Eastern State Woes Lead to More Work for Local Police, Courts

Tuesday, June 07, 2011

Eastern State Hospital is full to capacity. Combined with an insufficient community safety net, this means individuals who need behavioral health care aren’t getting it, according to a recent report from the Office of the Inspector General.

In the Historic Triangle, the overtaxed system means local police officers are often spending hours a day transporting citizens who need mental health care all over the state to get them to an available facility. It also means more people with behavioral health problems are ending up in court.

Individuals who can’t be placed are turned out on the street and can be a danger to themselves and the public, the report finds. There are also an increasing number of local crimes committed by people with behavioral health problems, likely due to the lack of mental health services, according to York County’s Commonwealth’s Attorney Eileen Addison.

Eastern State “has been unable to discharge patients into community-based programs because the needed community capacity has not been created,” according to the report. “CSB staff report that, in order to have someone admitted to ESH, the hospital must first discharge a current CSB client… the bottom line is that, as of March 31, 2011, ESH remains largely unavailable as a safety net for Hampton Roads residents requiring a secure state behavioral health facility.”

“Streeting,” which refers to individuals in custody who meet the criteria for a Temporary Detention Order and are released due to a lack of beds at ESH or a similar facility, is of particular concern to the OIG. “Streeting represents a failure of the Commonwealth’s public sector safety net system to serve Virginia’s most vulnerable citizens and places these individuals, their families, and the public at-risk,” the report states.

About 200 people across the state over the past year who met the TDO criteria were released, according to the report.

The result of streeting is that “emergency services personnel are often left with trying to patch together other creative treatment options in an effort to assure safety of the person and others.”

CSB personnel often have to call 15 or more private providers to secure a bed for individuals, based on anecdotal evidence the OIG gathered from around the state. If the CSB finds a bed it is often far from the organization’s service area, and law enforcement personnel have to drive the patient to the location, the report says.

This is an issue that greatly affects the James City County police, according to Rubino. When an officer picks up an individual suspected of having a mental disorder, the officer takes the person for prescreening with a mental health professional. If a Temporary Detention Order (for an individual who is likely to cause serious harm to himself or others and needs hospitalization or treatment) is filed, the Colonial CSB calls around the state trying to find an available facility.

“Then [police officers] have to transport them somewhere – sometimes it’s Virginia Beach or Western State [Hospital] in Staunton,” Rubino says. “Depending on the situation, we may need to commit two officers. This is a real drain on resources, to have two officers tied up, sometimes for the better part of a shift, when they could be working here [in the community].

This happens “on a regular basis,” he says, and the need for officers to perform this function has remained constant for several years. Years ago, the police would take an individual under a TDO to Eastern State, but the hospital doesn’t take these patients anymore. It’s been a long time since James City County officers have taken anyone to Eastern State, according to Rubino.

The same is true in Williamsburg. Riley says his officers sometimes have to take people as far as Petersburg for treatment. Also, he says prescreening takes a lot of an officer’s time. “Any time we take someone to a prescreening, it can take up to six hours. The officer has to stay with the person.” This can consume most of a shift, according to Riley.

Williamsburg police also no longer take people who need care to Eastern State. “When I first started, we used to take people to Eastern State all the time. Now, I can’t remember the last time I took someone there,” Riley said.

Those who aren’t placed in a facility are released, which can cause a dangerous situation. “To deny individuals an opportunity to receive the services, at the level of care deemed clinically and legally necessary, places each person at risk not only at the time of the immediate crisis but may create avoidable risk for the person and the community later,” the report warns.

Though she has no hard numbers, Addison says her observation is that there has been a significant increase in cases involving people with behavioral health problems. “In years past, we had a handful of people who were evaluated as not competent,” she says. “Now it seems it happens every month.”

The crimes committed by people with behavioral health problems in York County are generally not violent, she says, but often relate to substance abuse, disorderly conduct, and threatening calls or behavior.

Addison’s conclusions line up with the report’s findings. “There just isn’t enough community mental health treatment available” in the area, she says.

The problems at Eastern State stem from a number of issues, according to the report. “The current crisis was triggered by the confluence of historically inadequate facility leadership, the loss of operating beds at ESH resulting from the downsizing initiative, $2.6 million in community funding that was not appropriated in 2009, the absence of a meaningful response by DBHDS (Department of Behavioral Health and Developmental Services)to the repeated petitions from local governments and CSBs during 2008 and 2009, and the inability to create essential community capacity before obsolete ESH buildings were removed from service and patients transferred into the new downsized facility.”

Eastern State has a new director, Jack Wood, who has been working to address the problems, according to the report. The OIG recommends that the Department of Behavioral Health and Developmental Services come up with a plan to fix the admission and discharge problems and create a list of community services that are needed, among other suggestions included in the report.

As for the instances of streeting, the OIG “will monitor this issue going forward and make recommendations to end this questionable and dangerous practice, and hope that one day the term streeting will pass from the lexicon of Virginia’s behavioral health system.”