Guest Essays, Opinion

Guest essay: W.Va. needs to develop a better mental health system

by Jason D. Parmer

In the 2022 Regular Session, the West Virginia Legislature will be presented with proposals to change the “mental hygiene” court process. Mental hygiene courts involuntarily hospitalize people in crisis if they are found to have a mental illness which presents a danger to self or others. This process is called “civil commitment.”

But commitment to a locked psychiatric unit should be the last resort for people in crisis, because it separates them from society and prevents them from living in their communities with the help and support of their families and local services. Civil commitment should be viewed as just one part of the mental health system, only to be used when other services fail.

W.Va.’s mental health system should not be hospital centric

West Virginians with serious mental illness are faced with a recurring cycle of hospitalizations, without adequate community-based services to stop the next commitment. This process of “cycling admissions” is the hallmark of a failed system. And a mental health system that over-relies on psychiatric hospitals may run afoul of the Americans with Disabilities Act.

The cost of inadequate crisis care

In West Virginia, the rates of suicide, mental illness, serious mental illness, depressive episodes and disability exceed the national average. And when our mental health system fails, the only options available for a person in crisis usually involve a hospital or jail.

Nationally, it is estimated that behavioral health emergencies constitute 5% to 15% of all calls to 911 systems. A quarter of police-involved shooting deaths are linked to mental illness. And over 2 million adults with SMI are booked into jail each year, and the prevalence of mental illness and substance disorders in jails and prisons are three to four times that of the general population.

In 2020, 55% of people in West Virginia prisons were diagnosed with a serious mental illness. And it costs $124 million per year to keep people in West Virginia’s psychiatric hospitals. Part of this cost is attributable to the dozens of people who are ready for discharge from our psychiatric hospitals but cannot leave because there are inadequate services in the community. And many of these are individuals with intellectual/developmental disabilities who should not be in an institution at all.

A better crisis standard of care

West Virginia’s crisis system can be designed to reduce the need for hospitals and jails. The three core elements of an effective crisis system are: 1) regional crisis call centers coordinating in real time; 2) mobile crisis team response; and 3) crisis receiving and stabilization programs.

Fortunately, President Trump approved a bill in 2020 that creates the 988 Crisis Line, which can be used to establish regional crisis call centers. 988 is a universal number for people in mental health crises and suicide prevention. And the bill authorizes states to place a fee on all phone bills to support local call centers and related crisis services, like 911 funding.

The West Virginia DHHR Bureau for Behavioral Health has taken a positive step toward bolstering our crisis care system. In the next two years, some mobile crisis teams and crisis receiving and stabilization programs will be available for adults in crisis. But an effective crisis system must be available throughout West Virginia, not just in the cities. To that end, rural reimbursement rates for mobile crisis services may be needed to support the development of adequate crisis care in all parts of the state.

But it is important to follow through with these preliminary steps toward development of a better mental health system in West Virginia. Because changing the mental hygiene court process will not solve the larger problem of West Virginia’s over-reliance on hospitals and jails for people in crisis.

Jason D. Parmer is a staff attorney for the Protection and Advocacy for Individuals with Mental Illness program, which is part of Disability Rights of West Virginia.