The Richmond Times-Dispatch has a front-page article today that raises many questions. It reports that the Department of Behavioral Health and Developmental Services (DBHDS) has entered into a two-year, $7 million contract with a private company to transport persons, who have been temporarily detained, to hospitals or mental health facilities for evaluation of being involuntarily committed.
Traditionally, sheriffs’ deputies or police officers transported these individuals, usually in marked police cars and sometimes in handcuffs. The rationale for contracting out this service is that it will be less traumatic for the involuntarily committed person and it will free up law enforcement officers, who spend thousands of hours on these transportation runs, for other public safety functions.
I sympathize with the motives for the change. Putting mentally ill people in police cars, sometimes in handcuffs, undoubtedly increases their trauma and reinforces the stigma accompanying mental illness. Law enforcement officers often have to drive many miles, sometimes across the state, to transport these patients, wait until the mental health facility accepts them as patients, and turn around and drive back to their home locality. That is a lot of time that the officers could have been on patrol duty, enforcing traffic laws or responding to calls for law enforcement support.
Nevertheless, contracting out this function to a private company is not necessarily a good idea.As the term implies, persons being involuntary committed usually do not want to go where they are being taken. It takes special training to manage someone in a mental health crisis who is being forced to do something he/she does not want to do. The person can become violent, threatening injury to the person doing the transporting, or, probably more likely, injuring himself or herself. Of course, the company with which DBHDS will contract with promises to train its drivers “on behavioral health services, supporting and supervising people in a crisis, and human rights and crisis intervention.”
This raises several questions: Will DBHDS set the standards for this training? If so, to what extent will DBHDS monitor the training and the conduct of the contracted drivers to ensure that those standards will be met? What is the legal authority for a private contractor to constrain a person who is being transported to an involuntary commitment evaluation?
As a private business, the contracting company will seek to minimize its expenses as much as possible in order to maximize its profits. Therefore, it will tend to hire drivers at the lowest end of the salary scale and it will probably offer few benefits, such as health care and retirement. The result will be a high turnover of drivers, who are minimally experienced and trained.
State agencies contract out service delivery for a variety of reasons. Sometimes, but not always, it is cheaper. Sometimes, it is easier to delegate the administrative burden of recruiting and training employees to a private company. Regardless of the reasons or benefits of contracting out a service, a state agency loses some measure of control over the delivery of that service, although it is still accountable for it. For some services, it may make sense for a government to contract out a service. Building a road or bridge is a good example. But, for a sensitive service such as transporting a person in a mental health crisis, it would probably be better for the agency to use personnel who are accountable to it, rather than to a third-party contractor.
A better way to relieve the pressure on sheriffs’ offices would have been to provide additional funding to each office to hire one or more additional transportation officers. Those offices already have experience in transporting persons in a mental health crisis. To relieve the trauma and stigma associated with being transported by law enforcement, the officers could use unmarked cars and wear civilian clothes rather than a uniform. When they were not being used to transport patients, those additional officers could be engaged in regular law enforcement duties.
Finally, as a budget analyst, I would ask: How did DBHDS come up with an additional $3.5 million per year for this contract? Does the agency have that sort of extra money sitting in its appropriation, unneeded, or is something else being cut?
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