Greene County’s jail is set to become one of five in the state to offer mental health treatment to inmates who need to be restored to competency before standing trial, part of an attempt by the state to address the need for services quickly and efficiently.

When suspects arrive at jail and await trial, they may be ordered by the court to be evaluated for mental health competency. Those deemed to be incompetent to stand trial often are ordered to receive competency restoration treatment. Previously, the only option for this treatment was to go to a state hospital to receive inpatient mental health treatment. With a recent surge in people who were determined to need the services in order to proceed with their criminal cases, the limited number of available beds left many waiting in jail for months.

As of Sept. 28, there were 35 inmates at the Greene County Jail awaiting an inpatient bed to receive competency restoration services. Statewide, there were 253 individuals awaiting admission into state hospitals and 57 waiting to be added to that list as of Sept. 14. At the same time, there were 267 evaluations requested, with about 50% estimated to be found incompetent, according to a presentation to the state’s Mental Health Commission.

This summer, the Missouri legislature amended statute to allow mental health restoration services to be provided within county jails and out in the community. With the new law, the state allocated $2.5 million to establish jail-based restoration programs across five counties, including Greene.

Jeanette Simmons is the deputy director for the Missouri Division of Behavioral Health. She said the program was based on similar programs in other states that have faced the same problem.

“We have more individuals needing competency restoration services than we have inpatient hospital beds,” Simmons said. “This is not just a Missouri issue; this is a nationwide phenomenon.”

The program aims to solve this by easing the demand for inpatient beds while cutting down wait times for people to get treatment.

Sheriff’s office questions use of resources but state says moving ahead

Although state authorities said work to implement the program in Greene County is moving ahead, the sheriff’s office expressed doubts.

Deputy Paige Rippee, public information officer for the Greene County Sheriff’s Office and the jail, said that while many inmates have been waiting for treatment for several months, the program would not be the most efficient use of the jail’s resources.

Rippee said in order to create space for treatment, the jail would have to shut down one to two units. The inmates who would be housed there for treatment would not fill the units to full capacity, she said, which would mean the space is not used in the most cost-effective or efficient way.

“It is something we have looked into, but it’s just not in the cards for us,” she said of the jail-based model.

Debra Walker, spokesperson for the Missouri Department of Mental Health, reiterated however that the state is still moving forward with implementing the program in Greene County and currently working out the details of the contract.

Ironing out the details

The program will operate using the state’s Forensic Mobile Teams, which include nurses, nurse practitioners and social workers. Two staff members from a local community mental health center also will be hired to work at the jail.

The two existing Forensic Mobile Teams were expanded with state funding in the most recent budget. One of these teams was established a couple of years ago. Currently, the teams are serving those needing restoration services in jails across the state regardless of county while they await inpatient treatment.

The jail-based program will also be implemented in Clay County, the City of St. Louis, St. Louis County and Jackson County. Simmons said other counties have already requested to be included if the program expands, though currently the services are limited. She said the counties were selected based on the volume of referrals that come from each jail — no surprise considering that these are the most populated areas of the state.

While an option, the jail-based model will not become the default.

“We don’t anticipate that it will be the answer for every client, but I think individually we can look at it and make those types of assessments and ensure that people are receiving those treatment services while they’re there,” Simmons said. “That’s the intent they would receive the same types of treatment services they would receive in an inpatient setting.”

Stephanie Appleby, the executive director of NAMI Southwest Missouri, said she is grateful the department is putting time, energy and effort into providing more resources, which previously have been very limited.

“I think it’s fabulous and long overdue,” she said of the program. “I hope it works.”

Appleby said she hopes this program and any future efforts can establish a more continuous network of care providers. Creating a playbook on an individual’s care that both law enforcement agencies and mental health professionals can reference to determine best ways to support those needing care is a way to ensure a more sustainable approach to address mental health in the community, she said.

Other treatment options

Outpatient treatment will also be an option for some in need of competency restoration treatment. Simmons said this program would allow people to receive the needed services at their local community mental health centers. Providing this as an option would be a court decision for those demonstrating that they would be successful while free on bond, she said. Individuals held on dangerous felony charges are not eligible.

Rippee, with the sheriff’s office, said there are concerns about this model of service as well. In order for those out on bond to get to these services, they might have to rely on someone else for transportation, along with other potential obstacles.

“Homelessness often goes hand in hand with mental health issues,” she said.

Those who do not have the resources to actually get to their outpatient competency restoration treatment provider or keep on top of their medication may not fully benefit from the program, she said.

More: In the year since 988 went live, here’s what a Springfield mental health provider has seen

Appleby also has concerns about the outpatient portion of the effort. She said inpatient care is generally always a better option, since in order for patients to be successful in outpatient, they “have to really want to live a self-directed life.” Many who find themselves within the criminal justice system are not at that point in their recovery, she said.

But Simmons said the department hopes to work on more ways to connect individuals with treatment before they are within the criminal justice system. Increasing awareness and education of current resources like the 988 suicide and crisis hotline and local behavioral health programs is a large part of this.

“We’ve got to look at getting more upstream to try and help individuals engage in treatment services,” she said.

Marta Mieze covers local government at the News-Leader. Contact her with tips and story ideas at mmieze@news-leader.com.

This article originally appeared on Springfield News-Leader: Missouri plans new mental health restoration program at county jails

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Board members and institutional representatives convene for a meeting of the Iowa Board of Regents at the University of Iowa in Iowa City, Iowa on Wednesday, Sept. 27, 2023. (Nick Rohlman/The Gazette)

IOWA CITY — Before approving its state appropriations request in advance of the upcoming Legislative session, Iowa’s Board of Regents on Thursday tacked on another $1 million specifically for “extended mental health resources at our three regent universities.”

That $1 million addition will bring the board’s total ask to $39.3 million more than the $580.7 it received this year — or $620 million.

Regent Abby Crow — serving as the board’s student regent as she works as a University of Iowa Hospitals and Clinics nursing assistant — suggested the appropriations-request amendment after regents met this week with student leaders across the campuses.

“A central point of our conversation was the need to extend mental health services and the benefits this will bring to students at our regent universities,” Crow said during the board’s meeting Thursday on the UI campus. “Student leaders also provided us with a unanimous letter imploring us as regents to support their efforts for expanded mental health resources and funding. And noted several excellent examples of direct impacts on programming and staffing that having extended funding could allow at each of the institutions.”

Board of Regents member Abby Crow contemplates on a series of comments from student body leaders on proposed tuition increases on June 14, 2023, at the University of Iowa Levitt Center for Advancement in Iowa City. (Geoff Stellfox/The Gazette)

This, Crow said, isn’t the first the regents have heard from students about the need for more mental health services at the University of Iowa, Iowa State University, and University of Northern Iowa.

“In light of these ongoing discussions, I would like to make a motion to amend the fiscal year 2025 state appropriations request to include an additional $1 million to support our university’s efforts for extended mental health resources at our three regent universities,“ Crow said.

The board — excluding President Michael Richards, who was absent for the meeting — unanimously approved the amendment and the full appropriations ask, without discussion, after Crow noted the students also asked to be involved in conversations going forward “regarding the specific allocation of this funding.”

“And offer their insight as to what specific mental health-related resources, programming, or staffing might be the most good at their respective institutions,” Crow said.

A UI-specific version of the National College Health Assessment — administered to thousands of students in the spring — found an increase in reports of self-harm, diagnosed mental health conditions, and students receiving services.

⧉ Related article: UI health assessment shows rise in energy drinks, vaping

Among UI undergraduates who responded to the spring health survey, 56 percent said they had at some point in their life received psychological or mental health services, up from 50 percent who said so in 2021. Nearly 38 percent reported receiving services within the last year, up from 33 percent in 2021.

UI graduate students reported similar increases. And both groups reported as their “top conditions ever diagnosed” as anxiety, depression, and attention deficit disorder.

Iowa State’s most recent national health survey from 2021 found 23 percent of its female respondents had experienced “serious psychological distress,” while 53 percent of women and 47 percent of men were “positive for loneliness.”

According to that survey, 27 percent of the female respondents were “positive for suicidal screening,” along with 23 percent of men.

The rest of the regents’ request of lawmakers in the upcoming session includes $14.8 million for “general university” dollars — breaking down to $4.5 million each for UI and Iowa State and $5.8 million for UNI.

That, UNI President Mark Nook said Thursday, is the most important part of his campus’ request, “so that we can hold tuition flat for a year and develop some differentiation in our tuition relative to others public institutions in the state.”

In states surrounding Iowa, Nook said, the cost difference between research-intensive campuses like UI and ISU and regional comprehensive universities like UNI is about $3,500.

Mark A. Nook, president of the University of Northern Iowa, listens to a series of comments from student body leaders on proposed tuition increases on June 14, 2023, at the University of Iowa Levitt Center for Advancement in Iowa City. (Geoff Stellfox/The Gazette)

“In 2017, that difference was $88 here in the state of Iowa,” Nook said. “We’ve grown that to just a little over $1,000. I’d like to continue to be able to do that. It will certainly help with enrollment trends. But it will more importantly help the people in Iowa have choices.”

In addition to that general education increase, all three campuses have made significant “special purpose requests” — including $10 million for a UI initiative to address rural health care needs; $10 million for an Iowa State STEM workforce program; and $2.5 million for a UNI initiative to increase educators across the state.

Vanessa Miller covers higher education for The Gazette.

Comments: (319) 339-3158; vanessa.miller@thegazette.com

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A married Pennsylvania State Police trooper is facing false imprisonment charges after he allegedly violently detained his ex-girlfriend and committed her to a mental health treatment program under bogus claims.

Ronald Davis, 37, was arrested Thursday on accusations he abused his authority to carry out the twisted takedown that left his former girlfriend improperly stuck in a medical facility for multiple days, the Dauphin County District Attorney’s Office said.

Davis reportedly told her: “I know you’re not crazy, I’ll paint you as crazy” leading up to the forced medical treatment, the victim claimed, according to court documents released by the district attorney’s office.

His quest to have his ex committed began on Aug. 21 when he sought help from fellow troopers because he said the victim — identified by the district attorney as M.F. — had mental health problems, according to an affidavit of probable cause.

On advice from state police, Davis, then off-duty at the time, contacted county officials with his police email account and identified himself as a trooper, to successfully obtain an order after he submitted purported texts from her where she threatened suicide, according to the court docs.

The encounter happened on Aug. 21, authorities said. @francischardo8865

Once he got the order approved, the trooper went after the woman, who he had dated for about four months, before uniformed troopers reached her, authorities alleged.

“I’ll take care of it myself,” he allegedly said.

Davis and a civilian companion found the victim in a picnic area at a state forest where he picked her up and carried her to his car before the two struggled on the ground, the affidavit states.

Davis is seen sitting on top of his ex-beau as she claimed he tackled her to the ground, according to the footage captured by the man with Davis and released by the DA’s office. She also said she didn’t need help, but wanted to get away from the cop.

“You’re insane,” she said. “You’re absolutely insane … and then you paint me to look insane.”

As she made a move to get free, Davis manhandled her and kept her on the ground in a “wrestling-style hold,” the footage shows, according to authorities. She said more than once “I can’t breathe” as he was on top of her.

The victim did not know why she was being restrained, prosecutors said. @francischardo8865

When the two got up, Davis restrained her as she said repeatedly how she didn’t do anything wrong, according to the sickening footage.

“Why are you treating me like a criminal?” she said before uniformed officers arrived and took her to Lehigh Valley Hospital-Schuylkill.

M.F. appeared to “genuinely lack understanding on why she is being restrained,” the affidavit states.

She suffered injuries to her forehead, torso, back, buttocks, forearms, knee and lower body, according to the document.

The sickening footage was taken by someone Davis knew. @francischardo8865

The ex-girlfriend was involuntarily committed for five days and did not display any suicidal thoughts during that time, according to medical personnel.

She was released on Aug. 26 and was subsequently interviewed by police.

Once cops saw an exchange of messages between the pair, they didn’t think there was cause to force her into treatment, police said.

Her purported “suicidal” messages that Davis used against her appeared to be hypothetical in nature and part of a larger argument over their deteriorating relationship, authorities said.

“While Trooper Davis provided text messages from [the victim] … and purported them to be suicidal, he failed to provide the full context of those messages,” the affidavit alleged. “In fact, the text messages were the culmination of a larger, domestic dispute between he and the victim. Taken in context, the texts revealed her frustration with Trooper Davis and his controlling behavior … not a true desire to harm herself.”

Davis, who prosecutors said is married with a family, is facing charges of felony strangulation, unlawful restraint, false imprisonment, simple assault, recklessly endangering another person and official oppression.

He was remanded without bail following an arraignment Thursday, the DA’s office said. 

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GREENFIELD — A Greenfield preschool teacher has been recognized as being among the best of the best early childhood educators in the state.

Erin Day, who teaches in the Cougar Cubs preschool at Greenfield’s J.B. Stephens Elementary School, was among just two state educators who received an Early Childhood Educator Excellence Award at the Indiana Department of Education’s Excellence Awards Gala Sept. 8.

“Erin is most deserving of this award. We are so very proud of her,” said Dawn Sonsini, director of preschool and early learning for Greenfield-Central schools.

Day can think of nothing better than welcoming happy children streaming into class on any given school day.

Their happy smiles and sweet hugs are all the thanks she needs, she said, but statewide recognition as a great teacher never hurts.

“I do not like being in the spotlight … but it is an honor. It is exciting,” said Day, whose award included a surprise $2,500 cash prize.

 Greenfield preschool teacher Erin Day, right, was pictured alongside Indiana Secretary of Education, Dr. Katie Jenner, at a Sept. 8 gala hosted by the Indiana Department of Education. Day was one of two educators who received an Early Childhood Educator Excellence Award at the event.

The Early Childhood Educator Excellence Award recognizes individual early childhood educators with over three years of experience who demonstrate a commitment to supporting Indiana’s youngest students in developing kindergarten readiness skills.

Day has much more experience than that. She taught preschool for 22 years for Warren Township schools before joining Cougar Cubs program three years ago.

“I love what I do and I love being with young children, helping them learn and grow, but I’ve grown to be the teacher I am today because of all the other co-workers and friends that have been on this path with me over the last 25 years,” said Day.

“When you work with such an awesome, collaborative team and have leaders that expose you to new ideas in education, that grows your passion of being the best you can be for young students. It makes you want to share your knowledge with others and the children,” she said.

Sonsini said Day has proven to be a remarkable resource for both her students and peers.

“She’s definitely a leader among the Cougar Cubs team, and finds ways to make every child feel included and successful in our program,” said Sonsini.

“Her approach in working with children in our preschool is nurturing. She finds ways to develop relationships and grow students, and she has a wealth of experience and knowledge in early childhood,” she said.

Sonsini said it was a joy to see Day recognized at the state level for the amazing work she does with Greenfield preschool kids.

This year’s Excellence Awards Gala was the second such event hosted by the Indiana Department of Education, which used the gala to award nearly $5 million to schools and educators across the state.

The black-tie affair focuses on celebrating and elevating the work of Indiana’s educators as they support student learning.

“Our goal was to host a red carpet event to celebrate our very best educators, on a level similar to how we celebrate movie stars and professional athletes because their incredible impact deserves to be celebrated at the grandest level we can,” said Dr. Katie Jenner, Indiana Secretary of Education.

“Many of the educators tonight have positively impacted hundreds of students over the years and are leaders in their local communities. So, bringing them together for an awards night to roll out the red carpet and provide surprise monetary awards is one small way we can spotlight the massive impact they continue to make on our state,” she said.

Jenner said the Educational Excellence Awards Gala was created to shine a light on the impact of Hoosier educators and schools throughout the state, giving special recognition and monetary awards to a chosen few who are shining examples of education done right.

More than 500 educators and guests attended the gala, which recognized the 2023 Indiana Teacher of the Year, Indiana’s 2022 Milken Educator Award recipients and other dedicated educators from across the state.

While Day was thrilled to be honored this year, she said the real reward comes in seeing her young students’ eyes light up with learning each day.

“I love seeing the twinkle in a preschooler’s eye when they have that ‘aha’ moment of learning. I love reading books and stories to the children to expand vocabulary and see the excitement of what might come next. I love the hugs and the things sometimes kids say to us that makes us smile or laugh,” said Day, who is a longtime proponent for preschool.

“Preschool can be an essential part of a child’s success moving on to kindergarten,” she said.

“A lot of times kindergarten teachers can tell which students have been to preschool as those children tend to know how to sit and work with a group, work in small groups together, follow more directions and have some basic academic knowledge. Having a lot of those basic self help and social/emotional skills moving on to kindergarten helps a child be more ready to learn.”

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Fabio Azeredo earned a Ph.D. in psychology and practiced as a licensed supervising psychologist in Brazil for 29 years. Since moving to Minnesota two years ago, he has had to work as a pre-licensed psychotherapist under supervision. 

Suzana Duarte Santos Mallard also has a Ph.D. in psycho-sociology and a master’s in clinical psychology and has worked in private practice in Brazil since 2005. Since moving to Minnesota five years ago, she has been unable to earn a license to practice psychology. She now works as a pre-licensed therapist at a Twin Cities mental health clinic. 

In her native Guatemala, Ileana Ortiz de Leon was a psychologist in private practice for many years. To continue her mental health career after moving to Minnesota, she has chosen to reconfigure her professional credentials, becoming a licensed professional clinical counselor, or LPCC, and taking her goal of a private psychology practice off the table. 

Because of Minnesota’s complex licensing requirements, these three internationally trained mental health professionals say they haven’t been able to practice at a level equal to their education and experience since moving to the state. Other internationally trained mental health professionals face similar struggles in Minnesota. At the same time, Minnesota is struggling with a significant mental health workforce shortage, particularly among practitioners of color. 

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“I work under supervision,” Azeredo said. “I cannot have a private practice. I would like to have my license and not to be supervised because I am older. I appreciate and enjoy the process of supervision, but the truth is I’ve been licensed for 29 years.”

In Brazil, he added, “I was an established professional. I was regarded as an expert who had a voice in the mental health field.”

MinnPost photo by Andy Steiner

Azeredo shown looking over the many documents he has had to assemble to argue his case for licensure with the Minnesota Board of Psychology.

Ollie Schiefelbein, internationally trained professionals navigator at the International Institute of Minnesota, has heard stories similar to Azeredo’s plenty of times. 

“I have a client who has one bachelor’s degree and two master’s degrees,” Schiefelbein said. “She basically has to start over if she wants to work as a therapist here. She’s been told she has to go back to school to get licensure.” This client, Schiefelbein said, worked as a psychologist and a therapist in her home country, and even though she has been in communication with the Minnesota Board of Behavioral Health and Therapy for a couple of years, Schiefelbein explained, “She has not been able to identify a path forward.” 

Brooke Anttila-Escoto, International Institute medical careers pathway manager, said that her organization has been working with new Americans interested in health careers since 1990. In 2022, the nonprofit was one of seven Minnesota organizations awarded grants as part of the Internationally Trained Professionals Program administered by the Minnesota Department of Employment and Economic Development  (DEED), a grant designed to help more internationally trained health care workers gain licensure in the state.  

The grant, Schiefelbein explained, allows International Institute staff to serve “a very wide variety of clients falling under the category of physical and mental health care. We have clients who are doctors, pharmacists, nurses and psychologists.” 

In Minnesota, licensure for medical professionals is handled by a number of professional boards that set standards and make final decisions about allowing individuals to practice in the state. These boards, established by legislative statute, all have different methods of granting licensure. Mental health professionals are regulated by four boards: psychology, behavioral health and therapy, social work, and marriage and family therapy. 

Leah McNamee, senior program manager at the employment assistance nonprofit Hired, another Internationally Trained Professionals Program grant recipient, explained that the DEED grant money helps fund expenses involved in the licensure process. She said earning a license to practice as a mental health professional in Minnesota costs money, something that many new immigrants lack.   

“We help our clients get their credentials translated into English,” McNamee said. “We can also get them evaluated by whatever accrediting body would do that, to determine what they might need in order to become licensed here in the U.S.”  

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And it’s not just licensing fees that add up, Schiefelbein added. Many internationally trained mental health professionals have been told by their governing boards that they need to go back to school to earn further degrees if they’d like to practice in the state. 

“Money is the big issue,” Schiefelbein said. “Education in the U.S. is not cheap. Most of our clients already have families. They are in their 40s and 50s and may not be able to return to school. Going back to school just isn’t an option for everyone.” 

These roadblocks mean that some of Schiefelbein and Anttila-Escoto’s clients have given up on their dreams of picking up their mental health careers in Minnesota. “Many of the individuals I’ve spoken with who have backgrounds in psychology or mental health say there has not been a way to identify a path forward,” Schiefelbein said. “They’ve struggled with communication times, lack of information and misinformation barriers.” 

For their part, executive directors of state licensing boards say that their role is to ensure that mental health professionals practicing in Minnesota meet standards of care set by the state Legislature. This means that credentials earned in other countries may not be enough to meet those standards and that international applicants will need to have their credentials evaluated and might have to earn additional degrees or credits to gain licensure. 

“We evaluate all applicants, both applicants from another state but also applicants who have degrees granted in other countries,” said Sam Sands, executive director of the Minnesota Board of Psychology. “We evaluate each based on the degree they completed and the education they completed as is laid out in statute and rule.”

The application process is complicated, Sands explained. “It’s a case-by-case basis. Applicants have to get a transcript evaluation. Each situation is different. The way higher education is structured is different in different countries. In order for our board to evaluate whether an applicant has met the standards laid out, we ask that applicants get a transcript evaluation from a group of organizations.”

The reality is that there is not a worldwide standard for education and degrees, explained Samantha Strehlo, executive director of the Minnesota Board of Behavioral Health and Therapy, the state board that licenses and regulates licensed professional counselors (LPCs), licensed professional clinical counselors (LPCCs) and licensed alcohol and drug counselors (LADCs). 

When you are working with people who were trained internationally, she said, “It’s not like everybody neatly sits in the box. Usually they are going to have to complete some additional coursework, and they have to take the national exam that is required for licensure.”  

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‘It makes me want to give up’

When Azeredo decided that he and his family were going to move to Minnesota, he thought he had done his homework. He’d put time into researching states that accepted degrees from institutions credentialed by the National Association of Credential Evaluation Services, or NACES. He learned that Minnesota was a NACES-friendly state, which he believed meant that he should be able to practice as a licensed psychologist here. 

But when he settled in the state and began researching the process of gaining licensure through the Minnesota Board of Psychology, Azeredo said he realized that his degrees and long work history in Brazil carried much less weight than he anticipated they would. He said a staff member from the Board of Psychology told him that he would need to take a number of additional complicated steps to prove the validity of his degrees.  

“In Brazil I’m a licensed psychologist,” Azeredo said. “Here it is much more complicated.” He  took a job as a pre-licensed psychotherapist at Canopy Mental Health and Consulting, a Richfield-based mental health clinic that provides culturally informed care for underserved and marginalized populations.  While he appreciates his colleagues and enjoys his work at Canopy, Azeredo said the limitations placed on his practice by the Minnesota Board of Psychology feel frustrating, like his years of experience in Brazil count for nothing. 

“I have a Ph.D. in clinical psychology with a concentration in psychoanalysis,” Azeredo said. “Same thing for my master’s. I shouldn’t have to prove that, because NACES did it for me.”

He believes that staff at the Board of Psychology don’t have a strong working understanding of international mental health training and licensing. 

“It makes me want to give up,” Azeredo said. Board of Psychology staff, he said, “could improve their understanding of the different ways of being a licensed psychologist.” This lack of understanding about international training and licensure feels short-sighted, he continued. Though there is a great need for psychologists of color like himself, “There is no accumulated knowledge [among board staff]. It’s almost like, ‘Has anyone in the entire history of the board gone through this process?’” 

Suzana Duarte Santos Mallard

Mallard said she believes the licensing process for psychologists in Minnesota is biased against mental health professionals who’ve completed their training outside of the United States. She completed her Ph.D. in 2021 through the Federal University of Rio de Janeiro, because she thought it would meet the state’s education requirements for licensure. When she presented her credentials to the Minnesota Board of Psychology, Mallard said she was told they did not meet state requirements. 

“I was dismayed by the ethnocentric process of licensing implemented by the Board of Psychology in Minnesota,” Mallard said. “I aspire to practice and be acknowledged for my work because working without a proper license also means that insurance reimbursement rates for my work are lower than what I believe I am qualified for.” 

Though she’d found work as a pre-licensed therapist at the St. Paul-based Roots Wellness Center, a culturally specific mental health organization focused on healing intergenerational trauma in marginalized communities, Mallard was determined to practice as a psychologist. It was what she’d done for her whole career. She didn’t feel like she should  have to give that up. 

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She said she spoke with a staff member at the Board of Psychology, who told her one way she could continue to practice was to call herself a mental health “coach.” “I was able to tell her,” Mallard recalled, “‘I think this measure is very ethnocentric, very disrespectful toward my career by even implying I could call myself ‘coach.’ She said, ‘The only way you can apply here is to do another Ph.D.’ It is insulting.” 

Despite these roadblocks, Mallard said she’s not ready to give up. “I will keep fighting for this and I will keep telling my story,” she said. “I have a lot of support from my peers, my friends.”  

Rather than fight to have her Guatemalan psychology license recognized, Ortiz de Leon said she instead chose to work as an LPCC. 

Ileana Ortiz de Leon

“I already had licensure in my country,  but then once I came here I didn’t have it anymore,” she said. The complex and burdensome licensing process in Minnesota was, she said, a “cultural shock. Even though I’ve been practicing for 13 years outside of the country and seven years inside the country and I passed my boards as well, they still want all of that information.” Though she knew she could make more money as a psychologist, Ortiz de Leon explained, it didn’t seem worth the hassle and the expense: “I decided to go that other direction instead.” 

Sands said that he and his Board of Psychology colleagues acknowledge the great need for psychologists of color in the state. He added that during his time at the board, he estimated that four internationally trained psychologists have sought licensure and that three had been approved. Minnesota’s requirements for licensure — a PhD in  psychology — is the same as the rest of the country, Sands said. 

At the Minnesota Board of Behavioral Health and Therapy, applicants are sometimes required to take additional coursework, Strehlo said. “Maybe in the country they came from there isn’t an internship that is required. It might be little things here and there, but it hasn’t been a big issue over the years.”  

Azeredo said he wondered if the boards’ “American-centric” processes deter more internationally trained mental health professionals from even trying to get licensed in Minnesota. 

Katy Armendariz MSW, LICSW, Roots Wellness Center CEO, said that state requirements for licensure tend to discount academic and professional standards met in other countries, which can make it difficult for applicants like Azeredo, Mallard and Ortiz. “The boards don’t recognize international academic frameworks,” she said. “There is a condescending viewpoint. They don’t honor or validate or accept degrees — even if they are from the most respected universities in their countries.” 

Why international licensure matters

If the mental health profession wants to survive into the future, things need to change, Armendariz said. Increasingly, clients tell her they want to see providers who have a personal understanding of their own life experiences. In many cases, internationally trained mental health providers fill that need. 

“Black and brown communities are tired of white psychologists,” she said. Too often, she said, psychology and other mental health professions operate under a “Westernized, white, pathologizing lens. It is not a field that is welcoming or accepting of BIPOC providers. The BIPOC community wants that experience and background in their providers. We’re tired of the same old profession that has always been. We want to see more people like us.” 

Ollie Schiefelbein

Schiefelbein supports this perspective, adding: “People are best served in mental health by someone who has similar experience as they do, who speaks the same language, someone who understands the culture, who understands the refugee experience.” 

This issue feels particularly distressing for Armendariz, who would like Roots staffers like Mallard and Ortiz to be able to work at their full license.  Just having a therapist like Mallard, a Black woman who speaks multiple languages and who “understands and looks like the people who need her, changes everything. When clients have heard her talking, their demeanor just changes.” 

The same goes for Azeredo, who said he understands that his personal background is seen as a plus for many of his clients, many of whom are young people who have been adopted internationally. “The adoptive parent comes up to me and says, ‘He needs to talk to someone like you. He’s Latino. You’re Latino. You understand in ways I can’t.’ It is a thing. This is a place I know I can help. I hope I can keep it going.”

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About 1.6 million people in Rakhine state still haven’t received sufficient humanitarian aid almost three months after one of the worst cyclones to hit Myanmar in a decade, aid workers and local residents told Radio Free Asia.

Additionally, the rehabilitation process in the country’s westernmost state could be prolonged due to inadequate support from the military junta and the international community, the aid workers said.

The U.N.’s Office for the Coordination of Humanitarian Affairs recently announced that it has received only USD$24.3 million out of the estimated USD$333 million needed for relief and rehabilitation projects in cyclone-hit areas. Low-lying Rakhine lies along the cyclone-prone Bay of Bengal.

“There is an enormous gap between the amount needed and the amount provided,” a humanitarian organization official told Radio Free Asia. “They can only fill the very basic needs for the people.”

Cyclone Mocha made landfall on May 14 with sustained winds reaching over 220 kilometers per hour (137 mph), killing more than 400 people and leaving widespread destruction. Aid workers said that more than 90% of houses and buildings in northern Rakhine were damaged by the storm. 

In early June, junta officials issued a blanket ban on transportation for aid groups operating in Rakhine. Authorities mandated that all international humanitarian aid, including U.N. assistance, must first be donated through the junta. 

Maung Saw Win, a resident of Rathedaung township – where the cyclone hit hardest – told RFA that the people of his township have yet to receive any substantial aid.

“We haven’t received anything on the ground. We have seen 20 tractors arrive here. But that’s it,” he said. “We are trying to rehabilitate on a self-help basis.”

Other residents of cyclone-hit areas said they received some food, shelters and emergency aid materials from the World Food Program, the Red Cross and other international organizations right after the cyclone, but those deliveries have stopped. 

Members of a rescue team clean up fallen trees in Sittwe, Myanmar, on May 17, 2023, after Cyclone Mocha. Credit: Sai Aung Main/AFP

Aid from ASEAN

The junta’s spokesman and attorney general for Rakhine state, Hla Thein, told RFA that the junta has allotted 5 billions kyat ($USD 1.6 million) for Rakhine’s damaged areas, and plans to allot an additional 7 billion kyat ($USD 2.3 million).

“We are also negotiating with international aid organizations to provide aid,” he said. “It is important that the private sector cooperates with the government. Only then, we can complete the mission in a short time.”

State-run newspapers have reported that ASEAN, China, India, Thailand, Malaysia, Bangladesh, Cambodia, Korea and Japan have donated food, shelter, medicine and other materials through the ASEAN Coordinating Centre for Humanitarian Assistance on disaster management.

According to RFA records, emergency aid worth USD$1.64 million has been donated by ASEAN, 40 tons of food, medicine and other materials has come from India, and food, shelter and other aid material worth over USD$1 million has been sent by China.

Additionally, Cambodia has donated USD$300,000, Indonesia has given USD$500,000 worth of materials, South Korea has sent 500 tons of rice, Japan has sent 20,000 rice bags, Bangladesh has given 120 tons of material, and Thailand has sent 20 tons of aid.

Hla Thein said they are delivering aid from ASEAN and the international community right after the material arrives in Myanmar. 

But former lawmaker Aung Thaung Shwe said there is very little being delivered to cyclone victims. Some junta officials have summoned village heads to perfunctorily distribute some rice and paddy seeds, but that hasn’t been enough to meet the demands in the villages, he said.

The junta doesn’t have “effective means” to make the deliveries, Aung Thaung Shwe said.

The junta seized power from a democratically elected government in February 2021 and has been fighting anti-junta People’s Defense Forces and ethnic armed groups ever since.

One Rakhine businessman said it could take up to 15 years to rebuild the communities because of the junta’s unreliability.

“I don’t think the rehabilitation efforts will go smoothly and quickly if we relied on the government’s missions,” Khin Maung Gyi said. “We also see that the capacities of international NGOs and other NGOs have been crippled by the various restrictions.”

Translated by Ye Kaung Myint Maung. Edited by Matt Reed

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Six months to see a therapist, workforce shortages, astronomical counseling bills, sick people languishing in jails, younger children raced to the emergency department for suicide attempts, higher and higher rates of substance use disorder. 

The surge in mental health needs pushed leaders across the state into action. Gov. Tony Evers declared 2023 the “Year of Mental Health” in February and proposed $500 million in mental health programming over the next two years. 

In March, a roundtable of mental health stakeholders gathered from National Alliance on Mental Illness (NAMI) Wisconsin, Children’s Wisconsin, Sixteenth Street Community Health Centers and the Office of Children’s Mental Health, along with Rep. Paul Tittl, R-Manitowoc, chair of the Committee on Mental Health.

They discussed investing in sustainable school-based mental health counseling, reducing wait times to see mental health professionals, funding mental health courts, and addressing workforce shortages and delays in obtaining mental health-related licensures.

“I’m for supporting just about anything to get more access to mental health,” Tittl said. 

Cut to July 5, the day Evers signed the final $99 billion 2023-25 biennial budget published as Senate Bill 70, and few mental health-related items survived sweeping legislative cuts by the Republican-controlled Legislature.

Wisconsin public schools will see more funding for school-based mental health. However, items that would have emphasized prevention, better access to care, more youth crisis stabilization facilities, and wraparound services for people experiencing mental health disorders ended up on the scrap heap. 

That has mental health advocates and professionals across the state thinking of ways to reframe the needs of the community in future budgets and policies. 

And the needs have never been greater. Amy Herbst, vice president for mental and behavioral health at Children’s Wisconsin, said children are screening positive for anxiety and depression at record rates, and younger children are being admitted for suicide attempts and ideation.

Herbst wants youth — and adults for that matter — to have more access to care long before they end up at the hospital. 

Not addressing access to care will continue to create a bottleneck in crisis interventions, said Mary Kay Battaglia, executive director of NAMI Wisconsin. 

“If we could invest in community services now, then we wouldn’t have to spend so much on crisis services, which is not only more expensive, it’s traumatizing to the person living with an illness and their family,” Battaglia said.

Following Evers’ proposed mental health provisions, the Wisconsin Office of Children’s Mental Health identified 10 budgetary items important to children’s access to mental health services. Those included funding for psychiatric residential treatment facilities and youth wellness networks. 

“They were nearly all rejected, including the ones that would have allowed us to fill holes in our system of care for kids,” said Linda Hall, director of the Office of Children’s Mental Health. 

That’s a problem, said Herbst, who referenced the U.S. Centers for Disease Control and Prevention study that found about 44% of high school students felt persistently sad or hopeless in the last year. 

Hall hoped Legislature would see the benefits of permanent school-based mental health funding. And while the state is putting $30 million into schools for mental health services, a majority of that funding comes from pandemic relief dollars that won’t carry over to the next budget.

It’s also nearly a quarter of what Evers requested in his initial proposal.

“It’s a source of funding we can’t rely on going into the future,” Hall said.

Evers had proposed expanding Medicaid, a move that “would have brought $1 billion into our state,” said Hall, but as they have done for years, Republicans declined to expand Medicaid. That expansion would have funded much of the Office of Children’s Mental Health list of recommendations and given access to financially strained parents in need of mental health coverage.

Battaglia, of NAMI Wisconsin, said she was disappointed that Legislature rejected funding for Community Support Programs (CSPs), which would have put $40 million in community health services over the next two years. Counties and tribal agencies across the state have CSPs in place to better support people experiencing mental health disorders. It’s a preventive measure to help people struggling with illness to keep them out of crisis facilities and jails, and prevent homelessness.

“If we don’t invest in the community service, which is a more dignified way to help and support those folks, we end up spending a lot of money with police and Winnebago (Mental Health Institute) and carting people across the state and dealing with crisis,” Battaglia said. “We really need a medical response to a medical crisis, instead of a law enforcement response to a medical crisis.”

Funding for school-based mental health services will increase from $10 million to $30 million over the biennium, a move that many stakeholders see as a win.

“You’re meeting the child or the adolescent in their environment where they spend most of their time during the week, and you’re not pulling them out of school,” said Maria Perez, a licensed psychologist and vice president at Sixteenth Street Community Health Centers. “And so being able to have dollars routed to youth in particular is very encouraging.”

Herbst agreed, and said she feels grateful for the bipartisan effort of supporting youth mental health. “It’s absolutely made a difference,” she said. 

Battaglia said the state’s investment in 988 Suicide & Crisis Lifeline is a major win and speaks to the Department of Health Services’ robust media campaign over the last year. Wisconsin has seen the second-highest increase in call volume in the United States since the National Suicide Prevention Lifeline recast its 10-digit number last July. 

The state has also seen a major jump in certified peer specialists – individuals with lived experiences in mental health and substance use disorder services – which has helped ease some workforce demands.

That push for certified peer specialists is the product of conversations and collaboration across the state, Battaglia said.

Collaboration across mental health agencies key to workforce growth, future budget wins

To address the ongoing mental health crisis, efforts among providers have been collaborative, rather than competitive. 

“There’s less competition than I’ve ever seen. We’re all aligning together,” Perez said. “There might be agencies that do things better than we do, or there might be things that we do better than anyone and people are referring to us.” 

“I can tell you in communities where people are partnering on behalf of kids and their mental health, we’re getting more done,” Herbst said. “We’re getting to kids sooner and having greater success.” 

Herbst added, “We want mental health to be treated like physical health, and we need parity when it comes to funding.” 

Support for mental health has increased in the last few years as a result of the way people talk about their struggles, especially young people, Herbst said. Young people tend to be more comfortable talking to medical professionals about depression and anxiety, which creates a ripple effect across the community.

Herbst hopes future funds can go toward qualified training programs, or QTP, which would bring more mental health trainees to the state of Wisconsin, especially where child psychiatry is concerned. QTPs allow trainees to work at clinics and hospitals full time with benefits to fulfill the 3,000 clinically supervised hours required for state licensing. Without QTP, trainees would likely volunteer those hours while working a second job. Acquiring the hours without a QTP takes longer, Herbst said, and sometimes people quit before they complete their hours.

Allowing future therapists, social workers and psychiatrists to train in-state increases their likelihood of staying put in Wisconsin.

Herbst, Hall and other stakeholders are also working with the state to improve the licensure system, so that people can get mental health-related licenses in a timelier manner. Right now, it can take many months to process licensure applications for professionals transitioning to Wisconsin from another state, a result of understaffing, backlog and the general volume of applications.

Perez also sees QTPs as a game changer, adding that other successes, such as the federal push to give coverage to Medicare beneficiaries seeking licensed professional counselors, took nearly a decade of coordinated advocacy. Those conversations, Perez said, “led to legislative change, statutory change.”

Meanwhile, Battaglia will hold out hope that the state moves to better fund Community Support Programs, which would give people struggling with mental health disorders a range of community services that meet their needs.

“Politics is a slow machine. Everyone knows mental health is important. We’re talking about it when we didn’t talk about mental health much before,” Battaglia said. “Funding is not there this year, but this was the year of talking about mental health. It’s good groundwork for us to continue on.”

Brittany Truong of the Journal Sentinel contributed to this report.

Natalie Eilbert covers mental health issues for USA TODAY NETWORK-Central Wisconsin. She welcomes story tips and feedback. You can reach her at neilbert@gannett.com or view her Twitter profile at @natalie_eilbert. If you or someone you know is dealing with suicidal thoughts, call the National Suicide Prevention Lifeline at 988 or text “Hopeline” to the National Crisis Text Line at 741-741.

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When farmers & mid-day meal providers are made to struggle financially, there’s something rotten in the State

Elected leaders forget that people are under their care, they don’t want promises but empathy; our farmers haven’t got subsidies, and mothers and sisters of Self-Help Groups haven’t got dues for preparing mid-day meal schemes. This is cruelty

The biggest form of cruelty anytime anywhere in the world is harming the helpless. And this is true from the mountains of Manipur where innocent Kuki tribals are getting lynched in greater numbers than their Meitei brethren, in an orgy of violence, to an innocent farmer in Goa who has not received his support price subsidy for two full years, making it impossible for him to go back to his farm and grow food for us.

Both are equally cruel to the person suffering-for one it involves the loss of lives of loved ones, to the Goan farmer it’s a loss of livelihood and a future. And these cruelties are inflicted not by doing, but by doing nothing. Goa’s farmers already battling against shrinking farms and debris in their fields, flooding due to no de-silting of bunds, are quickly giving up their traditional occupations, out of utter despair and frustration,. Those who toil on the field to grow our food, struggle to find food on their tables.

Is this the Goa we fought for, where sons of the soil have become sufferers?

5,000 paddy farmers in Goa are suffering on account of the non-release of support price subsidy for two consecutive years, farmers from Maina-Curtorim. They have been denied the subsidy for machinery purchased during the same period and on top of that our Chief Minister had clearly indicated that he wants to take agriculture on the private route. He said in Pernem recently, “If we turn to the government for every aspect of agriculture, things will not work and only privatisation can ensure that changes take place in agriculture.” 

Are we trying to get big fish to take over our farms privately and bury the remaining Goan farmers?

Our farmers need protection and care and support. Those continuing to farm need to be encouraged to make a good living out of it. Privatising agriculture is throwing out Goan farmers to the sharks. Can they compete against big private farming? Will they survive? Aren’t you bringing fear into the minds of local farmers?

A doctor is always sensitive to the people under his care

A medical practitioner across the board is by default sensitive to the people he is supposed to care for, Which is why health and well-being are twin companions. A medical practitioner, even in a political avatar is naturally expected to wear concern on his sleeves.

Now when women in self-help groups, whose only motto is securing food for schools in rural areas, are being viewed as protestors and hindrance creators for asking for their dues so that they can continue to buy provisions to prepare mid-day meals for children, you ask, where is that concern?

Does a sensitive administration arm twist women Self-Help Groups after not paying them?

Already faced with low enrolment which results in some schools having less than ten children (some have less than 5) the mid-day meals are perhaps the only reason in many cases why parents send their children to school. The Self-Help Groups are like guardian angels that cook and reach hot nutritious food to the schools, in remote interior areas. Now imagine if their overdue payments for six months, add up to almost Rs 25 lakh in some cases, how are these groups expected to run and continue to buy provisions and cook for them?

These kind-hearted women have pawned jewellery, and taken loans to keep going, not for themselves but due to their sense of duty and service, Which MLA, MP or politicians like ex and future hopeful MLAs dip into their pockets to do this? The government’s reaction to the pleas and then their desperate message that they will not supply food from July 1 if bills are not cleared evoked a confrontationist response. The education director said there is a clause, wherein they can replace the SHGs, if the latter stops or threatens to stop the supply of mid-day meals to students. Was this tone of response needed from a sensitive government?

Good governance is not about schemes, it’s about trust, it has to be won

Cut to the Mopa link road at Suke Kulan in Dhargalim. Here farmers have had their cashew trees destroyed and many have lost their homes. Now on the road that has come up in its place, they are facing speeding trucks carrying construction material to the Moa airport. They have suffered accidents, and now deaths. In mid-June, people took to the streets demanding compensation for the family in the truck accident post where they set cranes on fire. Notwithstanding that the law has to be followed, a little bit of empathy, assurances, and personal visits by the  highest in the government could have  repaired nerves and hearts.

When there is a shortage of trust, any move of the government is viewed with doubt and scepticism

When farmers don’t get compensation for floods on their fields or subsidies for their crops, they have a right to cast doubt on any scheme or move. Therefore, when the government introduced a bill to impose restrictions on the transfer (sale) of agricultural lands in Goa to non-agriculturalists it was seen as back door entry for non-farmers from buying farmland and constructing large farm house since the collector can make exceptions and permit the transfer of agricultural land to non-agriculturist in certain circumstances. Ramkrishna Jalmi, convener of Goa Kul Mundkar Association, said in a news report, “We fear that with the provisions in the Bill, agricultural land will lose the protections and will be converted for use by industrialists. We will petition the Governor against granting assent to the Bill.

Governance is not a sum total of targets achieved, investments brought and schemes rolled out. It’s simply about ensuring peace and happiness

In Manipur or in Goa there is no bravery in troubling the weak or making them live in the fear of uncertainty for absolutely no crime of theirs. If the hands that grow our food or cook for children have to be raised to fight for justice, or folded to beg for it, we as a State have failed.

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The Marion County Board of Commissioners on Wednesday will consider accepting nearly $2 million from the state to provide incentives for recruiting behavioral health providers to the Salem area.

READ IT: AGENDA

The grant would come from a workforce initiative the state legislature created in 2021 to boost local recruitment and retention of behavioral health providers with associate, bachelor’s, master’s, doctoral degrees or other credentials.

The funding is also intended to “break down the systemic barriers that reduce access and exacerbate inequities in people of color, tribal members, and other communities harmed by historical and contemporary injustices,” according to the agenda item.

To participate

The commissioners meet at 9 a.m. Wednesday in the Senator Hearing Room at 555 Court Street N.E. Anyone can attend or sign up to give public comment in-person at the meeting. The meeting is streamed live on YouTube. 

Construction projects

Commissioners will consider approving a $1.3 million construction contract with Farline Bridge Inc. to rehabilitate the Abiqua Creek Bridge.

The work is intended to extend the bridge’s service life by correcting scour and foundation issues, and make travel safer by adding a new guardrail, according to the agenda item. The state will provide about $1.1 million while the county would provide the rest.

They will also consider approving a $238,000 contract with Brown Contracting Inc. to build sidewalks, ramps, pedestrian signals, signage and striping on Shaff Road to allow a safer pedestrian route for Stayton Middle School students. The state would cover about $190,500 and the county would cover the rest.

New sheriff, other appointments

The board will consider approving the appointment of Lt. Nick Hunter to Marion County Sheriff. 

Commissioners recommended Hunter’s appointment on June 7 to complete the term of retiring Sheriff Joe Kast. Hunter would be sworn in on Friday 

The Wednesday meeting will open with a presentation from the board recognizing Kast and his service to the county.

They will also consider appointing Josh Lair as chair and Eric Rasor as vice-chair of the Marion County Local Alcohol and Drug Planning Committee.

Also on the agenda

Commissioners will consider adding $142,500 to a contract with Metro Presort, Inc. for ballot and voter notification card services. The new contract would total $237,500.

The board will consider an $800,000 contract with DePaul Industries, Inc. to provide unarmed security and vehicular patrol for Marion County Health and Human Services locations.

Commissioners will consider two contracts to provide mental health assessments and care to adult behavioral health clients: a $400,000 contract with Nathaniel Kravitz and $500,000 with Dr. James F. Miller.

The board will consider a $270,000 contract with the Mid-Willamette Valley Community Action Agency to provide navigator coaching intended to help keep people out of state prisons.

Such coaching would include one-on-one consultation for success planning and referrals to employment, education, housing, child and family services, transportation and health health needs. 

They will also approve a $561,000 agreement with the county’s Health and Human Services Department to assess, monitor and provide treatment services for people with substance us disorders in the Student Opportunity for Achieving Results program.

Contact reporter Ardeshir Tabrizian: [email protected] or 503-929-3053.

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Ardeshir Tabrizian has covered criminal justice and housing for Salem Reporter since September 2021. As an Oregon native, his award-winning watchdog journalism has traversed the state. He has done reporting for The Oregonian, Eugene Weekly and Malheur Enterprise.

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In the language of state agencies, it’s “loss of custody.” In the vernacular of medical staff, it’s being “street-ed.” Both refer to when an emergency medical department is unable to stop a patient deemed a threat to themselves or others from leaving the facility before receiving proper treatment. 

Whatever you call it, in Virginia, it’s happening more frequently.

Data obtained from the state Department of Behavioral Health and Developmental Services shows the number of loss of custody events has nearly tripled since 2020, with 139 statewide for fiscal year 2022. In addition, last year 460 people under a temporary detention order (TDO) — a legal document signed by a magistrate that authorizes a person’s involuntary detention for mental health evaluation — were not admitted to state hospitals due to paperwork issues after being dropped off there by law enforcement.

“We all know there’s a crisis, but not everybody knows the extent of it,” said Ryan Dudley, crisis services director at the Hampton-Newport News Community Services Board, the second largest of Virginia’s regional boards charged with providing behavioral health services at the local level.

The figures reveal that even as the state is struggling to stabilize its beleaguered behavioral health system, long wait times for beds are allowing hundreds of Virginians in need of crisis-related mental health services to fall through the cracks. 

(Data from the Virginia Department of Behavioral Health and Developmental Services)

State officials have taken notice. At the end of last year, Gov. Glenn Youngkin announced the formation of a “Prompt Placement Task Force” focused on reducing wait times for beds. Budget amendments proposed by the governor this December as part of his “Right Help, Right Now” plan to overhaul the state’s behavioral health system include funding for alternative medical facilities like crisis receiving centers and mobile crisis units aimed at bringing support closer to home. But with no budget compromise between Democrats and Republicans in the legislature, that investment is on hold.

 While medical staff and mental health advocates are cautiously optimistic about the task force’s progress and the promised funding, in the meantime they continue to grapple with the chaos created by unintended consequences of state law.

“It is very frustrating,” said Hampton-Newport News CSB Deputy Executive Director Daphne Cunningham. “More so for the people who have to navigate it because they just don’t see that light at the end of the tunnel.”

Many of the cases where people in need of crisis-related behavioral health treatment are slipping out of the safety net can be traced back to the state’s 2014 “bed of last resort” law.  

In Virginia, TDOs last 72 hours and were designed to give medical staff enough time to find a bed so the patient can be committed to a psychiatric hospital. That has not always been enough time, as was the case in 2013 when a bed couldn’t be found for 24-year-old Gus Deeds, who was released from a facility where he had been detained and shortly after stabbed his father, Sen. Creigh Deeds, D-Charlottesville, before committing suicide. Following this tragedy, Deeds sponsored a bill, passed in 2014, that sought to make changes to the process to ensure that there would always be a psychiatric bed for someone who needed one.

Known as the “bed of last resort” law, the legislation mandated that state hospitals had to admit patients who had been placed under a TDO if a bed at a private psychiatric hospital could not be found. The shortage of beds in the private sector quickly became clear as the number of TDO admissions jumped from 2,192 in 2015 to 6,649 in 2019. During the same period, the percentage of TDO patients taken by state hospitals climbed from 8.8% to 23.9%, leading some in the field to unofficially rename the law “bed of first resort.”

Then the COVID-19 pandemic happened, and cracks in the psychiatric care system widened. Quarantine requirements limited the number of available beds further. Existing hospital staffing shortages got worse. In July 2021, the situation had gotten so dire that the state closed five of its mental health hospitals to new admissions.

Some of the changes instituted during the pandemic remain in place. Commitment hearings, which must occur within the 72-hour TDO period and pre-pandemic were typically held in person at the hospital where the patient was being admitted, now occur in emergency departments, often via Zoom call. CSB staff, who previously would only testify at those hearings, have now taken on the responsibility of facilitating them.

“[There’s] not a clear definition of where the CSB role ends and where the state hospitals should pick up,” Cunningham said. “At the time of that legislation, there was no real next step of what happens if that bed of last resort isn’t there.”

The lack of psychiatric beds has made both private and state hospitals strict about who they choose to admit. An individual can be denied a bed based on the severity of their crisis, their history or other medical complications. Even when the patient is committed, there can be long wait times while a bed is located, from several hours to days, according to DBHDS communications director Lauren Cunningham, who is not related to Daphne Cunningham.

“When admissions are delayed, all parties involved in the civil commitment process are negatively impacted,” Cunningham with DBHDS said in an email, “including the individual who is experiencing a mental health crisis who typically is not receiving any treatment during this time.”

It is this delay that opens the window for patients to leave the facility before being committed. 

By law, a police officer is required to monitor a patient under a TDO while the order is active, even up to the point of handcuffing them. But once the order expires after 72 hours, the officers return to other duties, and emergency department staff become responsible for holding the patient until he or she can be transferred to the state hospital.

Colonial Heights Police Chief William Anspach said that from 2019 to 2022, the total number of hours his officers spent waiting with patients under a TDO rose from 41 days to 103 days. 

“It’s just not healthy to sit there in handcuffs for that long,” Anspach said. “It’s not healthy for the officer [either].”

While some TDOs are placed on people who have been charged with a crime, the majority are civil cases. That has given rise to some concerns over civil rights: In 2021, Del. Mike Cherry, R-Colonial Heights, proposed a bill that would have removed law enforcement from the TDO process. The measure did not make it out of committee, because some lawmakers argued that without law enforcement, more patients would “elope” and pose a danger to themselves or others.

A police car in Richmond, Va. Police currently provide the vast majority of transports to psychiatric hospitals across Virginia. (Ned Oliver/Virginia Mercury)

“There’s just got to be a way we can all look at this and say when someone’s having a mental health crisis, they’re not a criminal,” Cherry said.

Without police or some other form of security present, however, many hospital and mental health workers say forcing the patient to continue waiting for a bed after the TDO expires is a struggle. Emergency departments can be noisy and turbulent environments and are not places where someone experiencing a mental health crisis often wants to stay. 

Will Armstrong, a former emergency services coordinator at Colonial Behavioral Health, the community services board in the Williamsburg area, said that while CSB staff can call the magistrate who issued the TDO and request another, such asks are not often granted. That forces staff to continue their search for a bed using what he described as an outdated process that relies mainly on making phone calls or even sending faxes.

“Some people have called us bed brokers,” Armstrong said. “That’s the part of the job that’s burning people out.”

It is possible for patients to receive some treatment at the emergency department, and some are cleared for release after their hearing. But even that procedure can be chaotic. One person who was under a TDO this year and asked to remain anonymous said the clinic where he was detained had no discharge plan to outline what would happen when the TDO was up. 

Some people have called us bed brokers. That’s the part of the job that’s burning people out.

– Will Armstrong, a former emergency services coordinator at Colonial Behavioral Health

While he was fortunate to have someone he knew pick him up after he was released, he said other TDO patients at the clinic were not as lucky and were only given bags to put their belongings in before exiting. 

“[There’s] certainly no care as to what happens to those people at the end of the TDO,” he said.

Complicating discharges even further is the fact that people under TDOs may be transported long distances to hospitals. Albemarle County Sheriff Chan Bryant said patients under her custody are often taken to places like Western State Hospital in Staunton, with no procedures in place to ensure their safe return. 

“We’re taking these people out of the community and out of their support system and sending them five hours away and saying, ‘All right, good luck getting back,’” she said.

Earlier this year, Bryant requested an opinion from Virginia Attorney General Jason Miyares on law enforcement’s role relating to temporary detention. Miyares defended the current law.

“Law enforcement must execute the order without delay and maintain custody of the individual until custody is accepted by the temporary detention facility,” Miyares wrote. “Further, the law does not permit law enforcement to transfer an individual under a TDO to the facility of temporary detention unless the facility accepts custody of the individual for admission. Finally, it is my opinion that there is no legal authority for law enforcement to continue custody of an individual pursuant to a TDO beyond the length of time specified” in state code. 

Dudley of the Hampton-Newport News CSB said stories like this can be disheartening for CSB staff, who are forced to come up with workarounds on a daily basis. 

“We’ve taken on challenges that weren’t necessarily meant for the CSB to take on. The impact this has on us delivering other services is also significant,” he said. “We want a predictable process.”

It is difficult to measure the exact steps the Prompt Placement Task Force has taken to overhaul the TDO process, because the governor’s office and the leader of the initiative, Janet Kelly, did not respond to multiple requests for further details. However, several people working with the task force offered insight into its workings.

Julian Walker, vice president of communications for the Virginia Hospital and Healthcare Association, said his organization has been engaged with the task force and supports the funding proposal the governor put forward in December. 

“Our hospitals have added hundreds of behavioral health beds in the last several years,” Walker said. However, he continued, “different beds and different facilities are going to have different capabilities and different capacities to treat patients with specific needs.”

Cunningham said DBHDS has also been working with the task force “to ensure that individuals experiencing a mental health crisis are receiving the right help they need, right when they need it, while also reducing the burden on law enforcement, emergency departments, and other community partners who are working to ensure these individuals are safe until a bed can be found for them.”

There are not enough places in Virginia for people experiencing mental health crises to go when they need help, said Mental Health America of Virginia Executive Director Bruce Cruzer, but there are options for support. He encourages those in crisis to call the 988 “warm” line to talk to someone who can help.

“Everything really starts with de-stigmatizing mental health so that everyone sees it as part of health,” Cruze said. “If that’s the case, then when people aren’t feeling well mentally or emotionally, they’re going to talk about it, and then they’re more likely to ask for help and then get the help they need.”

Today, the high number of loss of custody events in the Virginia behavioral health system shows that many undergoing acute mental health crises are not receiving the timely aid they need. Plans are in the works to fill the gaps, but in the meantime health care professionals like Armstrong worry that without more resources, the risk of another tragedy will rise.

“I’m surprised there haven’t been more critical incidents,” Armstrong said.

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