Alternative Transportation for Virginians Experiencing Mental Health Crises

John (“Jack”) Hilles
ILPPP Research Assistant
University of Virginia
B.A. Candidate, Class of 2020

Elena Kruse
ILPPP Research Assistant
Washington & Lee University
B.S. Candidate, Class of 2020

The following post provides an overview of alternative transportation for individuals experiencing mental health crises in Virginia. It describes challenges the state faces and alternative transportation programs currently underway.

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The Context

In November of 2013, Virginia Senator Creigh Deeds’s son, Gus Deeds, was issued an Emergency Commitment Order during a mental health crisis. However, clinicians were unable to find the 24-year-old a hospital bed within the six hours allowed for evaluation, so Gus was sent home. The next day, Gus Deeds attacked his father and then killed himself. The tragic incident may have been avoided if clinicians had a better capability of finding a hospital bed for an individual suffering a mental health crisis. (1)

Virginia’s Response

In 2014, Senator Deeds established the Joint Subcommittee to Study Mental Health Services in the 21st Century to improve Virginia’s delivery of mental health services. More commonly known as the “Deeds Commission,” the committee extended the maximum time for clinicians to evaluate an individual from six to eight hours, and expanded the time that facilities could hold an individual under a Temporary Detention Order (TDO) from 48 hours to 72 hours. Also, the Deeds Commission established legislation that requires state psychiatric hospitals to admit individuals who meet the criteria for temporary detention if a private bed cannot be found before the eight-hour window ends. (1)

The Problem

While beneficial for ensuring a bed is available for anyone in need of care, this new law has led to an influx of people admitted to state hospitals under a temporary detention order, and therefore statewide bed shortages. Now, individuals issued a TDO in the midst of a mental health crisis are often transported long distances to a hospital that has a bed available. As a result, the manner in which these individuals are transported is more important than ever.

According to the Virginia legal code, a magistrate issuing a Temporary Detention Order (TDO) for a mental health patient must specify either a law enforcement agency or an alternative transportation service to transport the patient to a hospital (2). Historically, law enforcement officers (LEOs) are most frequently assigned to transport individuals in a mental health crisis, and alternative transportation providers are almost never utilized. In 2018, 99 percent of the 25,000 individuals issued involuntary detention orders were transported by LEOs (1). This is problematic. Primarily, transporting individuals in the back of a marked law enforcement vehicle, often handcuffed, intensifies the trauma associated with an already distressing mental health crisis (3). Additionally, treating people experiencing a mental health crisis as dangerous criminals undermines the mental healthcare community’s ongoing efforts to reduce the harmful stigma associated with mental illness. In addition, LEO transportation is costly and time-consuming for law enforcement agencies (3). The Arlington-based Treatment Advocacy Center notes that for law enforcement agencies across Virginia at least 10% of agencies’ budgets are spent on transporting individuals in mental health crisis (3). Law enforcement transportation also removes police officers from their shifts for several hours at a time, which is especially taxing for many smaller agencies, both financially and in terms of maintaining community safety (3).

Pilot Program

In 2015, new legislation expanded the capabilities for magistrates to consider alternative transportation for any TDO or civil commitment. Previously, a magistrate could not consider alternative transportation for individuals with a “substantial likelihood” to “cause serious physical harm to himself or others” (4). The same year, the Virginia Department of Behavioral Health and Developmental Services (DBHDS) funded a pilot program in the Mount Rogers Community Services Board (CSB) region for alternative transportation with the security firm Steadfast Investigations & Security. This security firm provided transportation for individuals in unmarked cars with non-uniformed drivers trained in Crisis Intervention Team (CIT) principles and Mental Health First Aid. As planned, the alternative transportation was not used in every TDO transport. For many individuals with a risk of elopement or causing harm to themselves or others, law enforcement officers, police cars, and handcuffs ensure the safety of everyone involved.

From November 2015 to July 2016, 27% of Mount Rogers individuals under a TDO were provided alternative transportation (5). The pilot was deemed very effective. Every one of the transports was considered successful, and there were no instances of elopement. Importantly, alternative transportation provided a more humane experience for individuals undergoing mental health crisis and relieved law enforcement resources. Furthermore, the successful rollout of alternative transportation in the Mount Rogers area suggested similar results could be obtained if the pilot was expanded to a larger area (5).

Statewide Rollout

Based on the success of the pilot program and recommendations of the Task Force on Alternative Transportation[1], DBHDS agreed to a two-year, $7 million contract with private security firm G4S Secure Solutions. G4S will provide statewide alternative transportation for patients requiring involuntary hospitalization. If the statewide rollout is successful, the contract can be extended.

The G4S drivers will undergo a background check and 80 hours of classroom and pre-assignment training, including CIT training and human rights training (3). Individuals transported by G4S will not be handcuffed, and will be driven in unmarked cars by non-police officers.  As in the pilot program, law enforcement agencies will still provide transportation in high-risk cases; however, G4S is expected to transport 50% of TDOs across the state, nearly doubling the proportion of alternative transports seen in the pilot program. The contract thus aims to keep LEO resources in the community and improve conditions and reduce stigma for thousands of individuals experiencing mental health crisis.

[1] The Task Force on Alternative Transportation was created by the 2017 General Assembly (HB1426 and SB1221). It was a multi-stakeholder group that put forth recommendations for a statewide model for alternative transportation for individuals under temporary detention in Virginia.

References 

1. Balch, B. (2019, May 07). Virginia to sign $7M contract with private security firm to transport mental health patients, freeing up law enforcement. Retrieved from https://www.richmond.com/news/virginia/virginia-to-sign-m-contract-with-private-security-firm-to/article_6ebc45b0-ebd2-5b4e-b7e7-51ca7c93ea7f.html

2. Va. Code Ann § 37.2-810 (2015)

3. Albiges, M., & Albiges/Staff, M. (2019, May 17). Thousands in mental health crisis are handcuffed by police. The state wants to cut that number. Retrieved from https://pilotonline.com/news/government/virginia/article_c728d742-78ab-11e9-a85c-a733fb0ae39a.html

4. Va.Code Ann. § 37.2-808 (2015)

5. Larsen, M. (2016). Alternative Transportation Pilot [PowerPoint slides]. Retrieved from http://jchc.virginia.gov/documents/2016/aug/2%20Alternative%20Transportation%20CLR.pdf

6. Sorrell, R. (2019, May 08). State approves contract for mental health transports in Virginia. Retrieved from https://www.heraldcourier.com/news/state-approves-contract-for-mental-health-transports-in-virginia/article_1a28d40a-0624-566b-8c1b-427f93c6ff17.html