John Clair, the police chief of a small Appalachian town in southwest Virginia, spends his days consumed by a growing problem: the frequency with which his officers are tapped to detain, transport and wait in hospitals with people in the throes of a mental health crisis.
Officers from Clair’s 21-member Marion Police Department crisscross the state to deliver patients for court-ordered treatment, sometimes only to discover the hospital where they were sent has no available beds. Patients end up boarding in waiting rooms or emergency rooms, sometimes for days on end, while under the supervision of Clair’s officers.
It’s a problem for law enforcement agencies around Virginia, one that advocates, attorneys and leaders like Clair say ties up policing resources and contributes to poor patient outcomes. In the past five years, these types of transports have become the largest single category of case the Marion department handles.
“We are against the wall,” said Clair, an Army veteran and former lay pastor who sometimes shuttles patients himself, and did so last month on a nearly 15-hour round trip to a coastal city on the other side of the state.
The problem underscores a widely held consensus that Virginia’s mental health care system is in urgent need of reform, due to what Gov. Glenn Youngkin’s administration says is an overreliance on hospitalization at a time of growing need.
About a year ago, Youngkin, a Republican, rolled out an ambitious initiative that aims to transform the way psychiatric care is delivered by creating a system that allows people to get the treatment they need without delay, in their own community and not necessarily in the confines of a hospital, easing the burden on both patients and law enforcement.
While Virginia’s struggles may be particularly acute, Youngkin is not alone in his focus on the issue. Improving mental health care became a priority in the U.S. like never before as the pandemic brought new levels of isolation, fear and grief, in addition to pre-existing crises such as rising drug overdose deaths and the struggles burdening teen girls. Survey data from the U.S. Substance Abuse and Mental Health Services Administration found that in 2022, about half of adults with any mental illness did not receive treatment.
“We know that there’s a lot of partisan divide across the country, but what we’ve found is whether it’s red states or blue states, there’s a lot of support for behavioral health at this point,” said Brian Hepburn, executive director of the National Association of State Mental Health Program Directors.
Youngkin’s emphasis on mental health developed during his 2021 campaign, when person after person — from doctors to local officials to police — pleaded with him to make it a priority, according to John Littel, the cabinet secretary overseeing the Virginia initiative.
“It was just so clear that people were really struggling,” Littel said.
Youngkin has since won bipartisan support for his “Right Help, Right Now” initiative and praise from advocates, though some worry about the pace at which things are moving. The governor — whose press office says the initiative is exceeding key milestones — cannot seek a second consecutive term and leaves office in two years.
The initiative’s wide-ranging goals include building up the behavioral health care workforce and working to stem the tide of overdose deaths, which claimed the lives of an average of seven Virginians a day in 2022. Youngkin has signed dozens of related bills into law and has secured hundreds of millions in new funding, with more proposed.
The “foundational” part of the plan, as Littel describes it, is creating a system that delivers same-day help to individuals in crisis, which should also relieve some of the burden on police departments like Clair’s that are charged with transporting most patients a court deems a risk to themselves or others.
Youngkin’s administration hopes to build up that continuum of care by increasing the number of mobile crisis teams with clinicians to respond to mental health emergencies and creating more short-term stabilization centers for patients to avoid the need to take them hours away from their homes for care.
A recent report from the state’s legislative watchdog emphasized the need.
Virginia had more than 20,000 temporary detention orders in fiscal year 2023, according to a recent presentation to lawmakers. Some 8,538 of those individuals experienced delays receiving psychiatric treatment after they had been deemed an imminent risk to themselves or others, the report found.
The report also raised concerns about law enforcement “drop offs,” where officers or sheriff’s deputies leave patients before they’re accepted by a hospital or other facility. Recent testimony in a legislative hearing suggested drop-offs put some of those patients at risk of death.
Elsewhere in the U.S., states’ policy concerns and approaches to improving mental health care have varied.
States have used federal coronavirus pandemic relief funds to bolster access to care, and most governors have talked about mental health in their state of the state addresses in the last few years. Mental health was listed as a budget priority in most states in an analysis by the National Association of State Budget Officers.
Will that emphasis continue?
“It’s a marathon, it’s not a sprint,” said Katherine McGuire, chief advocacy officer of the American Psychological Association, “and our daily hope is that the states especially after the public health emergency was rescinded will realize they have to stay at it, they have to stick with it.”
Virginia’s lawmakers are considering bills on the intersection of law enforcement and mental health this year.
Clair said he hoped that speaking with candor about his department’s experiences will help them see the urgency of the problem. But he’s worried that the part-time General Assembly, also grappling with controversial gambling and sports arena deals, may rush through something that falls short of what’s needed.
The patient Clair transported across the state, costing his department thousands of dollars, has had around 15 mental health encounters with his agency in a year and a half, he estimates. One involved a suicide attempt.
The patient dropped off a handwritten thank-you note for the chief after their long ride. A short time later, she was back in his department’s custody.
Clair said both police and patients in need — whose crises can be exacerbated by time spent detained in the back of a police car — deserve better.
“We’re just setting ourselves up for tragedy over and over again,” he said.
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Geoff Mulvihill contributed to this report from Cherry Hill, New Jersey.
A Brooklyn woman who pleaded guilty to fraud in connection with various pandemic-era relief schemes was sentenced Thursday to three years of probation and $650,000 in penalties.
Prosecutors said Chanette Lewis, 32, carried out some of the schemes by leveraging her job at a call center, part of a New York program meant to provide health care workers with isolation rooms in hotels. They said she provided free hotel rooms to people she knew weren’t eligible health care workers or COVID-19 patients, including herself.
“During the pandemic, this defendant exploited a COVID-19 safe-lodging program for her personal profit; today she faces the consequences of her criminal conduct. I thank New York City Emergency Management for reporting this matter,” New York Department of Investigation Commissioner Jocelyn Strauber said in a statement.
It’s the latest example of how people are believed to have stolen an estimated $280 billion in government aid during the pandemic across the U.S., including New York. The sentencing Thursday was part of a larger case involving $400,000 of fraud in the hotel program.
Lewis admitted to defrauding the emergency programs, the U.S. Attorney for the Southern District of New York said in a statement, and she separately forged legal documents purporting to come from judges, prosecutors and doctors to get 30 people into public housing or into larger public housing apartments.
Using stolen personal information from real health care workers, she and three co-defendants were accused of securing the hotel rooms and then advertising them on Facebook to rent out, according to the Department of Investigation Statement. Co-defendants in the case have admitted to getting unemployment benefits in multiple states, along with fraudulent small business loans.
The Associated Press left phone and email messages with a lawyer involved in a plea deal in the case. It wasn’t immediately clear if that was Lewis’ current attorney; requests to prosecutors and investigators for updated contact info were not immediately answered.
Lewis was sentenced to three years of probation and ordered to forfeit $290,000 and pay another $360,000 in penalties. Her co-defendants received lesser sentences, or have yet to be sentenced.
For some people with COVID-19, antiviral pills that can be taken at home can lessen the chances of winding up in the hospital.
But the pills have to be taken right away, so you must get tested, obtain a prescription and get the medication within five days of symptoms appearing.
The medication is intended for those with mild or moderate COVID-19 who are more likely to become seriously ill — that includes older people and those with other health conditions like heart disease, cancer or diabetes.
Here’s how to get the pills in the U.S.:
— Take an at-home COVID-19 test and contact your health care provider. If they prescribe the pills, you can get them at your usual pharmacy.
— Use a test-to-treat site, where pharmacists can check if you have COVID-19, write the prescription and give you the pills all in one stop. Find a test-to-treat site at treatments.hhs.gov.
— Use the National Institutes of Health’s Home Test to Treat program, which allows people to get a telehealth appointment and then will ship medications to people who qualify. More information is available at www.test2treat.org.
Paxlovid is the most commonly prescribed antiviral pill for COVID-19. It has a list price around $1,400, but most people shouldn’t have to pay that amount. The drug is free through the end of 2024 for people on federal insurance programs like Medicaid and Medicare. Uninsured people also can get it for free.
However, you must go through a patient assistance program run by Pfizer to get the discount. People on commercial insurance with high out-of-pocket costs can also get financial help through a separate co-pay assistance program. Go to paxlovid.iassist.com for more information.
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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
Tens of thousands of Americans are hospitalized with COVID-19 every week. Thousands die from it every month. And yet, an antiviral treatment proven to lessen the chances of severe outcomes is going underused.
The drug, Paxlovid, is lauded by experts as a powerful tool that can prevent hospitalization and death from COVID-19. But the high price and doctors’ hesitation to prescribe the pills mean the five-day treatment isn’t getting to everyone who would benefit from it.
“When you read in your local newspaper that in this hospital, they’ve got this many COVID patients, most of those are preventable hospitalizations,” said Dr. Amesh Adalja, a senior scholar at Johns Hopkins University who sees Paxlovid as a useful tool to treat COVID-19.
One Centers for Disease Control and Prevention study found that Paxlovid can decrease hospitalization risks among adults by 51%. The drug is recommended for older people and other adults with certain underlying conditions.
When Paxlovid was first authorized for emergency use in the U.S. in December 2021, it was free for anyone who needed it. Once the government stopped funding the treatment, Pfizer set a list price of $1,390.
The drug remains free for people on federal insurance programs like Medicaid and Medicare through the end of this year, and uninsured people also can get it for free. But many of those people must go through a patient assistance program run by Pfizer to get the discounts. People on commercial insurance with high out-of-pocket costs can also get financial help through a separate co-pay assistance program.
Independent pharmacy owners find Paxlovid is expensive to carry because of reimbursement rates from commercial insurers, said Kurt Proctor, a senior vice president at the National Community Pharmacists Association.
“If you’re losing 5% on a $10 prescription, it’s very different than losing 5% on a $1,400 prescription product,” he said.
The high list price also is turning off some patients.
When Celise Ballow, of Junction, Utah, got COVID-19 recently, she never got the medication.
Ballow said her doctor declined to write her a prescription after telling her it wouldn’t be covered by her insurance. Now she wonders if she could have avoided some of the infection’s worst effects if she had been able to get the medication.
“I’m going on a month and a half and I’m still having nebulizer treatments. … I’m still exhausted,” Ballow said.
Another factor hurting uptake appears to be the long list of medications that shouldn’t be taken with Paxlovid. Many doctors may simply decide the risk of drug interactions isn’t worth it.
“If people are on four or five different medications, it does tend to be a pain to double check ‘is there an interaction here?’” said Dr. Sarah George, an infectious diseases professor at St. Louis University. Seeing a possible significant drug interaction “tends to put a physician off from prescribing a drug, even if there is a workaround,” she said.
The people most likely to benefit from Paxlovid were the least likely to get it in 2022, according to a recent study.
The study by Harvard researchers found that Paxlovid was disproportionately given to Medicare patients with lower risk of severe infection. If it had been properly utilized, the authors concluded, more than 16,000 COVID-19 deaths could have been prevented.
Dr. Michael Barnett, a Harvard health policy researcher who co-wrote the study, said it shouldn’t be that way.
“There are very few medications and very few patients whose potential medication interaction with Paxlovid is so severe that they’re better off not taking Paxlovid,” he said. “Very few of them are important enough that it’s a big risk to stop for a week.”
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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
Florida’s attorney general is expected to ask the state Supreme Court to keep an abortion-rights measure off November’s ballot on Wednesday, saying it misleads voters and could be used to expand abortion rights in the future.
Proponents of the proposed amendment say the language is clear and concise and that Attorney General Ashley Moody is playing politics instead of letting voters decide whether to protect access to abortions.
The case will be a test on whether Republican Gov. Ron DeSantis, who appointed five of the seven judges, has changed the direction of a court that in past years has interpreted a privacy clause in the state constitution to strike down some abortion restrictions. No decision is expected Wednesday.
The proposed amendment would allow abortions to remain legal until the fetus is viable. Moody has argued that abortion rights proponents and opponents have differing interpretations as to what viability means. Those differences along with the failure to define “health” and “health-care provider,” are enough to deceive voters and potentially open a box of legal questions in the future, she previously told the court.
The arguments come as both sides of the abortion debate wait for the Florida Supreme Court to rule on whether to uphold a 15-week abortion ban passed two years ago. Last year, lawmakers went further and passed a ban at six weeks, which is before many women even know they are pregnant, but it won’t take effect if the court throws out the 2022 ban signed by DeSantis.
If the question is allowed on the ballot, 60% of voters would have to approve it.
Any change in abortion access in Florida would be felt out of state as well because the Sunshine State traditionally has been a haven for women in the southeastern U.S. seeking abortions. Nearby Alabama, Louisiana and Mississippi have bans on abortion at all stages of pregnancy, and Georgia has a ban on terminating pregnancies after cardiac activity can be detected.
A former leader of Scotland acknowledged on Wednesday that she deleted WhatsApp messages sent during the COVID-19 pandemic, but she insisted that anything of relevance to how policymaking was conducted had been made available for the public record.
Nicola Sturgeon told the United Kingdom’s public inquiry into the pandemic that she didn’t use informal messaging such as WhatsApp to make decisions. Although Scotland is part of the U.K., its government has powers over matters relating to public health.
“During the pandemic I did not make extensive use of informal messaging and certainly did not use it to make decisions,” she said in Edinburgh during what was at times tearful and emotional testimony to the inquiry.
Sturgeon, 53, became first minister in 2014 after Scotland voted to remain part of the U.K. in a referendum and was in office until her surprise resignation in 2023.
Sturgeon won plaudits for her handling of the pandemic. She was widely seen to have been on top of things, and clear in her public pronouncements during the pandemic, especially when compared to former U.K. Prime Minister Boris Johnson, who led policy in England and who also gave evidence to the inquiry late last year.
During her testimony, Sturgeon became tearful, telling the inquiry that there was a “large part” of her that wishes she hadn’t been first minister during the pandemic.
Her reputation has taken a battering over the past few months, especially in the wake of her arrest last June over a police investigation into the finances of the governing, pro-independence Scottish National Party. She hasn’t been charged and insists that she has done nothing wrong.
Sturgeon’s standing has been further dented by the recent revelation that her WhatsApp messages had been deleted, which has led to questions about her trustworthiness or whether she has anything to hide.
While Sturgeon conceded that WhatsApp had become “too common” as a means of communication within the Scottish government, Sturgeon said she exchanged WhatsApps with no more than a “handful” of people, and wasn’t a member of any groups.
She also said that she deleted messages, in line with official advice, and that “salient” points were all recorded on the corporate record.
“I operated from 2007, based on advice, the policy that messages, business relating to government, should not be kept on a phone that could be lost or stolen and insecure in that way, but properly recorded through the system,” she said.
The former first minister said she had “always assumed there would be a public inquiry” and apologized for any lack of clarity at a public briefing in August 2021 where she said her WhatsApps would be handed over despite knowing they had already been deleted.
Last week, Sturgeon’s successor as first minister, Humza Yousaf, offered an “unreserved” apology for the Scottish government’s “frankly poor” handling of requests for WhatsApp messages. He has announced an external review into the government’s use of mobile messaging.
The inquiry is divided into four so-called modules, with the current phase focusing on political decision-making around major developments, such as the timing of lockdowns. Though the devolved governments in Scotland, Wales and Northern Ireland had policy independence, the U.K. as a whole often moved as one, especially when it came to lockdown decisions.
The inquiry, led by retired Judge Heather Hallett, is expected to take three years to complete, though interim assessments are set to be published. Johnson agreed in late 2021 to hold a public inquiry after heavy pressure from bereaved families, who have hit out at the evidence emerging about his actions.
