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Opinion/Editorial: Mental health transportation shows strain

The Daily Progress - 10/18/2017

In one of the many difficulties enmeshed in Virginia's mental health system, three serious problems converge:

» Unfunded state mandates.

» The lack of accessible mental hospitals, requiring patients to be transported long distances to receive care.

» The unsatisfactory practice of having law enforcement officers handle non-enforcement-related transportation of patients.

A new state study calls for an alternative system of transportation that could serve adult patients who are mobile and not considered to be a flight risk or pose a danger to themselves or others.

The idea has been debated since Virginia established a joint legislative subcommittee to review deficiencies in the state's mental health system, following the death of the son of state Sen. Creigh Deeds, who had sought emergency care for the young man. Sen. Deeds, of Bath County, chairs that subcommittee; the vice chair is Del. Rob Bell of Albemarle.

The study now formally recommends establishment of a transportation system by the state agency overseeing mental health services.

The current system is unsatisfactory in several regards.

Law enforcement officers who make the drives to deliver patients often must work overtime to complete their mission. And while they are away, the locality they serve may be left without adequate law enforcement coverage.

For some officers and patients, these may be long and uncomfortable trips. As the Richmond Times-Dispatch has reported, getting a patient from Carroll County to an available mental health bed and returning home can stretch into a 20-hour workday.

Nor is the situation to the liking of patients and their families. It sends a dispiriting message to a mental health patient to be placed under the authority of a law enforcement officer when the patient has done nothing to warrant what might interpreted as a punitive arrangement.

If there were crisis care options closer to home, these long trips would not be necessary. But Virginia has closed some such facilities, choosing to consolidate services in a handful of larger hospitals.

One can't necessarily fault that decision, since ideally it leads to reduced state costs and to better care. By consolidating services, Virginia can afford to improve its level of care while saving money by taking advantage of economies of scale.

But that, in turn, creates a set of new problems.

Patients may be far removed from families, who may not be able to visit them and offer the loving support they need.

And the responsibility for transporting those patients to distant hospitals falls to the locality, not the state. Law enforcement personnel are tasked with the job, both when patients need police supervision and when they don't.

And does Virginia recompense local governments or sheriff's departments when the localities must pick up an expense generated by the state and its mental health policies?

No, it does not.

Add this to the many unfunded mandates pushed down by the state to the local level of government - unfunded requirements for education being the most notorious.

The idea of a special transportation system funded and operated by the state could alleviate the problem. But Sen. Deeds notes that many of the people who must be taken to the hospital would not qualify for such a service; almost by definition, someone who is ordered into crisis care is at risk of hurting himself or others.

Still, such an option would help relieve the burden on localities.

And for those cases in which local law enforcement officers are required to provide transportation?

The state should provide reimbursement - not continue to rely on an unfunded mandate.


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