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

People in these situations can’t walk around, save to go to the bathroom, and they can’t see their families. They may be calm or exhibiting aggressive behaviors; they might be hearing voices or may not have eaten in days because they believe their food is poisoned.

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

Magistrates placed them under the civil custody of law enforcement officers, who have to stay with them until ER nurses can conduct a basic physical exam and clear them to go to that hospital’s behavioral health ward, where they will receive additional treatment.

That is how it should work.

But a statewide shortage of adult psychiatric beds means people in crisis — and under either an eight-hour emergency custody orders (ECOs) or 72-hour temporary detention orders (TDOs) — could wait hours under the eye of law enforcement for medical clearance while local social workers call every hospital in the state searching for beds. Once beds are located, police will drive their charges there — sometimes up to five hours away.

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

“You do wonder, how much is this helping this person as opposed to hurting someone?” said police officer James Herring, who is running for Arlington County Sheriff. “This ‘help’ feels very, ‘One Flew Over the Cuckoo’s Nest.’ That’s not what any of us wants, but it’s the way the system has evolved.”

The current crisis is a result of the state’s decision in 2021 to close most state psychiatric hospitals, which were understaffed due to low wages, hazardous working conditions and Covid. This took some 260 psychiatric beds offline, resulting in people across the state being diverted to remaining state facilities, including Northern Virginia Mental Health Institute, where many Arlington patients go.

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

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

“The crisis with the state hospital beds has forced us, locally and regionally, to bust our butt to come up with [ways to] help people who are in crisis,” says Deborah Warren, the executive director of the Arlington Community Services Board and the DHS Deputy Director.

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

“It’s true for every population and age band,” Warren said. “People aren’t doing well, post-pandemic… Anybody can go into a behavioral health crisis… It’s neurotypical people who are overwhelmed and overrun with feelings of anxiety and depression… People are more self-destructive. It’s gut-wrenching.”

Last year, the Virginia legislature directed the state Dept. of Behavioral Health and Developmental Services to discuss alternatives to police transportation, with stakeholders that included Arlington police, says ACPD spokeswoman Ashley Savage. 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. Glenn Youngkin announced the creation of this task force, of which Warren is a member, in December 2022. The goal is to come up with solutions that could be enacted this legislative session.

But the problem won’t get better until every locality has more services upstream, said state Sen. Barbara Favola, who noted Arlington has “more community-based care than most parts of the state.”

“Virginia has more people in psych beds than need to be there because we don’t have a community-based network to release them into care,” she said.

Getting by 

Historically, Virginia mostly funded state facilities and wealthy jurisdictions in Northern Virginia, like Arlington County, applied local tax dollars to their community services boards, explains Warren. But as evidenced by the current crisis, even Arlington has room to improve.

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

(more…)