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Southwest Virginia delegation tackling mental health transport issues

Bristol Herald Courier - 2/5/2018

Legislators in Virginia will consider a number of budget amendments during the current General Assembly session to help alleviate the hurdles facing law enforcement officers and inpatient treatment facilities when transporting and treating mental health patients.

"Mental health transports by law enforcement is an issue the entire Southwest Virginia delegation is aware of," Del. Todd Pillion, R-Abingdon, said Friday. "In fact, Speaker of the House Kirk Cox met with us and members of local law enforcement agencies to discuss these issues in more detail last summer."

Virginia law requires that police officers transport mental health patients when court-ordered emergency custody orders and temporary detention orders are issued, after which officers have 24 hours to transport the individual to a facility for additional care. But due to space shortages in area hospitals and treatment centers, sometimes the only available beds are hours away - and officers receive no additional funding for transportation.

"It's a problem," said state Sen. Bill Carrico, R-Galax. "I think everybody realizes - since the [state Sen. Creigh] Deeds' incident and the focus on mental health and the number of bed spaces and how far they are to get available beds. They [lawmakers] realize these agencies can't continue to take resources away to drive to Virginia Beach to take a patient."

In November 2013, Deeds' 24-year-old son, who was scheduled to be admitted for court-ordered inpatient treatment, was sent home after a clinician was unable to find available space for him. After returning home, Deeds' son attacked his father and then killed himself. The death led Deeds, D-Bath, to take on improving the state's mental health system.

In response, legislators extended the time clinicians have to evaluate someone - from a maximum of six hours up to eight hours. They also allowed facilities to hold someone for inpatient treatment a total of 72 hours, raised from a maximum of 48 hours, and state facilities were required to admit patients who qualified for court-ordered inpatient treatment if a suitable private bed could not be found before the end of 72 hours, the Roanoke Times reported.

For the 2018 General Assembly session, Del. Vivian Watts, D-Annandale, Sen. Emmett Hanger, R-Augusta, and Deeds have requested an amendment to the state's budget that would provide $10.2 million each year for the Department of Behavioral Health and Developmental Services to implement an alternative transportation system for adults and children under a temporary detention order.

"My focus this year remains on our continued work to reform Virginia's mental health system," Deeds said in a January newsletter to constituents.

Deeds said he chairs a joint subcommittee on mental health, which put together a list of budget recommendations for 2018. The recommendations include improving transportation for those under a temporary detention order.

Recommendations also include expanding discharge planning for inmates with mental illness, increasing access to care using telemental health - which uses technology to provide mental health services from a distance - and ensuring more law enforcement officers have training to help de-escalate situations.

"While we have made so much progress over the past four years, the list of unfinished tasks and unmet needs remains long," Deeds said.

The alternative transportation system could be similar to one piloted in 2015 by the Mount Rogers Community Services Board.

"The pilot program at Mount Rogers is because of a pilot program I initiated," Carrico said. "It was supposed to start in Mount Rogers and work its way into Highlands and Planning District 1, but they never did expand the program."

The pilot program concluded that individuals transported by the alternative provider safely arrived at their destination without incident, Pillion said.

Rebecca Holmes, clinical director at Highlands Community Services, said the project demonstrated "very successful and promising outcomes."

"It allowed individuals in need of involuntary inpatient hospitalization to be transported to inpatient facilities by trained individuals in a manner that was much less traumatic for the individuals than a typical law enforcement transport can be," Holmes said.

The pilot, funded by the General Assembly, ended prior to its planned expansion due to its high cost. With a larger footprint, Holmes said the economy of scale would improve the cost effectiveness of the program. It would also remove the unfunded mandate from law enforcement, she added.

The $1.7 million amendment would implement non-law-enforcement transportation in two areas of the state: Health Planning Region 3, served by the Mount Rogers Community Services Board and the five neighboring CSBs in New River Valley, Cumberland Mountain, Highlands, Dickenson County and Planning District 1; and the areas in Health Planning Region 1, served by the Region 10 CSB - Charlottesville and the counties of Albemarle, Fluvanna, Greene, Louisa and Nelson.

The amendment would implement a regionally based transportation service with state oversight and certification of providers.

Carrico said there are currently four budget amendments under consideration regarding transports, ranging in cost from $1.3 million to $10.2 million.

"We're trying to get through, based on the number of committals, [requirements for] long distance travel," Carrico said. "Sheriff's agencies have been having to try and transport these individuals."

Carrico expects legislators will compromise in the $5 million to $6 million range. Legislators are trying to figure out how to address the problem, whether through an RFP, or request for proposals, with companies or through regional jails.

"We want to put some money in it to alleviate the pressure off the sheriff's departments and local police from having to drive back and forth," he said.

A former Virginia State Police trooper, Carrico said he's been trying to get the General Assembly to do something for about four years.

The senator added that he's not sure how feasible it would be to use a private firm to transport patients.

"A private company is limited in who they can transport," he said, adding that a 2017 study found that private firms couldn't transport juveniles.

"Even though those numbers [for juvenile mental health patients] are low, there is an issue not being able to transport them [juveniles] or not having the civil service ability to serve the [orders]," Carrico said. "They're limited, so that's why I thought the regional jails would be the best fit to do it. They could enter the RFP and have the ability to do the job. They can serve the civil warrants."

Abingdon Police Chief Tony Sullivan, whose department regularly conducts mental health transports, said he has spoken with the local legislative delegation about the issue for some time.

Sullivan said lawmakers have been "very sympathetic to our concerns, but they don't get much help from the larger jurisdictions who have the manpower to handle these issues."

The chief said Abingdon and other small agencies tend to get excluded from many conversations because the transport issues are "not paramount across the state."

"Like most issues, it comes down to party politics," he said. "Reforms always seem to get hung up in bills to extend benefits of some type."

Staff writer David McGee contributed to this article.


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