Imagine a scenario where a nine-year-old boy is experiencing a mental health crisis.
His doctor at Methodist Medical Center of Oak Ridge recommends that he stay at a facility for involuntary hospitalization.
When his ride shows up, it’s a sheriff’s vehicle. Officers place him, cuffed, in the back of the patrol car and transport him to a mental health facility a few hours away.
Up until now, that has been the reality mental health patients have faced when they’re taken from a hospital to a mental health treatment center.
Whether they’re a juvenile or not doesn’t matter, according to Anderson County Sheriff Russell Barker.
“We have no business transporting a 9-year-old like that,” Barker said of the above scenario, which took place recently. “They’re already having some issues, and that’s not helpful.”
Why is it done this way?
It’s a state statute, one that finally changed on May 1.
Under the newly approved legislation (HB 643/SB 579), law enforcement is removed as a transportation option “for individuals with developmental disabilities, mental illnesses, and serious emotional disturbances.”
An amendment was made to the law in 2003 that would allow friends, family members or mental health professionals familiar with the person to make the transport, but they would have to do a screening that determines whether the patient requires physical restraint or vehicle security. Sheriffs still had primary transportation responsibility.
Last year, the sheriff’s department transported 520 patients. That’s 1,426 hours of manpower and 85,996 miles driven in patrol cars, according to Barker.
“Officers have to stay on average one hour for the facility to evaluate the patient,” he said. “Trips to Memphis and Jackson require two officers due to drive time.”
The long drive times are because most of the mental health facilities have very few beds available.
Barker tries to use reserve units for the transports since his department already has staffing issues.
“Our youngest transport was nine, but other sheriffs have talked about younger than that across the state,” he said. “And a family member can’t come with them. Unless they want to be cuffed up, too.”
Who will transport them now?
“We don’t know,” said Barker.
The sheriff’s department has been on the hook for not only transporting patients and the costs involved with that, but if they are in a car accident — something that has happened twice since Barker became sheriff in November — the sheriff’s department is financially responsible for the patient’s hospital bill if they are taken to the hospital.
“Even if they have insurance, we don’t have the mechanism to bill,” Barker said.
Methodist Medical is the regional hospital for many of the surrounding rural counties.
Whether a patient comes from Campbell, Morgan or Scott County, if they need to be transported to a facility, it’s been the Anderson County Sheriff’s job to do it, according to Barker.
Under the new legislation, local sheriff departments can volunteer for transports, but they can’t be forced to do it. They can now contract with third parties for transportation.
The Department of Mental Health and Substance Abuse will be responsible for transports in the five counties that have the highest number of transports (Maury, Montgomery, Rutherford, Sullivan and Sumner).
It was unclear who would be responsible for the costs associated for transports in other counties.
Transporting patients from hospitals to long term facilities is the tip of the judicial mental health iceberg. It’s just one aspect of a failing mental health system in not just Anderson County, but the country as a whole. Prior to 1955, people with severe mental illness were treated in state institutions.
These institutions were overcrowded and cost a whole lot of money to run — at one point, there were half a million Americans living in these institutions, or asylums.
By 1994, there were 71,619 patients in psychiatric hospitals.
The arrival of antipsychotic medication played a part in changing the system, as did advocacy for patients to live as a part of their community instead of being locked up away from it. And while there were very valid reasons for deinstitutionalization, there have been unintended consequences.
When the state institutions were shut down, smaller community centers were supposed to be built to replace them. Half of them were not built, and many of the ones that were lost their funding a few years later, according to the Center for Prisoner Health and Human Rights.
The number of state prisoners with severe mental illness was 21-percent in 2005.
According to the U.S. Department of Justice, 4 out of 10 inmates at local jails have mental disorders.
Nearly 50-percent of the homeless population have a severe mental illness, according to the National Alliance on Mental Health.
The Courier News will continue exploring how mental health affects the Anderson County judicial system in this series.