A workgroup to study options to increase the use of alternative custody arrangements for individuals who are subject to an emergency custody order (ECO) or a temporary detention order (TDO) held its first meeting on June 16. The workgroup, which is led by the Secretary of Health and Human Resources and the Secretary of Public Safety and Homeland Security, was convened at the direction of legislation passed during the 2022 General Assembly session (SB 202, Newman) in response to the continuing stresses on law enforcement agencies posed by delayed admissions to inpatient psychiatric care. Secretary of Health and Human Resources John Littel pointed to the pressures on law enforcement in the ECO and TDO process as a symptom of larger problems in the behavioral health system overall, citing the need for better capacity, coordination, and communication.
The workgroup is charged with developing recommendations for options to allow law enforcement officers to transfer custody of individuals subject to an ECO or TDO and to increase the availability of beds in order to allow “prompt transfer to an appropriate facility,” including the expansion of crisis intervention team assessment centers and development of regional crisis receiving centers. The June 16 meeting began with the perspectives of law enforcement, represented by the City of Lynchburg’s Chief of Police, Ryan M. Zuidema, and Elizabeth Hobbs, Staff Attorney with the Virginia Sheriffs’ Association. Chief Zuidema outlined some of the challenges in his locality, which has experienced a 479 percent increase in TDOs in the last five years. The increasing numbers of TDOs, exacerbated by lengthy delays in admissions, now require the equivalent of ten full-time officers to implement (representing 17 percent of the patrol officers in the department). In addition to the stress on the department’s staff, Chief Zuidema noted that his department’s involvement in the TDO process strains the department’s community relationships and hampers recruitment of new officers.
Ms. Hobbs provided an overview of the TDO process as it is currently set out in statute, and explained the changes made by SB 268 (Favola), which also passed in 2022. This bill requires magistrates to prioritize alternative transportation when determining a transportation provider for an individual subject to a TDO, and allows a law enforcement officer to transfer custody to the designated alternative transportation provider upon execution of the TDO. Since the state’s current contract for alternative transportation only covers the transport of the individual once a bed is available, the bill also requires the Department of Behavioral Health and Developmental Services (DBHDS) to amend an existing contract or enter into a new contract for alternative custody of individuals who are subject to TDOs, subject to the availability of funds. (The biennium budget that was signed by the Governor last week includes $2 million in FY 2023 and $3.4 million in FY 2024 for alternative custody.)
Nelson Smith, Commissioner of the Department of Behavioral Health and Developmental Services, and DBHDS staff Gail Paysour and Suzanne Mayo provided information on numbers of TDOs issued over the last several years, average wait time, and the number of TDO transports handled by the state’s contracted alternative transportation provider, G4S (now Allied). The state’s goal is for 50 percent of TDO transports to be provided by alternative transportation; however, in recent months, that percentage has fallen to as low as 8 percent of TDOs. DBHDS has been in discussions with the company about improving its performance, but staff also indicated that the current structure of the program may need to be revisited in order to allow more individuals to be candidates for alternative transportation, as the current program requirements limit its ability to serve high-acuity patients. Other issues raised in the workgroup’s ensuing discussion included the current regulatory limitations on crisis receiving centers (such as their ability to dispense medications); current Code language regarding an individual’s suitability for alternative transportation (the determination made by the magistrate under the current statutory language), which may not be the same as the individual’s suitability for alternative custody; and the importance of training for custody and transportation providers on de-escalation and the effects of trauma. The workgroup’s next meeting is July 12; a report is due October 1.
VACo Contact: Katie Boyle