West Virginia’s mental hygiene process is overdue for reform
Over the past two years, we have heard much about how West Virginia’s medical health system is straining because of the pandemic. We also need to address the challenges our state’s mental health system is facing, not because of a new disease, but because of systemic problems that have needed to be fixed for years.
We need to modernize West Virginia’s mental hygiene process. That will require the Legislature to change the law, the Supreme Court to adopt new technology, public defenders to embrace the use of videoconferencing for mental hygiene hearings, hospitals to change their procedures and mental health professionals to make a series of changes at each step that could improve the process vastly.
The mental hygiene process is meant to get treatment for individuals suffering from mental illness or substance use disorder who could be an imminent danger to themselves or others – even if they are unwilling to subject themselves to that treatment voluntarily. Unfortunately, as it is now structured, the process isn’t as effective as it should be. It simply takes too long – ranging anywhere from four to 24 hours. It places undue burdens on sheriffs’ departments and hospital emergency departments. And it lacks uniformity from one jurisdiction to another.
One problem is transportation. By law, sheriffs’ departments are responsible for taking in individuals for assessment and possible commitment. This is a great burden on those departments, whose limited resources are stretched further not only by their obligation to provide the transportation, but also because the process is so drawn out that it ties up deputies for many hours. Anything we can do to reduce the time law enforcement must spend with people who are mentally ill the better.
A 2020 law complicated the process further by requiring medical clearance in all mental hygiene cases. Medical clearance is used to rule out any other issues, such as brain tumors, cancer or dementia, that could be causing individuals to be a danger to themselves or others. One physician tells the story of her 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 commitment, but the current process is putting an undue strain on emergency departments across the state.
Another unresolved issue related to medical clearance is whether an individual can be subjected to medical tests before it is determined whether the person’s constitutional right to liberty should be suspended. That could be a constitutional issue.
Yet another problem is the lack of uniformity in the mental hygiene process across the state. It differs from judicial circuit to judicial circuit and county to county. Circuit court judges appoint mental hygiene commissioners, who act as gatekeepers in the process, but those 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 get a regional mental health center involved in the beginning – before a case reaches a mental hygiene commissioner and gets law enforcement involved. That might eliminate perhaps one-fourth of the people suspected of needing involuntary treatment. This has worked in Raleigh County, where the mental health center meets the person petitioning to have an individual committed before the petition is filed. The center explains the process and walks the petitioner through it. Sometimes, that results in pursuing other, voluntary options.
Next, instead of taking individuals directly to medical clearance, the commitment process should move forward first. That could eliminate perhaps another quarter of the remaining individuals. Those deemed to be unsafe to themselves or others then could go through medical clearance and on to commitment 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 hygiene commissioners who would be on call in each region of the state. In addition, the process could be sped up further by utilizing telehealth connections to conduct commitment hearings instead of requiring them to be handled in person. Again, it would be the responsibility of the Supreme Court to implement that change, while public defenders would have to embrace the use of videoconferencing.
Further, admitting hospitals and the hospitals to which some patients are diverted would need to complete medical clearance on their own.
And yes, members of my organization, the West Virginia Behavioral Healthcare Providers Association, have 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 improve the process tenfold.
It has been more than a decade since Chapter 27, the section of state code that governs mental health issues, has been revised. It’s time to revisit it.
Everybody wants the process to be improved. Everybody has a stake in it. Everybody must do their part.
(Mark Drennan is CEO of the West Virginia Behavioral Healthcare Providers Association)