Youngkin announces task force on troubled temporary detention order system

With state hospitals continuing to be strained by mental health patients in crisis, Gov. Glenn Youngkin announced Monday, December 12, 2022, the creation of a task force to combat deficiencies in how Virginia handles individuals whom magistrates order to be held involuntarily for treatment.

Virginia’s current system “is bad for patients, care providers, families, and law enforcement who wait with these patients for a placement,” said Secretary of Health and Human Resources John Littel in a release. “This task force is a key step in improving the behavioral health system in Virginia.”

The announcement follows comments by Youngkin this November after two mass shootings at the University of Virginia and a Walmart in Chesapeake that he intends to propose legislation during the upcoming session to boost mental health resources.

According to the administration release, the task force will focus on the state’s system of temporary detention orders. Under state law, TDOs can be issued by a magistrate for a person if a petition and an evaluation conclude the person has a mental illness, there is a “substantial likelihood” they will cause serious physical harm to themselves or others, and they are unwilling or unlikely to seek treatment on their own.

Task force objectives will include “ending the TDO waitlist, finding rapid placements for individuals under a TDO, releasing police officers from spending significant hours away from patrolling the streets, ensuring the safety of all parties, and setting the stage for lasting systematic change to the way Virginia processes TDOs.”

Youngkin advisor Janet Kelly, who led a similar initiative this year to end the practice of children in foster care sleeping in government offices and other unsuitable locations, will lead the new task force, which will include other public officials involved in the mental health system.

Since 2014, TDO admissions to state hospitals have been spiking, with one state report from the past June finding a 389% rise between fiscal years 2013 and 2019. 

Temporary detention order admissions in Virginia, FY2013-22. (Virginia Department of Behavioral Health and Developmental Services)

That report concluded those increases were “specifically related to” the 2014 bed of last resort law put forward by Sen. Creigh Deeds, D-Bath, after his son Gus stabbed Deeds and then killed himself during a mental health crisis. State officials had been unable to find Gus Deeds a psychiatric bed.

Under the bed of last resort law, state hospitals must admit patients subject to a TDO after eight hours if a bed cannot be found at another hospital.

In the wake of the legislation, limited bed capacity and staff shortages have caused large backlogs at state facilities, with patients under a TDO waiting an average of 43.2 hours for a state bed over the last fiscal year. During this time, private hospitals’ share of TDO admissions has also dropped, from 91% of all TDO admissions in the fiscal year 2015 to 76% in 2019.

Problems peaked in July 2021, when Alison Land, former commissioner of the Virginia Department of Behavioral Health and Developmental Services, closed five state mental hospitals to new admissions, citing workforce shortages that produced a “dangerous environment where staff and patients are at increased risk for physical harm.”

“The challenges faced by state hospitals are now an immediate crisis for two reasons: First, the level of dangerousness is unprecedented, and second, recent admissions are occurring in an environment that is no longer adequately staffed,” wrote Land in a July 9, 2021 letter.

Staffing has been a perennial problem at the state’s hospitals, with shortages only exacerbated by the pandemic. This May, Littel told the General Assembly’s Joint Commission on Health Care the hospitals were “losing a lot of people to Chick-fil-A” and other companies offering better pay and less stress than positions at state facilities.

The General Assembly agreed to this summer to increase direct care staff salaries by 37% on average using millions in federal American Rescue Plan Act dollars. The boost was in line with a proposal by the Republican-controlled House of Delegates, but less than one put forward by the Democrat-controlled Senate.

“The present TDO process has failed by not delivering care to patients when they need it most,” the Youngkin administration said in the Monday release. “The process also contributes significantly to increased workforce burnout within healthcare and extensive hours devoted by our law enforcement.”

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