Editor's Note: This is one of the final two articles in a series on the state of Vermont's mental health care system since the closure of the Vermont State Hospital in August 2011.
BRATTLEBORO -- The condition of mental health care in Vermont, especially since Tropical Storm Irene forced the closure of the Vermont State Hospital in Waterbury in August 2011, has many law enforcement officials concerned, especially considering police officers, sheriff's deputies and state troopers are often the first responders on scene during a mental health crisis.
"We have seen an increase in dealing with people with mental health issues," said Capt. Ray Keefe, commander of Troop D of the Vermont State Police, with barracks in Brattleboro, Rockingham and Royalton.
Part of that is due to the fact that over the past 20 years, law enforcement has come to recognize that many of the crimes they investigate have a root cause in mental health, he said. Two decades ago it was strictly considered a legal matter, but with more accurate diagnoses, officers understand lawbreakers sometimes need mental health assistance more than they need to be sent to jail.
"We are better trained today," said Keefe. "And the minute we realize we are dealing with someone who has a mental health issue, our first call is to Health Care and Rehabilitation Services.
HCRS is one of the state's "designated agencies" that serves the "catchment" of Windsor and Windham counties. It serves almost 5,000 people a year through its five major service programs: Adult Outpatient; Children's Division; Community Rehabilitation and Treatment, Developmental Services; and Windham/Windsor Recovery Assistance Program.
HCRS also supplies what are called qualified mental health professionals who are part of a screening team poised to react when a need presents itself, such as in a hospital emergency room or other community service provider.
In Brattleboro, the police department often escorts people experiencing a mental health crisis to the emergency department of Brattleboro Memorial Hospital.
"These are the same things we have been dealing with for the last 25 years," said Gene Wrinn, Brattleboro's chief of police. "It's different people with the same issues."
Through HCRS, the Brattleboro Police Department has a social worker on staff to assist officers in difficult situations such as these. But, said Wrinn, the police have an immediate responsibility when responding to someone in a mental health crisis.
"We need to stop the behavior and protect the person and the public."
When a person in need of inpatient care ends up in an emergency room because there is no bed at a psychiatric facility, the wait time can be anywhere from 24 hours to several days. In those cases, the sheriff's department is called in for security.
"From time to time, facilities ask the sheriffs to provide a secure environment so a patient doesn't hurt him or herself or others," said Windham County Sheriff Keith Clark, who is the president of the Vermont Sheriff's Association.
He said the lack of secure hospital beds for those with acute mental illness is "absolutely challenging" for law enforcement officials in Vermont.
"When we are watching people at an ER, it is not therapeutic and not for the benefit of the patient," said Clark. "It puts our deputies in a difficult position of balancing who they are there to protect -- the staff, the patient or the public."
Depending on the person's behavior, it might require one or two deputies for supervision, said Clark.
"We initially start on the premise that we have the need for two," he said. "If the person starts taking medications or if we don't see any activity that makes us worry about safety, we will go down to one deputy."
Vermont's sheriff's departments are reimbursed by the state for the security they provide while a patient is waiting for a bed in a secure facility.
The sheriff's association has been in discussions with the Legislature and the Department of Mental Health on how the problem can be resolved.
"These people are patients. They are not prisoners," said Clark. "They need treatment and we should be a therapeutic part of that process and not just armed guards watching over them."
The state of Vermont's mental health care system has also raised concerns in the judicial system. During an open records request hearing in Windham Superior Court on Feb. 22, Judge John P. Wesley said the lack of hospital beds has also affected the state's courts.
"This has created issues for this court and other judges all over the state," he said. "With respect to instances where requests for involuntary treatment come in ... significant periods of time lapse when we learn about those requests for involuntary treatment."
The Reformer had requested the hearing after a records request was denied. Those records had to do with an involuntary commitment hearing, in which the subject of the hearing was accused of making threats that resulted in precautionary security measures at area schools.
That patient was held at Brattleboro Memorial Hospital for six days under 24-hour guard by sheriff's deputies until a bed was found for him at the Brattleboro Retreat. The man was held at the Retreat from Jan. 8 to Jan. 25, when Wesley released him following the hearing.
During the Feb. 22 records request hearing, Wesley said he felt releasing the records was crucial in the discussion about how to resolve the lack of beds issue in Vermont.
"It legitimately deserves some scrutiny on our decision-making in the state on how we are proceeding with the difficult dilemma of mental illness in our community and discriminating against those who need involuntary treatment," he said.
Though Wesley released the documents to the media, the transcript of the Jan. 25 hearing remains confidential pending a decision by the Vermont Supreme Court after Wesley's ruling was appealed by the Mental Health Law Project.
Bob Audette can be reached at firstname.lastname@example.org, or at 802-254-2311, ext. 160. Follow Bob on Twitter @audette.reformer.