March 31, 2021

Good Afternoon. First let me say thank you to the both the members of the media
and the law enforcement representatives here today. Thank you all for being here
to help bring attention to a growing crisis that impacts some of the most
vulnerable members of our communities, the mentally ill. We in the New River
Valley felt compelled to speak out on this issue because unfortunately we have
seen first-hand the tragedy that too often results when the mental health system
fails people in crisis. However, that does not make us unique. Communities across
the Commonwealth, in fact communities across America, have experienced
tragedies involving mental illness. Mental health issues seem to be on the rise in
America and the pandemic has only added to that problem.
We made the collective decision long ago not to wait idly by for the next tragedy.
For over a decade now we have worked in close partnership with our local
Community Service Board to come up with better, more innovative solutions for
our community members in need of mental health services. We have worked
hand in hand with local mental health officials to develop, implement and utilize
programs like Crisis Intervention Team training for law enforcement, Crisis
Intervention Team Assessment Centers and most recently, mental health/law
enforcement co-response to in-progress mental health calls in the field. This
collaborative, regional approach has proven to be beneficial to all involved,
including the citizen in crisis.
However, after the initial response to a person in crisis, our efforts are often
hindered, delayed, or outright stymied by systemic failures in the mental health
system at the state level. For years there has been a shortage of bed space in
mental health facilities, both public and private, throughout the Commonwealth.
This has grown from the decades-old shift in philosophy from commitment to an
institution to community-based treatment. The community-based model is more
humane and is quite effective at long-term maintenance-type treatment
programs for persons with mental illness. However, very few communities have
sufficient resources to provide adequate emergency in-patient treatment for
persons experiencing acute crisis and the shift to a community-based model saw
both private and state facilities reducing available bed space. This means that
even after a successful intervention by law enforcement and local emergency
service clinicians, there is often no-where for the person in crisis to be
hospitalized for much need treatment and stabilization. When there is no bed
available, the Code of Virginia identifies the state mental hospitals as the hospital
of last resort and very clearly states that:
“Under no circumstances shall a state facility fail or refuse to admit an
individual who meets the criteria for temporary detention pursuant to §
37.2-809 unless an alternative facility that is able to provide temporary
detention”
Despite a very clear legal obligation, the various state hospitals refuse to admit
individuals who meet the criteria for temporary detention with frightening
regularity. They say they are not refusing to accept patients. They will instead say
“we are accepting, but you can’t bring them yet” but will provide no timeline for
when they may accept the patient. For them or the Department of Behavioral
Health and Developmental Services to claim they are not technically refusing
when they are in fact explicitly saying “do not bring the person here, tell law
enforcement to execute the TDO and sit with them indefinitely” is disingenuous at
best. They are merely playing semantic games at the expense of the consumer.
Anyone who has dealt with mentally ill persons in the field knows that these
situations are unstable and that the longer the person is held in limbo, with no
clear outcome or progress toward resolution, the more agitated the person
becomes. This is accelerated by requiring the person to lie in a bed in a local
emergency room. Emergency Rooms are not equipped to provide the necessities
of life. There is no way to provide a meal or shower. Even allowing the consumer
to go to the restroom in an ER creates a risk to the safety of all present. In effect,
the mental health consumer is denied any form of treatment and is instead held
indefinitely in law enforcement custody. If that’s not bad enough, this practice
also ties up a medical hospital resource in the middle of a pandemic and
potentially places the mental health consumer at higher risk of exposure to Covid
19 while they wait in limbo. That too is unacceptable.
While Covid has certainly magnified the problem, the issue of insufficient bed
space has existed for years, with Department of Behavioral Health sending out
messages numerous times per year, and not so coincidentally on most all holiday
weekends, stating that we should expect delays because the state facilities are at
or near capacity. The position of the Department of Behavioral Health to merely
pass the consumer back to law enforcement and expect us to maintain indefinite
custody with little real legal authority to do so is simply no longer acceptable.
That practice is particularly offensive in an era where everyone from the Governor
to the General Assembly to mental health professionals, including the
Department of Behavioral Health, are publicly advocating for getting law
enforcement out of the mental health crisis response model. We have all seen
communities torn apart, literally burned to the ground, after tragedies involving
interactions with mentally ill persons and law enforcement that result in the
police using force. Those circumstances, even if not always accurately perceived,
have led to initiatives like co-response and legislation like the Marcus Alert. For
those types of initiatives to be the forward-facing public statement from
Department of Behavioral Health and politicians, but the behind-the-scenes
protocol to be simply to pass the consumer back to law enforcement any time the
system encounters a challenge is blatantly dishonest. The Department of
Behavioral Health argues that the police are too violent and cause more harm
than good in mental health response, but every time they face a challenge in their
own process, their answer is to punt the ball back to law enforcement so the
consumer can spend even MORE time with law enforcement.
Now the Department of Behavioral Health is using the Covid pandemic to do this
more frequently by instituting a policy that no Covid-positive consumer can be
admitted to a state mental hospital. It is hard to fathom that this can possibly be
the official position of the Commonwealth of Virginia a full year into the
pandemic. All other congregate facility settings ranging from correctional facilities
to long-term care providers have all had to deal with how to effectively
quarantine new arrivals and isolate positive cases while continuing to provide
service to their respective communities. It has taken hard work to develop
solutions that work for each unique setting, but they have done it, because the
service they provide IS essential to the community. Mental health care is no less
essential and for the Department of Behavioral Health to take the position that
people simply can’t have a mental health crisis during Covid is disturbing, but not
surprising.
For too long the Department of Behavioral Health has refused to address issues
within its operational purview, instead choosing to pass the buck to others, most
often local CSB’s and law enforcement. Yet they have no problem standing idly by,
silent while the community tears itself apart over incidents that occurred as a
direct result of their own refusal to uphold their obligation as the State’s mental
health service provider. Again, it is disingenuous for the mental health experts to
pass their problematic mental health cases off to law enforcement and then
criticize law enforcement for not being able to successfully handle a problem that
they were not only unable to handle, but were unwilling to even try to handle
themselves. It is past time that the Department of Behavioral Health and the
General Assembly stop passing the buck and step up to develop and implement
solutions to address the constant bed shortages and other deficiencies in the
state response to mental health crises. While it may seem that only law
enforcement is inconvenienced by this inaction, it is the consumer who is being
punished by the substandard level of care created by these policies.

We are asking for the Department of Behavioral Health and Developmental

Services to develop effective strategies to address both the shortage of bed space
and the need to provide mental health services to consumers in the Covid era. We
are also asking the General Assembly to address this by providing the funding
needed to increase bed capacity system-wide at state facilities. In the meantime,
we will be requesting an advisory opinion from the attorney general regarding the
state hospitals constantly telling law enforcement to delay transporting and
instead maintain law enforcement custody of persons who meet the criteria for
further mental health treatment and evaluation.

That is all I have except to say that I did not even touch on the logistical
nightmares that are experienced by the person in crisis and our officers during
transports that often take hours to complete, some all the way across our
Commonwealth.
Let me leave you with this scenario to think about:
Imagine a family member who is experiencing a mental health crisis and is under
a temporary detention order. The local state hospital has no available beds so we
are ordered to transport the individual to another state hospital 5 to 8 hours
away. Your family member is loaded into the back of a police vehicle almost
always in handcuffs. In the meantime, law-enforcement on the other side of the
state are transporting a patient in crisis to the state hospital closest to us. We do
not believe these are acceptable practices for anyone involved.