Lack of mental health beds pushes Arlington toward community-based care

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In Arlington and across the state, hospital emergency rooms are filling with people struggling with mental health crises, who are often handcuffed and attended to by law enforcement officers.

People in these conditions can’t move, save for going to the bathroom, and they can’t see their families. They may become calm or display aggressive behavior; They may be hearing voices or have not eaten for days because they believe their food is poisoned.

In whatever case, they are in the emergency room because local physicians have determined they are a danger to themselves or others or unable to care for themselves, and need to be treated by specialized staff at the hospital.

Magistrates placed him in the civil custody of law enforcement officers, who are to remain with him until ER nurses can conduct a basic physical exam and clear him to the behavioral health ward of that hospital, where they will receive additional treatment.

This is how it should work.

But a statewide shortage of adult psychiatric beds means people in crisis – and under either an eight-hour emergency detention order (ECO) or a 72-hour temporary detention order (TDO) – spend hours under the eyes of law enforcement for medical clearance. can wait. Local social workers call every hospital in the state looking for beds. Once a bed was found, the police would lay their charges there – sometimes for up to five hours.

The shortage is straining Virginia’s mental health care system, which is staffed by under-resourced physicians, nurses and dwindling ranks of law enforcement working overtime.

“You wonder, how much is it helping this person instead of hurting someone else?” said police officer James Herring, running for Arlington County sheriff. “This ‘help’ sounds a lot like ‘one flew over the cuckoo’s nest.’ It’s not what any of us want, but it’s the way the system has evolved.

The current crisis is a result of the state’s decision to close most state psychiatric hospitals in 2021, which was fueled by low pay, dangerous working conditions and staff shortages due to COVID. It took some 260 psychiatric beds offline, resulting in people across the state being transferred to remaining state facilities, including the Northern Virginia Institute of Mental Health, where many Arlington patients go.

The bed shortage has prompted Arlington County law enforcement agencies, the Department of Human Services and the Board of Community Services and VHC Health — the new name for Virginia Hospital Center — to work together to move away from a system that says trauma and pulls officers away from critical duties and toward community-based continuity of care.

Just yesterday (Tuesday), VHC announced that it would be building a facility dedicated to behavioral health at its former urgent care facility at 601 S. Carlin Springs Road.

“The crisis of state hospital beds has forced us, locally and regionally, to bust our butts [ways to] Help those who are in crisis,” says Arlington Community Services Board executive director and DHS deputy director Deborah Warren.

Other events also threw these systemic issues into relief, says Warren. The Richmond police shooting of Marcus-David Peters, which was a psychiatric episode, demonstrated the risk of police responding to a behavioral health problem, while pandemic-era isolation has made mental illnesses more acute.

“This is true for every population and age group,” Warren said. “People are not doing well, post pandemic… anyone can go into a behavioral health crisis… It is neurotic people who are overwhelmed and overtaken by feelings of anxiety and depression… People are more self-destructive. This is heart wrenching.

ACPD spokeswoman Ashley Savage says that last year, the Virginia legislature directed the state Department of Behavioral Health and Developmental Services to discuss options for police transportation, with Arlington police involved. The workgroup came up with the idea for the Prompt Placement Task Force, which brings together government agencies, public and private hospitals, law enforcement and community partners to address the crisis.

Gov. Glen Youngkin announced the formation of this task force in December 2022, of which Warren is a member. The goal is to come up with solutions that can be implemented in this legislative session.

But the problem won’t get better until there are more services in every neighborhood, said state Sen. Barbara Fevola, adding, “Arlington has more community-based care than most parts of the state.” “

“Virginia has more people in psychiatric beds because we don’t have a community-based network to drop them off into care,” she said.

A whiteboard at Arlington County’s Crisis Intervention Center (Staff photo by Jay Westcott)

getting by

Historically, Virginia funded mostly state facilities and wealthy jurisdictions, like Arlington County in northern Virginia, applied local tax dollars to their community service boards, Warren explains. But as the current crisis shows, even Arlington has room for improvement.

“We have a long way to go, and the state has a long way to go,” she said.

Currently, people taken to hospital under an Emergency Detention Order (ECO) are assessed for a longer, three-day order – a temporary detention order – under which they would be able to receive more treatment in hospital Huh.

The process often begins with an evaluation by county social workers at the Arlington County Detention Facility, where “a significant number of people with severe mental illness are in our custody,” says Major Tara Johnson, a spokeswoman for the sheriff’s office.

Two sheriffs will take someone under ECO to the hospital, and one may return if the person seems calm. In 2022, the longest the sheriff had to wait for someone to bed with was five days, or 113.5 man-hours. During the same period, sheriffs spent about 1,828 total man-hours at the hospital, she said.

Data from the Arlington County Sheriff’s Office on ECOs released from jail

Sometimes people show up at Arlington’s Crisis Intervention Center within the county’s health facilities at Sequoia Plaza (2100 Washington Blvd.). This five-room tranquil center has hospital-grade recliners, neutral colors, a shower and bathroom, therapists on staff, and a pharmacy upstairs. The staff there try to avoid sending the person to hospital if possible.

“People’s presentations can be fluid,” said Kellyanne Reimer, a licensed Arlington County social worker. “There can be situations where with us here in the office and we can ease the stress and bring them down somewhat so that they don’t meet the criteria, or we can use different community resources or support, family, friends, Can wrap in shelters. , various resources that can reduce their risk so they don’t need to go to the hospital. This is the goal.

But if they have to go to the hospital, and there aren’t beds, “we’ll keep going,” Reimer says. This includes working with the Crisis Receiving Center in Chantilly for a temporary placement.

TDO Hiring at Virginia Hospital Center

Driving patients to the ER and sitting with them, then driving them to the hospital or these receiving centers, is a significant drain on law enforcement.

To reduce the impact of the crisis on police staff, Savage said, “the department has created alternate transportation, an overtime detail of officers dedicated solely to the transportation and custody of patients.”

Officer Herring says it’s difficult to find people willing to work overtime, though, “because you don’t know when your day will end.”

According to Major Johnson, the conditions inside the prison are equally difficult.

“We are coping by modifying facility operations – canceling programs and going and reducing out-of-sale times – pulling staff from other divisions, and mandating overtime,” she said.

Reimer says she wants to protect vulnerable people from lying on a gurney in a hospital hallway, exposed to “nonstop noise, nonstop excitement, lights” while nurses draw their blood or do other tests.

“I would really love to build out our crisis intervention center to be able to accommodate medical clearance,” she said.

Many Warren says he and the county’s Department of Human Services are pursuing only one solution, with the support of the Arlington County Board.

Arlington County Department of Human Services Deputy Director Deborah Warren (Staff photo by Jay Westcott)

Solution

The aim of DHS, says Warren, is to remove law enforcement from the process and keep people out of the hospital, or jail, where possible.

The first point of inflection is the county’s alert system to transfer through calls to 911 or 988 — a new national suicide and mental health crisis hotline — to determine what type of response is needed.

This could be Community Regional Crisis Response (CR2), a 24-hour rapid response team that handles people of all ages experiencing a mental health or substance abuse crisis. Or, once they become operational this spring, mobile crisis response vans that transport physicians to behavioral health emergencies.

If law enforcement is to respond, Warren aims to ensure all personnel are trained in de-escalation and taught techniques for dealing with different situations, such as a person with autism or a person hearing voices. About half of Arlington’s officers have this training.

“The silver lining in this [crisis] It is that more and more people, now, when they are displaying behaviors that would be strange or potentially violent, the police are now more aware that these people are suffering from a mental health crisis and should not be jailed.” Favola said.

Warren also wants people to come to the Sequoia facility, which is in the process of getting a license to allow people to stay for up to 23 hours. Soon, it will also have security guards authorized by a judge and the Arlington County police chief to receive people under temporary detention orders and drive them to the hospital.

“Our vision is that this will save law enforcement substantial time and money in terms of overtime,” she said.

Fevola said he has a bill that “would essentially require hospitals to come up with trauma-informed security, which would be the first step in the goal of removing the police from responsibility for being with this person.”

Because increasing hospital capacity could take years, in the interim, municipalities in the area are adding more crisis receiving centers that have beds and can hold people under TDO. In the meantime, area hospitals are making arrangements to be treated and evaluated in the ER.

VHC Health plans to build a new 72-bed facility dedicated to mental health and substance abuse treatment at the 601 S. Carlin Springs Road property. It includes a 24-bed adult unit, a 24-bed youth unit, a 24-bed “recovery and wellness unit” and five outpatient programs. It will have 40 separate beds for people with brain and spinal cord injuries, stroke recoveries and those with neurological and other conditions.

In addition, Warren told ARL Now earlier this month that VHC will update its emergency room to include eight “safe space” bays for individuals in psychological distress, three private quiet rooms and a shower and bathroom in the emergency room. Will happen.

“They are the best possible partners that we could have,” Warren said. “They’ve been great at working with us on this problem.”

Due to the closure of the government hospital, many areas including private hospitals were forced. After 50 years in the field of mental health, Warren thinks the crisis has sent communities in the right direction.

“State hospitals can be scary places, a place where the whole building is behavioral health,” she said. “I like the idea of ​​units in community hospitals: You’re home, you’re near your family, your family can visit you during visiting hours, your family can participate in therapy. You’re connected to your community. Has happened.

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