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 tapped to detain, transport and wait in hospitals with people in the throes of a mental health crisis.
Officers from Clair's 21-member Marion Police Department crisscross the state to deliver patients for court-ordered treatment, sometimes only to discover the hospital where they were sent has no available beds. Patients end up boarding in waiting rooms or emergency rooms, sometimes for days on end, while under the supervision of Clair's officers.
It's a problem for law enforcement agencies around Virginia, one that advocates, attorneys and leaders like Clair say ties up policing resources and contributes to poor patient outcomes. In the past five years, these types of transports have become the largest single category of case the Marion department handles.
“We are against the wall,” said Clair, an Army veteran and former lay pastor who sometimes shuttles patients himself, and did so last month on a nearly 15-hour round trip to a coastal city on the other side of the state.
The problem underscores a widely held consensus that Virginia’s mental health care 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.
'People were really struggling'
About a year ago, Youngkin, a Republican, rolled out 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 in the confines of a hospital, easing the burden on both patients and law enforcement.
While Virginia’s struggles may be particularly acute, Youngkin is not alone in his focus on the issue. Improving mental health care became a priority in the U.S. like never before as the pandemic brought new levels of isolation, fear and grief, in addition to pre-existing crises such as rising drug overdose deaths and the struggles burdening teen girls. Survey data from the U.S. Substance Abuse and Mental Health Services Administration found that in 2022, about half of adults with any mental illness did not receive treatment.
“We know that there’s a lot of partisan divide across the country, but what we’ve found is whether it’s red states or blue states, there’s a lot of support for behavioral health at this point,” said Brian Hepburn, executive director of the National Association of State Mental Health Program Directors.
Youngkin's emphasis on mental health developed during his 2021 campaign, when 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 Virginia initiative.
“It was just so clear that people were really struggling,” Littel said.
'Right Help, Right Now'
Youngkin has since won bipartisan support for his “Right Help, Right Now” initiative and praise from advocates, though some worry about the pace at which things are moving. The governor — whose press office says the initiative is exceeding key milestones — cannot seek a second consecutive term and leaves office in two years.
The initiative's wide-ranging goals include building up the behavioral health care workforce and working to stem the tide of overdose deaths, which claimed the lives of an average of seven Virginians a day in 2022. Youngkin has signed dozens of related bills into law and has secured hundreds of millions in new funding, with more proposed.
The “foundational” part of the plan, as Littel describes it, is creating a system that delivers same-day help to individuals in crisis, which should also relieve some of the burden on police departments like Clair's that are charged with transporting most patients a court deems a risk to themselves or others.
Youngkin's administration hopes to build up that continuum of care by increasing the number of mobile crisis teams with clinicians to respond to mental health emergencies and creating more short-term stabilization centers for patients to avoid the need to take them hours away from their homes for care.
A recent report from the state's legislative watchdog emphasized the need.
Virginia had more than 20,000 temporary detention orders in fiscal year 2023, according to a recent presentation to lawmakers. Some 8,538 of those individuals experienced delays receiving psychiatric treatment after they had been deemed an imminent risk to themselves or others, the report found.
The report also raised concerns about law enforcement “drop offs,” where officers or sheriff's deputies leave patients before they're accepted by a hospital or other facility. Recent testimony in a legislative hearing suggested drop-offs put some of those patients at risk of death.
Elsewhere in the U.S., states' policy concerns and approaches to improving mental health care have varied.
States have used federal coronavirus pandemic relief funds to bolster access to care, and most governors have talked about mental health in their state of the state addresses in the last few 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, it’s not a sprint,” said Katherine McGuire, chief advocacy officer of the American Psychological Association, “and our daily hope is that the states especially after the public health emergency was rescinded will realize they have to stay at it, they have to stick with it.”
Virginia's lawmakers are considering bills on the intersection of law enforcement and mental health this year.
Clair said he hoped that speaking with candor about his department's experiences will help them see the urgency of the problem. But he's worried that the part-time General Assembly, also grappling with controversial gambling and sports arena deals, may rush through something that falls short of what's needed.
The patient Clair transported across the state, costing his department thousands of dollars, has had around 15 mental health encounters with his agency in a year and a half, he estimates. One involved a suicide attempt.
The patient dropped off a handwritten thank-you note for the chief after their long ride. A short time later, she was back in his department's custody.
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're just setting ourselves up for tragedy over and over again," he said.
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Geoff Mulvihill contributed to this report from Cherry Hill, New Jersey.
