West Virginia’s Mental Hygiene Process Overdue for Reform | Opinion
Over the past couple of years, we’ve heard a lot about how West Virginia’s medical health care system is under strain as a result of the pandemic. We also need to address the challenges facing our state’s mental health system, not because of a new illness, but because of systemic issues that have had to be addressed for years.
We need to modernize West Virginia’s mental hygiene process. It will require the legislature to change the law, the Supreme Court to adopt new technology, public defenders to embrace the use of video conferencing for mental hygiene hearings, hospitals to change their procedures, and for medical professionals. mental make a series of changes at each step that could greatly improve the process.
The mental hygiene process is intended to obtain treatment for people suffering from mental illness or substance use disorders which could constitute an imminent danger to themselves or to others – even if they are not willing to submit voluntarily to it processing. Unfortunately, as it is now structured, the process is not as efficient as it should be. It just takes too long – anywhere from four to 24 hours. It places excessive burdens on sheriffs’ departments and hospital emergency departments. And there is a lack of uniformity from one jurisdiction to another.
One problem is transportation. By law, the sheriff’s services are responsible for receiving people for assessment and eventual engagement. This is a heavy burden on departments whose limited resources are strained not only by their obligation to provide transportation, but also because the process is so long that it immobilizes MPs for many hours. Anything we can do to reduce the amount of time law enforcement has to spend with people with mental illnesses, the better.
A 2020 law further complicated the process by requiring medical clearance in all mental hygiene cases. Medical clearance is used to rule out any other problem, such as brain tumors, cancer, or dementia, which could put people in a position of danger to themselves or to others. A doctor tells the story of his grandmother whose psychiatric problems were caused by a urinary tract infection. There are good reasons to rule out medical issues before subjecting a person to involuntary engagement, but the current process puts undue strain on state emergency services.
Still an unresolved issue Related to medical clearance is whether a person can be subjected to medical tests before it is determined whether the person’s constitutional right to liberty should be suspended. It could be a constitutional question.
Yet another problem is the inconsistency in the mental hygiene process across the state. It differs from one judicial circuit to another and from one county to another. Circuit court judges appoint mental health commissioners, who act as gatekeepers in the process, but these commissioners are not always available when needed.
The process clearly needs to be reformed in several ways. One action that would help greatly would be to involve a regional mental health center early on – before a case reaches a mental health commissioner and involves law enforcement. This could eliminate perhaps a quarter of those suspected of needing unintentional treatment. It worked in County Raleigh, where the mental health center meets with the person asking that an individual be hired before the petition is filed. The center explains the process and guides the petitioner through the process. Sometimes this results in the pursuit of other voluntary options.
Then, instead of bringing individuals directly to the medical examination, the engagement process should move forward first. This could wipe out perhaps another quarter of the remaining individuals. People deemed to be dangerous to themselves or to others could then obtain medical clearance and be placed in appropriate facilities.
Another change that would benefit the process would be for the West Virginia Supreme Court to appoint a rotating group of mental health commissioners who would be on call in every region of the state. Additionally, the process could be further expedited by using telehealth connections to conduct engagement hearings instead of requiring them to be handled in person. Again, it would be up to the Supreme Court to implement this change, while public defenders would have to embrace the use of video conferencing.
In addition, admitting hospitals and hospitals to which some patients are transferred should obtain medical clearance themselves.
And yes, the members of my organization, the West Virginia Behavioral Healthcare Providers Association, has an important role to play in streamlining the mental hygiene process. Mental health professionals can make a series of small changes at each step that together would make the process even greater.
It has been over a decade since Chapter 27, the section of the state code that governs mental health issues, was revised. It’s time to see him again.
Everyone wants the process to be improved. Everyone has an interest in it. Everyone must do their part.
– Mark Drennan is CEO of the West Virginia Behavioral Healthcare Providers Association.