‘It’s heartbreaking to see someone wait’: Law enforcement in Smyth County teaming up to address placement of mental health patients

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SMYTH COUNTY, Va. (WJHL) – Law enforcement leaders in Smyth County are speaking out for change, advocating for mental health patients who end up in their custody.

Due to the pandemic and a recent executive order by Governor Ralph Northam, these people are experiencing extended wait times while accompanied by law enforcement in their search for proper care.

However in recent months, some either never got the care they needed or waited over 20 hours for it. “It’s heartbreaking to see someone wait and 50 hours is just ridiculous,” said Smyth County Sheriff, Chip Shuler.

Sheriff Shuler is one of the four agency heads leading this charge. Marion Police Chief John Clair, Chilhowie Police Chief Andrew Moss, Saltville Police Chief Erik Puckett alongside Sheriff Shuler all met Monday afternoon to discuss their on-going efforts and future plans to address this issue.

While the extended wait times for these patients also ties up officers in already small departments, that’s not their top concern.

All four were very clear that their number one concern is the care of the patient. They compared the unnecessarily long wait time to that of a criminal process. “Any person handcuffed and left on a bench for 47 hours, now that would immediately be a case of a violation of civil rights, why is this any different?,” said Marion Police Chief, John Clair.

The usual wait time prior to the pandemic was about 8 to 10 hours, according to Clair. However, over the last six months, they’ve seen a tremendous increase in wait times, attributing the majority of it to the guidelines laid out in Governor Northam’s executive order 70 that specifically addresses COVID-19’s impact on psychiatric hospitals in the state.

It’s not just a problem for Marion, but all across Southwest Virginia, especially Smyth County.

“It’s a problem for them, it’s a problem for us, it’s a problem for the CSB, it’s a problem for the state hospital, and we understand that but just saying that we’re doing the best we can, doesn’t work,” said Chilhowie Police Chief, Andrew Moss.

Moss served in the Marion Police Department for decades, most recently as a lieutenant in the department before recently accepting the role of Chilhowie Chief of Police. Monday marked his first official day in the role and he’s hit the ground running, ready to address this on-going issue.

His department is made up of six people, including himself, so when they have to send officers to wait for extended hours and accompany a patient, it takes manpower off the street where it’s needed.

Other small departments, such as the Saltville Police Department also have about seven officers. In recent weeks, three officers were exposed to COVID while accompanying a mental health patient for extended hours.

Not only does this pose a health concern to officers, but according to Saltville Police Chief, Erik Puckett, that individual waited an extended period only to never receive proper care, or care at all for that matter.

“We’re going to have some type of incident whether it be medical or physical that’s going to take place due to not having a rapid response to this time wide to et them relocated to where they need the treatment at,” said Puckett.

Officials are already seeing smaller-scale incidents occurring, proving their point that extended wait periods can lead to dangerous situations. The first incident escalating to an altercation happened after a 30 plus hour wait.

“We had a lady who was suffering from a mental health crisis who ended up assaulting hospital staff, destroying property inside the hospital. So instead of the mental health issues that she was there to address, she ended up being criminally charged,” said Shuler.

Following an incident last week where a man was forced to wait 47 hours for care, the push for this issue to be resolved has become a top priority. Letters are being drafted with plans to circulate them to the participating agencies and hopes to send them out by Tuesday.

“I’m asking for the state hospital and Mount Rogers CSB to help us find an alternative. I know there are challenges, there’s nowhere to put some of these folks, I know it’s difficult, but the reality is that these folks need the help, the code demands they do it, and I’m simply asking them that if they can’t do it in the normal ways, then find an alternative,” said Clair.

We reached out to the Southwest Virginia Mental Health Institute, they sent News Channel 11’s Kelly Grosfield this statement:

“The partnership among Virginia’s state psychiatric hospitals, community services boards (CSBs), private hospitals, and local law enforcement requires collaboration, patience, and open communication. In addition, the COVID-19 pandemic response has challenged our support delivery system and both the state and community providers have taken extraordinary measures to keep staff and individuals safe.

State hospitals across Virginia, including Southwestern Virginia Mental Health Institute (SWVMHI), are regularly operating at 100% of their bed census. When all of the state hospitals are full, there may be delays in admissions to state hospitals. As always, we are not denying admissions except in cases related to COVID-19, but are delaying admissions if state hospital staff need to work to make a bed available.

We understand that this makes it incredibly difficult on local law enforcement, especially smaller departments, who may have to stay with a patient for several hours before a bed becomes available. However, it is absolutely unsafe to leave an individual without police presence while being assessed in the emergency room, or drop an individual off before a bed has been found. This is specifically mentioned in the Governor’s Executive Order issued on August 17, 2020. The executive order was issued to help address the significant impact on COVID-19 in Virginia’s state psychiatric hospitals. The critical reality is the state hospitals will remain in this cycle until Virginia implements more comprehensive payment strategies and rules for admissions to private hospitals and strengthens community services that facilitate discharges.

SWVMHI staff are working hard to turn out discharges just as quickly as new admissions are brought in to the facility. While going above and beyond to make this possible, it is important to remember that facility staff is also working hard to maintain infection control measures against COVID-19, and this can increase the time that it takes to both turnout discharges and find beds for new admissions.

It should also be noted that statewide partners, notably Virginia’s 40 community services boards (CSBs), are working intensively alongside state hospital staff to facilitate safe discharges and help those known to be at risk in the community avoid crises. This degree of expenditure of emergency resources is not sustainable. In addition, DBHDS agrees that law enforcement cannot continue to operate in such a capacity that strains both individuals in crisis and community resources.

DBHDS is working through existing discharge processes and engaging in specialized actions to facilitate discharges; however these tremendous efforts have not been enough to reverse the increasing census trends. Below are recent examples of this heavy-lift:

· DBHDS developed three, CSB-operated assisted living facilities exclusively dedicated to state discharges.

· DBHDS set up Gateway transitional mental health group homes that have aided in discharges.

· Three new contracts with private providers to divert admissions or increase discharges have been established since December 2019. Ongoing funding is required to sustain these and other similar contracts that will relieve pressure on our state hospitals.

· DBHDS is currently working with urgency with long-term care organizations to safely discharge appropriate geriatric patients.

· Since March, individuals have transitioned through the use of Crisis Stabilization Units for patients ready for discharge. In addition, a contract with Fellowship Health for use of the CSU for state hospital discharges went into effect on July 1.

· A contract with Commonwealth Senior Living is targeting discharges that need assisted living level of care or lower-level nursing needs.

· A pilot discharge team began accepting referrals in March with the goal of discharging patients with complex needs with long lengths of stay on the Extraordinary Barriers to Discharge List (EBL).

· DBHDS is working with CSBs on a Discharge Assistance Plan (DAP) workgroup to develop a plan to address an anticipated DAP shortfall in FY 2021.

It’s important to note that the issue of transporting individuals under a TDO is one we are working on improving across the Commonwealth. Over the last year, DBHDS has begun expanding alternative transportation statewide. G4S, a nationally recognized contractor for behavioral health security and transportation services, provides alternative transportation for people under a TDO who are assessed to be appropriate for such a service. Not only does this ease the burden on local law enforcement, it provides a trauma-informed approach to transporting individuals under a TDO. This program first started as a successful pilot program in the Southwest region.

Finally, the challenge of high state hospital census levels has been exacerbated by the recent rise in COVID-19 cases in southwest Virginia. As COVID-19 cases are rising statewide, we anticipate impact on other state hospitals across the commonwealth that may need to close units or hold new admissions to keep current patients and staff safe.

This is an incredibly difficult time for state and private hospitals as well as local community health providers and we are grateful to our many partners such as law enforcement for all they are doing to support Virginia’s health care system.”

Southwest Virginia Mental Health Institute

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