Contracting Out MH Transportation Not Best Choice
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7 responses to “Contracting Out MH Transportation Not Best Choice”
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There’s no mention of a bigger problem — the lack of mental facilities within reasonable distances of localities. That lack requires enormous amounts of law enforcement time to transport and escort disturbed persons.
At our April Mathews County Board of Supervisors meeting, our sheriff described a recent situation. After a deputy was in court most of the day, a call came in at 3 p.m. to take a person into temporary custody and transport him to the local hospital for mental evaluation. After a lengthy process, a full time deputy and part time deputy were then sent to transport the person to a mental facility in Staunton, VA. They did not get back until 6 a.m. the next day. This is a hardship on a mentally ill person and for a small sheriff’s department to provide coverage in the county, and the county gets to absorb the overtime costs. I’d be surprised if there is any accounting of all the time and expense involved for our localities.
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Thanks for the specific example. It illustrates the problem well.
You mentioned the lack of mental health facilities within reasonable distance of localities. There is actually a second problem–a shortage of beds. The first problem is not applicable to Mathews County. There are two major state mental health facilities within reasonable of you: one in Williamsburg and one in Petersburg. The fact that the Mathews deputies had to go all the way to Staunton to transport the patient was, I suspect, a result of the unavailabilty of a bed at either Eastern State or Central State or at any private facility on that particular day. Localities in Southwest Virginia have to contend with both problems.
The broad questions of how many beds and their type (community or residential) are needed are thorny ones and are being grappled with by the General Assembly.
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Yeah, I’m with Cbova on this one. This is an example of penny-wise and pound-foolish and it’s driven by a mentality that mental health on the public dime is “expensive” and we need to cut it to the bone and as a result we have terrible overcrowding in the existing hospitals which then results in having to drive to a facility that has a bed.
Creigh Deeds had a tragedy in his own family as a direct result of this problem.
I’m ashamed of how Virginia deals with this issue.
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The delivery of mental health services is a knotty issue. It is not primarily a case of the Commonwealth cutting the funding “to the bone”. The major issue is how services should be delivered. About 50 years ago, there was a movement to shift services from central institutions to care in the community. There was a lot of justification in this argument; many people committed to the “insane asylums” did not belong there and some of those facilities were real hell holes.
About ten years ago, the federal Dept. of Justice, in a continuation of this movement toward community care, sued Virginia over condition in the mental health facilities. As a result of the consent agreement, the state increased its closure and consolidation of mental health facilities.
There are a couple of problems with the shifting of the emphasis to community care. Although the Commonwealth has provided a substantial amount of funding for community care, an adequate network of community residential facilities, both inpatient and outpatient, has not been developed. Unfortunately, some people need residential care. As a result, a significant number of people with serious mental health issues are “on the street.” Many end up in jails (a subject of a later post).
The Deeds Commission has brought new attention to all these issues. As a result of this awareness and the adoption of its recommendations, more people are being referred to the state mental health facilities for evaluation. The inevitable result has been a squeeze on the availability of beds. The 2019 GA approved the replacement of Central State Hospital in Petersburg, although with fewer beds than DBHDS had proposed. There is language in the Appropriation Act for the department to study the “right-sizing” of the system and report to the GA this fall on its recommendations. In summary, the problems are known, but the solutions have not yet been agreed upon.
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There’s nothing wrong with outsourcing a service like transportation of MH patients — as long as the key performance criteria are spelled out and carefully monitored, and the contractors are held strictly accountable. Unfortunately, many government agencies figure that once they outsource a function, they don’t need to worry about it anymore.
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I’m okay with outsourcing per explicit performance agreement but also the employes need to be qualified. Replacing qualified folks with cheaper unqualified folks is dumb and pound foolish and in this case – it appears the whole problem is not enough space in the system so they transport folks to other facilities that do have space. This is a bigger problem than just “outsourcing” – they’re underfunding a basic function and in doing so – they’re endangering patients and increasing transport costs – and they’re trying to “save” on those transport costs.
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I read the RTD article, Creigh Deeds and the National Alliance for Mental Illness endorse this contract and approach.
I am familiar with the Temporary Detention Order (TDO or Green Warrant) process in VA, having been involved with one over 15 times in Henrico. I am also familiar with the Police training in Crisis Intervention Team Training (CIT), which is key for all police to receive.
Before this contract, the way a TDO usually happens is this: The PD can do a health check with/without the local Mental Health board (usually in coordination with) and then the TDO process can be initiated and the PD apprehends the person and takes them to a temporary facility (Parham road in Henrico) where they are further assessed then if it is determined they are to be hospitalized, a bed is searched for, and they are transported to the hospital.
From reading the RTD article, it sounds as if the contractor will transport from the check-in facility, and not be involved in the initial apprehension. Unless the contractor had CIT training and was experienced at de-escalating a situation and apprehending a non-compliant person, I do not believe they would transport from pick-up to check-in, only from check-in to hospital (I intend to investigate this more).
If that is the case, then I do not see anything wrong with the logic behind outsourcing this transport function. The Sheriff/PD would not have to transport the patient at that point, after initial pick-up. If, however, this contractor is now going to do initial apprehension, then I think this would be a big issue.
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