Contributor: Gary Taylor, MSW
An article came out recently in the Richmond Times Dispatch citing alternative transportation for individuals who are in a mental health crisis. The article goes on to share how the current way we transport individuals to psychiatric facilities puts tremendous strains on local budgets and adds to the mental health stigma. As someone who works in crisis therapy, I agree with this sentiment.
Let me explain further as I break down the back end process of admission into a psychiatric facility. As a crisis therapist, the general public are typically unaware of the work we do. There are two separate things that we are looking for. We assess for inpatient hospitalization meaning, seeing if individuals “meet the criteria” for inpatient treatment. The other thing we are looking for entails assessing for least restrictive options that would keep an individual out of the hospital.
There are two options at the end of the assessment if we find you meet criteria for inpatient treatment. Those options include a voluntary admission to a psychiatric facility or involuntary admission to a psychiatric facility placing an individual under a Temporary Detention Order also known as a TDO. If placed under a TDO an individual will be placed at a psychiatric facility involuntarily for a period of up to 48-72 hours. In order to meet these criterias, there has to be significant warning signs such as danger to self, danger to others, inability to care for self or protect self from harm, or lacks capacity to consent to treatment. Once that is up you will have a hearing to determine if you continue to meet criteria for inpatient treatment.
Now when being transported to a psychiatric hospital, under a TDO, typically law enforcement does the transportation. You are placed in handcuffs, then in the back of a police car and driven to the hospital. Once there, the handcuffs are removed and you are admitted to the facility. A voluntary admission looks different. You may be transported via ambulance or security van depending on hospital policies and procedures. Got it?
This can be a very traumatic experience, especially if it is your first time being admitted to a psychiatric facility. It makes the job difficult to tell someone that “Hey, We’re going to get you some help, but we’re also going to involuntarily commit you and handcuff you. Oh, and by the way an officer will transport you.”
Looking into alternative transportation would be beneficial and help reduce the stigma because as it stands our mental health system looks eerily similar to that of the criminal justice system. Yes, officers are typically CIT (Crisis Intervention Team) trained. CIT is a program that teachers law enforcement how to appropriately de-escalate clients who are experiencing a mental health or substance abuse crisis. However, it still feels and look exactly like you are being arrested. It would also help law enforcement who have a tough job as it is, work extremely hard then possibly have to either transport individuals and or sit with individuals until we finish our assessment.
As far as a possible pilot program, using private companies to transport would mean they would have to be trained in dealing with individuals in a mental health crisis and look like normal medical professionals in plain clothes. They shouldn’t use handcuffs, look into soft-restraints if needed in extreme cases. It makes the process more human and medical related. These thoughts along with the pilot program cited in the article seems to be a good idea, but there are also downsides.
As Senator Deeds said everyone would not qualify. He cited those who are a flight risk, I would add those those who are at risk of harming themselves or others, and those who are experiencing psychosis. In these cases we could examine what would work best together. Maybe look at how other states do their transports. Law enforcement and crisis therapists are the only ones at the front line that can give you direct accounts as to what it would look like and how it would go. I feel these things are simple if we stop looking through a complex lens. Those who need treatment are counting on us.
If we want to eliminate stigma surrounding people receiving mental health treatment, we need to do it sooner rather than later because there has been a significant uptick in assessments and treatment needs. One way we can do this is decriminalize it. You can't treat those who need help in a crisis, like someone who has committed a crime. Who would know the difference from the outside looking in? Who would continue to seek out treatment for mental health issues if in the back of their mind they know it's a potential they could be hauled away in handcuffs by law enforcement? It's not fair to the people we serve, law enforcement and it's not fair to us as people.