Violators Flood Virginia State Mental Hospitals For Re-establishment Of Jurisdiction

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More people in Virginia are being found mentally unfit to stand trial, crowding already struggling public mental hospitals with patients who in many cases have only been charged with minor offenses like trespassing or disorderly conduct. .

But the long process of restoring their skills often means that patients spend more time waiting to be assessed and treated than they would in prison if they were ultimately convicted, creating civil rights issues. , according to officials who work in the Virginia Behavioral and Legal Health Systems.

“There was a time when you could do an assessment in a week, 10 days,” said Nate Green, Commonwealth Lawyer for Williamsburg-James City County. “Those days are over – we just don’t have the manpower to do these assessments so quickly. ”

State data and new research from the University of Virginia’s Institute of Law, Psychiatry, and Public Policy shows an increase in court-ordered skill assessments and the number of people ultimately found unfit. From 2007 to 2018, the number of evaluations in Virginia increased by 218%, according to the researchers. The number of patients found unfit to stand trial has also increased, jumping nearly 40% between 2016 and 2018 alone. These numbers have steadily increased over the past three years

The influx of patients is another constraint for state mental hospitals, which are still struggling to maintain safe census levels and keep beds open after overcrowding forced more than half of them to temporarily closed to new admissions earlier this summer. But delays in restoration – the process of ensuring mentally ill defendants are fit to stand trial – are an even greater concern for most experts. Some assessments can take up to a month or more, leaving patients in limbo. Green said some are released on bail, sometimes under the supervision of an interim probation officer. But many patients are ordered to remain in prison, where they will remain until an assessment can be completed.

“It doesn’t mean they’re happening any faster,” he said. And assessments, once completed, often determine that patients are not competent to stand trial, meaning they cannot understand the procedure or are not equipped to help with their own defense.

In many cases, clients who have only committed misdemeanors are in fact more likely to be found unfit to stand trial. The UVA study looked at more than 1,100 assessment reports conducted statewide and found that 44 percent of felony defendants were found to be incompetent, compared to 31.2 percent of felony defendants.

The same research indicated that clients who only committed offenses are also more likely to be sentenced to inpatient catering in public hospitals than outpatient catering in prison or through local community service boards. – although the Virginia code gives priority to outpatient services as a preferable option. Sherri Carr, a public advocate for the City of Norfolk, estimated that 75 percent of her catering clients ended up being referred to the public hospital for treatment.

It has become a huge challenge for institutions as they continue to struggle with census levels. The increase in the number of patients found unfit to stand trial has been increasing statewide since 2017, according to data from the Virginia Department of Health and Developmental Services. But the problem has particularly hit the Eastern State Hospital in James City County, which experts say is traditionally considered one of the best hospitals in the state to treat defendants whose mental illness renders them unable to. stand trial.

Eastern State Hospital in Williamsburg, Virginia (Virginia Department of Behavioral Health and Developmental Services)

“They have people who are experts in this area,” Green said. “Eastern State has just been filled with people all over the Hampton Roads area – and really all over Virginia – who have been sent there to regain their skills. And over the past three years, nearly 40% of those cases – over 100 people each year – have been patients who have committed only minor offenses.

It’s a growing problem for the hospital, according to Dr. Kristen Hudacek, director of forensic services at Eastern State. On the one hand, the state-run facilities of Virginia have become a catch-all for all kinds of psychiatric patients, not just so-called forensic cases referred by the criminal justice system. But while private hospitals can treat persons civilly engaged by temporary detention orders – a legal mechanism that makes hospitalization compulsory in cases where patients could constitute a danger to themselves or to others – only public hospitals can take care of restoring the skills of the accused.

In recent years, however, private hospitals have taken fewer and fewer involuntary commitments, a trend attributed to a 2014 law that requires public hospitals to accept patients after an eight-hour period if a bed cannot be found at another facility. Although it is often referred to as a “bed of last resort” law, the result, critics say, is that private hospitals are able to defer difficult cases – making public facilities the option of choice for them. patients in crisis.

Three years after the law came into effect, lawmakers in Virginia passed another bill that requires public facilities to admit patients for restoration to their skills within 10 days of a court order. The legislation stems from the 2015 death of Jamycheal Mitchell – a 24-year-old Portsmouth man with a mental illness who died in prison while awaiting a bed at Eastern State. He was arrested and ordered to restore his skills after he stole $ 5 worth of snacks from a local convenience store.

“We started to see a huge increase after this point,” said Hudacek. The law, like Virginia’s legislation of last resort, was passed with good intentions in the wake of a tragedy. But like many in Virginia’s behavioral health system, Hudacek said there had been unintended consequences for mental hospitals across the state. At Eastern State, in particular, civilian engagements go “neck and neck” with admissions for restoration of skills, according to Hudacek.

Given the state’s mandate to admit these patients within 10 days, they are often given priority for available beds. But there is generally an equal demand for civilian engagements and a limited number of spaces to put them. Statewide, staffing issues continued to restrict beds at mental hospitals in the state of Virginia. Eastern State, for example, has a total capacity of 302 patients but currently accepts only 242, according to a recent presentation by DBHDS Commissioner Alison Land.

“These two laws have really helped to be constantly at full capacity,” said Hudacek. But across the behavioral health and criminal justice system, patients themselves are also concerned, especially those accused of minor offenses. According to the UVA study, these patients are more likely to present with severe symptoms of mental illness, and the median length of stay for restoration is 56 days. With the time it takes to complete an assessment, some patients end up in prison and then in a public hospital for nearly a quarter of a year, sometimes for offenses as minor as public drunkenness or petty theft. Some people end up seeing new charges added to their case, often because they do not receive proper mental health treatment while they wait for an assessment.

“I had a lot of people who entered jail for simple misdemeanors and ended up with a crime because they were scared and they assaulted a deputy in the jail,” said Annette Miller, civil lawyer in Virginia Beach. Even more troubling, for many who work in and around the legal and mental health systems, is the fact that restoration is not the same as holistic mental health treatment.

Medication and therapy are usually part of the process when patients are reintegrated into public hospitals, according to Joseph Scislowicz, director of the Chesapeake Local Community Services Board. But courtroom training is another central element, and the focus of the suspension is less on long-term case management and more on adhering to the narrow definition of jurisdiction.

“They can get treatment, but that’s not why they’re there,” Scislowicz said. So beyond capacity issues in public hospitals, there is widespread frustration that so many patients spend so much time undergoing restoration without ever being connected to the right treatment or services.

In many cases, the accused are quickly released into the community after returning from the public hospital. The result, Hudacek said, is that many end up committing the same crimes over and over again and return to the Eastern State for services.

“I’m not kidding when I say it’s a revolving door,” Hudacek said. “The truth is, it’s disturbing.

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