RICHMOND, Va. -- As the parent of an adult daughter who struggles with severe mental illness, Prudence Justis constantly questions, "How can we make this better?"
'This' -- being Virginia's mental health system.
“Because if you haven't been through it, you have no idea. It's horrible. It's a horrible experience," Justis said.
In 2021, Justis said her daughter was hospitalized a total of ten times within a three-month period. While her daughter voluntarily admitted herself during some of the episodes, there were a few times Justis said the only way she could get her daughter help was through a temporary detention order (TDO).
To initiate that process, Justis said she went to the Richmond Justice Center and requested a magistrate place her daughter under an emergency custody order (ECO). Once she was taken into emergency custody, she underwent a mental health evaluation and was then issued a TDO.
A magistrate of the court will issue a TDO upon determination that an individual is a danger to themselves or others due to their mental illness and must be involuntarily admitted to a psychiatric facility because the person is unwilling or unable to care for themselves.
Once issued, law enforcement officers are tasked with serving, executing, and transporting the individual to the "facility of temporary detention." Mental health employees with local community service boards are tasked with assigning the facility based upon bed availability.
“That's another challenge. There has to be a hospital available to take them to, and that seems to be one of the issues to getting people help is finding a bed," Justis said.
Under a TDO, patients are typically held at the facility for up to 72 hours or until a special justice re-evaluates the individual, during what's called a commitment hearing, to see if they need additional services.
For Justis, she believed her daughter always needed more treatment than what she received within 72 hours. During the times when her daughter was hospitalized voluntarily, she could leave the facility at any point she wanted.
It was a cycle that kept repeating itself, and oftentimes, Justis' daughter would end up homeless on the streets.
“They kept letting her out of the hospital instead of just keeping her and treating her until she was articulate and able to have a rational conversation, which is what needs to happen," Justis said. "Because until they're stable, their minds are playing tricks on them, and they are making terrible decisions.”
Between July 2022 and May 2023, more than 18,600 TDOs were issued across the Commonwealth, including:
-1,072 in Richmond
-686 in Henrico, Charles City, and New Kent
-313 in Chesterfield
-109 in Hanover
Though the 2023 (fiscal year) numbers, provided by the Department of Behavioral Health and Developmental Services (DBHDS), did not include June data, they were already higher than the total number of TDOs served in 2022 which was 15,828.
However, the 2023 numbers were still lower than the annual number of TDOs issued from 2015-2021 which ranged from 22,000-25,000.
According to a 2022 DBHDS report submitted to the General Assembly, state hospitals were struggling to meet the need. State-run psychiatric facilities are required by the "Bed of Last Resort" law, enacted in 2014, to admit patients under a TDO who could not find a bed at a private facility.
The report found the law put a strain on state hospitals, which were already grappling with staffing shortages. In 2022, more than 7,000 patients experienced a delay in admission to a hospital and waited, on average, 43 hours for a bed.
“The TDO system has been broken, and it not only burdens law enforcement for extended periods of time, but it’s terrible for Virginians who are in a state of crisis," Governor Youngkin said Tuesday following a public event.
Back in December 2022, Youngkin announced the creation of the Prompt Placement Task Force, a group of hospital employees, psychiatrists, and community service board professionals. The task force's goal, according to Youngkin, is to "address key priorities including improving the speed, coordination, and accessibility of psychiatric care for patients."
When asked what recommendations the group has presented thus far, Youngkin said they helped create clear communication "for the first time" between private facilities and the state agency that keeps track of the public bed registry. Youngkin said the public wait list has since decreased by 28%.
A December 2022 report by the General Assembly watchdog agency JLARC found the registry was "useless" because facilities were not updating the wait list with real-time information.
Youngkin is also pushing forward on his $230 million 'Right Help Right Now' plan to overhaul the behavioral health system.
“Which is going to decrease the number of TDOs substantially, because we're going to go meet folks that are in a state of crisis where they are-- mobile task force, crisis receiving centers-- and the ability to keep folks from having necessarily to go to a hospital setting and therefore find themselves in a criminal justice moment, as opposed to a medical health moment," Youngkin said.
Youngkin said the plan was "not perfect" but "really good." He called on the General Assembly to send him a budget, which republicans and democrats continue to negotiate, so the state can start making investments.
"At the top of the list is our behavioral health transformation which Virginians deserve to get moving," Youngkin said.
Justis said she hopes leaders will listen to the voices of those impacted by the mental health system and respond with urgency. She said she has reached out to lawmakers with her own suggestions and has not yet heard back.
One of the ideas she proposed included having every patient under a TDO assigned a special advocate to follow the individual in crisis through the entire TDO process.
“I’d like to see the state of Virginia lead the nation in mental health," Justis said. “I would like for these decision-makers to hear the side of the families and the people who are suffering.”
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