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Staunton’s Commonwealth Center for Children & Adolescents is the only state mental hospital for children.
The Virginia General Assembly won’t meet again for another six months, but when they do, that esteemed body should tackle the practical problems with the “bed of last resort” law.
Passed in 2014, this law mandates that state mental hospitals find a bed for a patient under a temporary detention order if no bed in a private psychiatric facility can be found within eight hours of the person being taken into emergency custody.
The primary sponsor of that law, state Sen. Creigh Deeds, D-Bath, sought to address circumstances that brought about a heart-rending personal tragedy in 2013.
Deeds’ 24-year-old son Gus was released from emergency custody because the Rockbridge Area Community Services Board failed to find a bed for him in a psychiatric hospital. Gus Deeds returned home, stabbed his father multiple times in the face and chest with a knife, then used a firearm to take his own life.
Evidence later emerged that two state psychiatric hospitals had beds available that night, but the community services board evaluator never contacted them.
The “bed of last resort” law specifically prevents that situation by making it so that the search must continue until a bed is found in the state system.
However, critics of the law said that it would increase the burden on understaffed state hospitals, given that private institutions can still be choosy about their admissions. This has proven true: by 2021, emergency admissions at state institutions had increased almost 400%, creating a crisis of overcrowding that has been worsened by staffing shortages and by COVID-19 outbreaks that killed patients and employees.
As a result, the practice of “streeting” has become increasingly common. That’s when patients are released without receiving treatment because their temporary detention order expires before they can be admitted to a hospital. This is usually a matter of the hospital’s inability to meet the required ratios of staff to patients.
The admissions crisis has more than once pitted local governments against state mental health facilities, with the care of children hanging in the balance.
A judge’s dismissal last month of a lawsuit filed by the Giles County Department of Social Services against the Commonwealth Center for Children & Adolescents in Staunton and against the Virginia Department of Behavioral Health and Developmental Services puts this dangerous problem back into the spotlight.
As reported by the online news site Virginia Mercury, Staunton Circuit Judge Anne Reed dismissed the Giles County suit, ruling that the complaint became moot because the 9-year-old girl whose welfare forms the lawsuit’s central concern was admitted and treated to the Commonwealth Center — during a second mental health crisis a few days later.
The ruling, however, in no way addresses the problem raised by the county’s lawsuit.
In the document, Giles County Attorney Richard Chidester warns that the state behavioral health department’s repeated “violation of Virginia’s Mandatory Admission Provisions constitutes a clear and present danger to the juveniles who are the subject of the temporary detention orders and other persons who may be harmed by the actions of such juveniles.”
The suit describes the Commonwealth Center for Children & Adolescents refusing to admit the girl, despite claiming that the center would have a bed for her in an e-mail sent to a Giles foster care worker. The girl ended up spending the night in a hospital emergency room with only a police officer for company. She was returned to Giles County without receiving treatment.
Giles County is hardly the only local government that has been faced with this dire problem. “This wasn’t an original idea on our part,” Chidester told the Virginia Mercury. “There’d been discussion amongst many local government attorneys about filing something, and we felt like the facts of this case were bad enough to warrant it.”
When the hospitals refuse admittance, localities are not equipped to step up themselves. “Our local hospital, they don’t have any mental health professionals, so you’re not going to get any treatment, and sitting for four days in a hospital until the TDO expires is not going to help,” Chidester said.
There’s plenty of evidence the problem persists. In May, WSLS (Channel 10) shared extraordinary body cam footage of a Covington police officer bringing a 16-year-old boy to the Commonwealth Center.
As shown in the video, a center staff member turned the officer away. “I am commanded to execute this order,” the officer said, holding up his paperwork to the window. As the staff member continued to argue, the officer pointed into the hall, saying “there is a chair right there” for the boy to wait.
Ultimately, he told the boy to stay put, got in his patrol cruiser and drove out of sight of the entrance, though he did not leave the grounds.
Covington Police Chief Chris Smith told WSLS, “It was the intention of the officer to give them the appearance he actually left to force them to bring that child into that location.”
Psychiatric hospitals and police should not be pitted against one another. This problem must not be waved off with an out of sight, out of mind approach.
A pair of bills sponsored this year by Sen. Steve Newman, R-Lynchburg, that were passed unanimously by both houses and signed by Gov. Glenn Youngkin offer hope for partial solutions.
One directs the Secretary of Health and Human Resources and the Secretary of Public Safety and Homeland Security to study options for “alternative custody arrangements” that alleviate the burden on police when transporting someone subject to a temporary detention order. It also calls for state officials to study ways to increase the number of beds available for TDO subjects.
The second bill permits the training of “auxiliary police officers” who can be called in to provide transportation in temporary detention order cases, giving police departments a way to handle that duty without tying up regular officers for days at a time.
Though these new laws represent movement in the right direction, it’s too soon to know how effective they will be in assisting the treatment of these vulnerable patients. The real answers these measures might provide cannot come soon enough.
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Staunton’s Commonwealth Center for Children & Adolescents is the only state mental hospital for children.
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