transport and wait in hospitals for people in the middle of a mental health crisis. .
Officers from Clair’s 21-member Marion Police Department crisscross the state taking patients for court-ordered treatment, sometimes only to discover that the hospital they were sent to has no beds available. Patients end up in waiting rooms or emergency rooms, sometimes for days, under the supervision of Clair officials.
It’s a problem for law enforcement agencies in Virginia, a problem that advocates, attorneys and leaders like Clair say ties up police resources and contributes to poor patient outcomes. Over the past five years, these types of transports have become the largest category of cases the Marion department handles.
“We’re up against a wall,” said Clair, an Army veteran and former lay pastor who sometimes transports patients himself, doing so last month on a nearly 15-hour round trip to a coastal city in another side of the state.
The issue underscores a widespread consensus that Virginia’s mental health health care The 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 own community and not necessarily within the confines of a hospital, easing the burden on both patients and authorities.
While Virginia’s struggles may be particularly serious, Youngkin is not the only one focusing on the issue. Improving mental health care became a priority in the United States like never before, as the pandemic brought new levels of isolation, fear and pain, on top of pre-existing crises, such as rising drug overdose deaths and the struggles that overwhelm adolescent girls. Survey data from the U.S. 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 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 Directors of State Mental Health Programs.
Youngkin’s emphasis on mental health developed during his 2021 campaign, as 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 initiative. of Virginia.
“It was very clear that people were really struggling,” Littel said.
Since then, Youngkin has garnered 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 is passing key milestones, cannot seek a second consecutive term and leaves office in two years.
The initiative’s broad goals include strengthening 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 in 2022. Youngkin has enacted dozens of projects related laws and has secured hundreds of millions in new funding and more were proposed.
The “fundamental” part of the plan, as Littel describes it, is to create a system that provides same-day help to people in crisis, which should also take some of the burden off police departments like Clair’s, which handle to transport most patients during the week. the court considers a risk to themselves or others.
The Youngkin administration hopes to strengthen that 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 away for hours from their homes to receive attention. .
A recent report from the state’s legislative watchdog emphasized the need.
Virginia had more than 20,000 temporary detainers in fiscal year 2023, according to a recent presentation to lawmakers. About 8,538 of those people experienced delays in receiving psychiatric treatment after they were deemed an imminent risk to themselves or others, according to the report.
The report also raised concerns about law enforcement “drop-offs,” where deputies or sheriff’s deputies drop off patients before they are accepted into a hospital or other facility. Recent testimony at a legislative hearing suggested that deliveries put some of those patients at risk of death.
Elsewhere in the United States, policy concerns and states’ approaches to improving mental health care have varied.
States have used federal coronavirus relief funds to bolster access to care, and most governors have talked about mental health in their State of the States 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, not a sprint,” said Katherine McGuire, advocacy director at the American Psychological Association, “and our daily hope is that states, especially after the public health emergency was rescinded, will come around. realize that they have to continue like this. They have to move forward.”
Virginia lawmakers are considering bills this year on the intersection of law enforcement and mental health.
Clair said she hoped speaking candidly about her department’s experiences would help them see the urgency of the problem. But he worries that the part-time General Assembly, which is also grappling with controversial deals on gambling and sports stadiums, could rush to approve something that falls short of what is needed.
The patient Clair transported across the state, costing his department thousands of dollars, has had about 15 mental health encounters with his agency in a year and a half, he estimates. One of them involved a suicide attempt.
The patient left a handwritten thank you note for the boss after his long trip. A short time later, he was returned to the custody of his department.
Clair said both police and patients in need, whose crises can be exacerbated by time spent detained in the back of a police car, deserve better.
“We are preparing for tragedy again and again,” he said.
Geoff Mulvihill contributed to this report from Cherry Hill, New Jersey.