At the Suffolk Police Department, it’s not unheard of for an officer to spend eight hours driving to Staunton and back with a patient who’s in the middle of a mental health crisis, handcuffed in the back of the cop car, headed for a psychiatric hospital on court orders.
The same can be said for police departments across Virginia, where thousands of people — at least 5,700 in Hampton Roads, according to the latest estimates — are taken into custody each year for such “involuntary commitments.” Many are taken far away from their homes in search of a hospital bed and medical help, even though they usually haven’t committed a crime.
State code says that’s how authorities are to handle people who have a mental illness and could be deemed a threat to themselves or others.
“It’s ineffective, it’s costly; it’s — for a lack of a better word — inhumane,” said Dana Schrad, head of the Virginia Association of the Chiefs of Police, to a group of people who are figuring out ways to change the system of temporary detention orders, or TDOs.
TDOs, signed by a magistrate, involuntarily commit people experiencing a mental health crisis who might harm themselves or others to a hospital for up to 72 hours. After that, a magistrate can order further treatment if it’s still needed.
At the work group’s first meeting in April, Schrad and Ashland Police Chief Douglas Goodman recounted one instance in which officers in Smyth County spent hours looking for a car seat to transport a 5-year-old on a TDO to Western State Hospital in Staunton, and another in which they had to find a wheelchair-accessible vehicle to transport a 71-year-old Vietnam War veteran.
“It kills me to put someone in crisis — who may or not be violent — into a cage,” Goodman said. “We feel like we’re just caught in the middle and we are the wrong person for this job.”
State officials recognize it’s a problem. They know the last thing someone who’s being involuntarily hospitalized needs is to be handcuffed and put in the back of a police car.
In October, health officials began searching for a company that would be able to transport people who are subject to a TDO “in such a way as to decriminalizes (sic) the process and reduce stigma,” according to a request for proposals.
Last week, the Department of Behavioral Health and Developmental Services awarded a $7 million, two-year contract to G4S Secure Solutions, which will take about half of the people under a TDO from where they’re evaluated to wherever they will be temporarily hospitalized.
Impact on police
More than 25,500 TDOs were ordered in fiscal year 2018 — a rise of 294% since 2013 — and law enforcement transported 99% of the people who had a TDO, according to the Department of Behavioral Health and Developmental Services. The region that includes Hampton Roads had the second-highest amount of TDOs issued after Southwest Virginia.
Out of every general district court in Hampton Roads, Suffolk had the highest number of TDOs per 1,000 people in FY16, according to a February University of Virginia Institute of Law, Psychiatry and Public Policy report.
Suffolk Deputy Police Chief Steve Patterson said his officers’ safety is a concern when it comes to transporting people undergoing a mental health crisis. A TDO can be issued near the end of an officer’s shift, and with limited resources, that officer could be spending extra hours with the patient.
“Bottom line is, I’ve got to think about this guy that’s been working for eight hours already,” he said.
Another concern? Taking two officers off the streets for each TDO transport. For smaller departments — the majority of the 366 law enforcement agencies in Virginia have fewer than 50 officers — that means less resources in the community during a shift.
And police departments are racking up costs for gas, car maintenance and overtime, plus food and hotel bills when traveling long distances to drop someone off.
Looking for beds
The Treatment Advocacy Center, an Arlington-based nonprofit focused on policies related to mental illness, surveyed 355 law enforcement agencies across the country and found police drove a total of 5.42 million miles to transport people with mental illness in 2017 — more than 217 times around the Earth’s equator.
The center, which released a report this month, also found:
At least 10% of the law enforcement agencies’ budgets were spent on transporting people with mental illness;
The average distance to a medical facility was five times farther than the distance to a jail, and in some cases, officers were encouraged to use the jails as psychiatric holding facilities because they were closer;
32% of the agencies surveyed have a force of less than 10 full-time officers;
Officers spent a combined 165,295 hours transporting people with mental illness.
Why so much driving?
“Virginia just doesn’t have enough treatment beds when people are in crisis, and doesn’t have enough options that aren’t treatment beds for people that might not need that most intensive service,” said John Snook, executive director of the Advocacy Center.
Private hospitals are accepting more patients who seek help voluntarily, and they aren’t required to accept patients with TDOs. So police officers must look farther afield, or to the state hospitals.
Snook said it’s a problem nationally, but Virginia has struggled with it for at least a decade, with the number of psychiatric beds declining as hospitals close or downsize.
“Every one of those trips, you have to think about — someone who is really sick is sitting in the back of a police car, often in handcuffs; and that’s an awful way to treat an illness,” he said.
Over the past four years, the number of people admitted to private hospitals on TDOs has dropped 11%, while such admissions to state hospitals have risen 144%.
Virginia’s “bed of last resort” law, passed in 2014, says state hospitals have to accept patients under TDOs if no bed can be found at a private psychiatric hospital after eight hours. But all nine state hospitals were above the 85% capacity threshold considered safe in FY18.
To address the shortage, nearly 160 more private inpatient beds will be coming online by mid-2022 in the state, including 80 at two Norfolk hospitals, according to the Virginia Hospital and Healthcare Association.
Daniel Herr, deputy commissioner for facility services at the state health department, said Community Services Board workers — who determine if patients are eligible for temporary hospitalization and find them a bed — call an average of 25 places before resorting to the nearest state hospital, either because they’ve run out of time or run out of private places to call.
In Hampton Roads, the nearest is Eastern State Hospital, 60 miles away for Patterson’s officers in Suffolk.
The new model
Gail Paysour is hoping the new transportation model will reduce instances in which issuing a TDO means criminalizing a mental illness.
The state hired Paysour to coordinate the alternative transportation project. She has experience working in community services boards and said she knows how difficult the process can be for everyone involved.
“To be handcuffed and shackled in addition of being in the midst of a mental health crisis can be stigmatizing, can be traumatizing,” she said in a phone interview.
Modeled after a successful pilot program in Southwest Virginia’s Mount Rogers, the alternative transportation project involves taking people under a TDO in nondescript cars to their final destination. The patients won’t be handcuffed and drivers won’t be in police uniforms.
Last year, the General Assembly agreed to spend $7 million on the new model, which G4S Secure Solutions will use to hire specially trained drivers on call 24 hours a day starting this summer. The drivers will have to pass a background check and receive 80 hours of training, including human rights and crisis intervention team training.
The alternative transportation model will roll out slowly by region, starting in Southwest Virginia. Paysour said the contractor will spend a few months building the program in each of the five regions. Hampton Roads is fourth on the list.
G4S uses sedans and SUVs equipped with secure lockers for personal belongings and medical records, tracking capabilities, speed monitoring, a first aid kit and video monitoring, according to a presentation the company gave a state work group in 2017.
One of the largest private security firms in the world, G4S is headquartered in London. It was in charge of security at a jail in Birmingham but recently came under fire after an inspection found a “dramatic deterioration” in the prison, with inspectors documenting instances of violence, uncleanliness and rampant drug use.
In the U.S., the Department of Homeland Security has awarded G4S millions of dollars to provide border security, according to USAspending.gov.
G4S did not respond to a request for an interview, referring the Daily Press to the press release announcing the contract award.
Police officers in Virginia will still be handling about 50% of the TDO transports, because dangerous situations could still arise during transportation, Paysour said.
“Law enforcement will continue to be a partner in this out of necessity and out of safety,” she said.
Not a total relief
While Patterson, the Suffolk deputy chief, realizes there will be some relief with G4S taking over part of the job, the alternative transportation model doesn’t address the first part of involuntary commitment.
An Emergency Custody Order, or ECO, starts the eight-hour window the CSB worker has to evaluate the patient for a possible TDO and find a bed.
Police still have to detain the patient during that time, and Patterson said multiple officers often are working ECOs on a shift.
The new transportation model is also not changing anything for jails and state prisons that issue TDOs and have to transport inmates to state hospitals.
William Smith, who oversees Western Tidewater Regional Jail in Suffolk, said he regularly has to call off-duty jail officers when an inmate gets issued a TDO, and officers are usually busy with that for two to seven hours. The jail had around 25 TDOs last year.
“It’s a severe inconvenience,” the superintendent said, adding he wants to see the state provide more funding so he can hire more officers to drive people to hospitals.
Bruce Cruser, the executive director of Mental Health America of Virginia, praised the state’s alternative transportation model but said it’s merely putting a Band-Aid on the bigger issue of how mental health treatment is given in Virginia.
“It’s sort of like we’re fixing a problem of our own creation,” he said.
Cruser, who sits on the state work group tasked with evaluating the TDO process, wants to see early intervention and diversion programs in the community, better access to outpatient mental health services, mobile crisis units and peer respite centers.
The hospital association has also proposed and begun implementing initiatives like increasing the use of crisis triage centers, creating more diversion programs and expanding psychiatric emergency response services.
“You’ve got an immediate issue of the beds being full, but the real underlying issue is to have a continuum of support in the community at the local level,” Cruser said.
