As of 2019, Virginia has spent millions of dollars implementing the alternative transportation program aims to reduce the role of law enforcement in driving patients into state mental hospitals and other psychiatric facilities.
According to a contract with the state, the security company Allied Universal is tasked with building the capacity to eventually transport 50 percent of the patients assigned for treatment under the so-called. temporary detention orderor TDO — is issued in cases where the person does not want to seek care, but poses a danger to himself or others.
But over time, the number of shipments carried out by the company actually decreased. Before the COVID-19 pandemic, Allied was consistently transporting 25 to 30 percent of patients in Southwest and Southern Virginia, the first region where the program was fully implemented, according to Gail Paysour, alternative transportation coordinator for the state Department of Behavioral Health and Developmental Services. As the program expanded across the state, its capacity also declined, and by 2021, Allied was providing only 10 to 12 percent of TDO transportation in Virginia.
Advocates say the troubled program illustrates Virginia’s continued failure to meaningfully reform its mental health services. Unlike most police transports, Allied doesn’t restrain patients while driving, and Peysour said the service was intended as a more compassionate way to get them to the inpatient treatment they need.
But the program was also intended to be a relief to law enforcement officials, who were previously responsible for transporting almost all TDO patients in the state. Amid a critical shortage of psychiatric beds, that often means hours of driving across the state to drop patients off at the nearest hospital with space.
“When you have to transport someone from Abingdon to Petersburg, that’s a problem,” said Dana Schrad, executive director of the Virginia Association of Chiefs of Police. Right now, though, she said the program isn’t doing much to ease the pressure on employees.
That hasn’t stopped lawmakers from trying to expand its reach. Allied initially stepped in to transport patients only after an inpatient bed was found. But under new legislation which went into effect in early July, law enforcement officers can now transfer custody of patients immediately after a TDO is issued.
That means allied workers will be the ones sitting with patients while they wait for a bed — something Paysour said the company isn’t able to do.
“Because staff don’t have the ability to deter or anything like that, maintaining custody for long periods of someone who could become highly dysregulated is not something they’re willing to do,” she said. “Nor is it part of their current contract.”
The struggle to promote alternative transportation services and expand the program to patient custody underscores broader challenges within Virginia’s mental health infrastructure. Allied, as in virtual all supplierscurrently struggles to recruit and retain staff, limiting the availability of its services.
As of July 8, Paysour said there were 20 percent vacancies for transportation workers in Virginia, which — while an improvement over December’s numbers — makes it nearly impossible for the company to respond to more requests.
“It really just goes back to the difficulty of hiring someone for a job that has to cover 24/7, 365 days a year,” she said. “When we started, wages were competitive. But over time we had to reconsider that.
Eligibility is another limiting factor. Because allied drivers do not restrict clients, alternative transportation services are only approved for patients who do not show signs of aggression. But given the current bed shortage, most Virginians with TDO wait at least two days (and sometimes much longer) to be admitted—the time they typically spend in local emergency departments. The stress of waiting can worsen mental health symptoms, Peysour said, so by the time a bed is found, many patients are no longer eligible for Allied’s services.
The COVID-19 pandemic has also reduced already limited bed space and delayed the agency’s work and the training of law enforcement and local magistrates. Shrad said some courts still don’t seem to know that alternative transportation services are already available across the state.
But funding is also insufficient. Until recently, Virginia paid $4.5 million a year for its contract with Allied, which – according to the analysis from the state Department of Planning and Budget — was not enough for the company to cover 50 percent of TDO shipments through Virginia.
Virginia’s current budget increased that funding by approximately $2 million, but DBHDS now estimates it will cost more than $16 million to extend the company’s services for the full term of a patient’s custody.
“It makes me wonder if we need to go back and reevaluate the program from the ground up,” said Sen. Cray Deeds, D-Bath, chairman of the state Behavioral Health Commission. “Maybe our expectations weren’t reasonable in the first place.”
Paysour said the agency is also reviewing its contract with Allied, including whether it was overly ambitious in its goal of providing half of all TDO transports in the state. The company is also considering retention bonuses and there have been discussions about implementing limits to accommodate patients with higher behavioral health needs.
But both she and Schrad said the current reliance on law enforcement stems from deeper problems in Virginia’s mental health system. Schrad said policymakers have never fully invested in the type of community-based programs that can really reduce psychiatric hospitalizations — and the need for staff to drive patients to those beds. Without these services which may include stabilization centers and mobile crisis teamsshe said demand for transportation is unlikely to drop anytime soon.
“We need smaller programs spread across the state so someone isn’t being driven around for hours in a police car while they’re in crisis,” Schrad said. “But right now we’re just scratching the surface.”