Sheriffs cope with exploding costs of involuntary committals
Law enforcement officers in Western North Carolina have been spending too much time and money driving all across the state in search of available hospital beds.
When magistrate judges issue an involuntary committal order, an officer from that county is required by law to transport the patient to a hospital for evaluation, but the shortage of available beds for mental health patients is making the process burdensome.
It’s not always as easy as dropping them off at the nearest hospital. So where do they take them?
“Wherever the next available bed opening is determined,” said Macon County Sheriff Robbie Holland. “From Haywood to Manteo ... anywhere in the state the hospital finds a bed.”
That kind of drive can eat up a lot of patrol hours and fuel, and can put a lot of wear and tear on patrol vehicles. In 2014 alone, Macon County Sheriff’s Office spent 8,299 hours and $253,625 on involuntary committals.
It’s an issue that law enforcement departments all over North Carolina are trying to find a solution to while still following state laws. It’s a multi-faceted issue with limited solutions.
“The state reduced the number of beds for involuntary commitments, which creates a backlog,” said Maj. Shannon Queen with the Jackson County Sheriff’s Office. “We also have more people needing help and more people willing to get them help — society isn’t looking bad on it … so it’s good more people are coming forward, but it’s reducing manpower on the road or in the jail.”
Holland said at least larger cities to the east have more hospitals in their jurisdiction and can deal with these situations better.
“I have spoken to sheriffs across the state, and all consider mental health commitments to be a problem,” he said. “Western North Carolina appears to have the greatest problem due to lack of hospital space for psychiatric assistance.”
Holland said it’s been an issue for his department since 2005, when transports began increasing due to the closing and availability of state beds within mental health facilities.
“Statutorily, we are required to transport, and the law does not state that we’re required to stay with them while that process is being determined. However, safety concerns have historically required us to stay from beginning to end as a matter of public safety from the point a person is picked up,” he said. “Our reason for doing so is because from the start of the commitment process the person was deemed to be a threat to themselves or others.”
Jeff Haynes, chief deputy for the Haywood County Sheriff’s Office, said his officers have had to drive to the coast to find services for a patient. When it’s that far away, the transport requires two officers.
“This happens at least weekly,” he said. “Of the 117 clients we transported in 2014, 63 were transported farther east than Hickory.”
Holland recently brought up the issue to Macon County commissioners, because it may affect his department’s budget request for 2015-16. Transporting is not something that can be easily estimated, and Holland said it’s not getting any better.
“Honestly, at times it is a guessing game. We never know what is going to happen in the coming year,” he said. “All we can do is go by the trends we have seen and the data we have collected during the previous budget years and predict.”
With the implementation of the Affordable Care Act, Holland may face some problems with part-time officers going over their allotted 20 hours a week due to involuntary committals.
“The regulations do become more and more difficult, and unfunded mandates continue to make life difficult for those on the front line who are required to actually deal with the issues at hand,” Holland said.
As a solution, Holland told commissioners he’d be asking to replace those part-time positions with full-time detention center positions because those officers are typically responsible for transporting committals. He currently has five part-time officers assigned to the detention unit.
“If (officers) work more than 19 to 20 hours a week consistently, they need to be on county retirement and we need to be taking it out of their check,” said Mike Decker, Macon’s human resources manager. “If they work more than 30 hours a week, we need to be providing them health care.”
Haynes said the Haywood Sheriff’s office was working on putting together more concrete numbers on the cost of involuntary committals for this year’s budget process, but the impact is clear when looking at staffing adjustments.
“We added one full-time and one part-time transport officer midway through 2014 to address the need,” he said. “These additional officers work four times per week. After-hours we depend on part-time staff, but it is difficult to keep their work hours under the new national part-time standards.”
Additionally, transport mileage in Haywood County was more than 100,000 miles in 2014. At that rate, Haynes said, transport vans would only last a year or two before they need to be replaced.
Jack Register, executive director for the National Alliance on Mental Health in North Carolina, said the lack of beds for mental health patients makes it hard on local officers and on families of the patients when they have to travel hours to be with their loved ones in the hospital.
“We believe in the idea that we have to have publicly funded access to care where people live,” he said. “And people should still be in their hometown so family can be part of their recovery.”
NAMI is currently working with the state to create capacity solutions. Register said one of the problems is the constant shifting in North Carolina.
“North Carolina has been under reform for 20 years — we need consistent stabilization for the entire system,” he said.
Telemedicine is making great strides but people still need to be hospitalized immediately. Telepsych technology allows a video link between a hospital and a psychologist. The mental health professionals can assess the patient via video with the psych unit to determine the needs of the patient and if necessary, locate bed space and place that patient immediately on the waiting list.
Register said mental health should be looked at no differently than if a patient needed emergency heart surgery or needed a cancer treatment.
“We’re trying to get the General Assembly to understand the consequences for families and mentally ill patients that have to be transported,” he said.
In the meantime, he said, NAMI has had some success in training officers how to better deal with mentally ill patients during transporting. A recent Crisis Intervention Training Conference had 500 law enforcement officers in attendance.
“We teach them how to work with someone in crisis because they may not be safe to be around,” Register said. “More and more law enforcement are realizing it’s a huge issue, so the silver lining is that more people are wanting to get involved.”
Haynes said there are contract agencies that do transporting, but it might end up being just as expensive as transporting in-house, because these agencies are such a niche business.
“It is obvious the system is overloaded, and until something happens we will continue to spend days with patients, and those days have even reached weeks waiting on a placement,” Holland said.
Haynes said the sheriff’s department is in regular contact with legislators and will make sure this issue is on their radar. But until more funding is allocated for mental health services in the state, officers will continue to follow the law and transport patients who need help.
“It’s definitely a topic near and dear to us — we need to put attention to it and look at creating positive resolutions,” he said. “Until then, we have to comply with the law and get help for people who need it.”
By the numbers
Macon County Sheriff’s Office increased expenses related to involuntary committals 2006-2015:
• Increase in commitments — 127 percent
• Increase in officers utilized — 423 percent
• Increase in officer hours — 651 percent
Involuntary commitments by year/average time spent with committals
2006: 109/12 hours
2007: 143/9.5 hours
2008: 128/17.5 hours
2009: 152/ 17.5 hours
2010: 100/18.5 hours
2011: 138/32 hours
2012: 197/30 hours
2013: 218/40 hours
2014: 247/41 hours
2014 Macon County Sheriff’s resources on committals
• 1,113 officers spent 9,572 hours on commitments.
• 8,299 of those hours were spent at the emergency room with commitments.
• Officers drove 55,021 miles transporting involuntary committals across North Carolina.