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Chester County Press

Involuntary mental health commitments are a slippery slope for police and emergency responders

10/18/2022 12:58PM ● By Steven Hoffman

An involuntary commitment, also known as a “302” is an application for emergency evaluation and treatment for persons who are a danger to themselves or others, due to mental illness. 

A person applying for a 302, because they are concerned about another, is referred to as a petitioner. Beyond that textbook description of a 302, who to call for help in many states, including the state of Pennsylvania, becomes a slippery slope for police and all emergency responders.

The issue was recently brought up by Police Sgt. Chris Coverly during an Oxford Borough Council meeting where he laid out his concerns. Fortunately for Oxford residents, the borough's mayor and members of the police department and Union Fire Co. and Ambulance worked together to solve a serious problem.

Here in southern Chester County, a “302” became an even more serious issue than it already was when both the Jennersville Hospital and Brandywine Hospital closed. Brandywine Hospital was the only hospital with mental health beds in Chester County. Although Jennersville Hospital did not have mental health beds, professionals at that facility could evaluate a person who was being petitioned for a 302. And Jennersville Hospital was a close option for people  who reside in southern Chester County. In the state of Pennsylvania a person being evaluated for a 302 cannot be transported out of state.

As Gary Vinnacombe, Deputy Chief of EMS explained, “it can be much more than an issue of mental health. When patients need to be medically cleared, there can be many underlying medical issues. Blood tests of the patient are needed to see if drug and alcohol are involved. There can be cardiac, liver problems, and many more medical issues that can change the behavior of a patient. A doctor is necessary to verify that the patient does have a mental health issue.”

Another overarching issues is the 911 system. 

“Some EMS systems have a piece where they support non-emergency transports,” Vinnacombe explained. “When someone calls for the ambulance and there is not a 302 in place, the ambulance doesn’t have the authority to take them if the person doesn’t want to go and they are of sound mind. So then the police have to enforce that involuntary piece. We both, (police and ambulance) want the best for everyone with mental health issues,” 

Vinnacombe added, “I couldn’t have been happier with the outcome from our meeting.  We were all on the same page. We have had a huge increase in ambulance calls which affects all of us. We had to hear each other’s perspectives and respect each other. The good thing is, we all wanted the same outcome. We all agreed on the safest manner to transport the patients and what was best for them.”

Oxford Police Chief Sam Iacono said, “We left the meeting feeling good with the temporary protocols that we have set up. We expect some hiccups along the way, but we will work those out together. What we agreed upon is that when a 302 comes up, the police and ambulance groups will jointly work together. The ambulance will transport the person with the police either riding with them or following behind in the police car as needed. However, the public needs to be aware that this recent arrangement will leave the community without an ambulance or police for a period of time. We are hopeful that the county and state will come up with funding to help us with this mental health issue as we move forward.”

Both entities feel that when Christiana Hospital takes over the former Jennersville Hospital building, they will be able to work out ongoing issues with them.

There is a new national number to call in Chester County for Mental Health issues—988.

“Moving to the three-digit 988 phone number gives us the opportunity to strengthen our existing suicide prevention hotline service, and to expand the crisis care system that provides direct, life-saving service for all in need,” said Pat Bokovitz, the director of the Chester County Department of Human Services, in July of 2022.

However, the closing of Jennersville and Brandywine Hospitals has still left a void in mental health care in Chester County.

Involuntary mental health treatment continues to be a highly controversial issue among practitioners, advocates and those who have sought and received treatment. Some argue that involuntary treatment is the only way to guarantee that certain people get the help they need. Others say it infringes on a person’s civil rights and can push them away from seeking help in the future. And therein lies the rub for the police and ambulance entities. The minute you throw the phrase “civil rights” into the scenario, you open the door to liability. And there is more to consider than liability. Nurses also figure in this health issue. One local nurse who wishes to remain anonymous,  said, “This is a much bigger problem than liability. It is a health care crisis.”

“Unless people look at this as a health care crisis there will be no solution,” she said. “Recent statistics show us that the number of people with mental health issues, which also may include substance abuse, continues to grow. According to the National Alliance on Mental Illness (NAMI), 1,814,000 adults in Pennsylvania have a mental health condition. That is just the number in Pennsylvania. All health care issues require a multi-disciplinary approach when caring for any patient. And this is a health care issue.” 

The nurse continued, “In a hospital, you don’t just have nurses, or even one doctor caring for a patient. You have a team and you need a team when dealing with mental health. There is a lot of education needed when dealing with mental health issues. It is not safe to ask either the police or the ambulance to transport someone with mental health issues. You can’t throw the police or ambulance personnel into the line of fire without training. This is uncharted territory.” 

She continued, “The real problem here is that people don’t believe mental health is a real issue. And, mental health is not always seen as a community problem. The community has to see mental health as issues that affect every family at one time or another. A person suffering from mental health issues can affect anyone they come in contact with. Society has seen the increase in mental health issues during the COVID pandemic. It doesn’t just happen to other people. It happens to people of all ages and socioeconomic status.”

Mental health issues certainly affects taxpayers since municipalities pay for the police, fire and ambulance services needed to respond to problems. Remember, that first line of defense during the pandemic was emergency personnel.  COVID-19 continues to impact municipal budgets, with business closures, unemployment, and property foreclosures. So if mental health issues such as a 302 commitment is using a municipality’s emergency personnel, it does become everyone’s problem. Ignoring mental health issues won’t make them go away and will impact municipal budgets, not to mention the human population.

Candy Craig, the mental health deputy administrator, met with the Oxford Police Department, Union Fire Company and Ambulance and said, “I was so grateful when Oxford reached out to me for a meeting. I was impressed that we came together so quickly and we all walked away with a very strong partnership moving forward.”

Craig added, “At the Chester County Mental Health Department, we are limited to what we can do from our office. We support any individual who is willing to travel to a hospital for mental health issues, but we also need help from the municipality. In the past we have contracted with ambulance companies for people uninsured or in need of behavior health attention. Regulations limit us on how those ambulances get reimbursed. We are constantly looking for any way to do our job more efficiently. Funding what we need is always an issue. We have done a great deal of advocacy to get more funding for mental health services. It has been 12 years since we have seen an increase in funding from the state. We apply for any funding opportunity or grants and are always working with all of our partners to see how we can meet the needs of the mental health community. We have a few things coming in the next year. Chester County will look very different by next year. Our commissioners are so supportive. They are amazing and truly value behavior health in our communities.”

Craig did stress that, “As far as the Pennsylvania law covering 302s and other mental health procedures, they are roughly 80 years old. So there is that to contend with.”

Craig also added, “We certainly need more ambulances throughout Chester County, especially since Brandywine and Jennersville Hospitals closed. We also need mental health beds in hospitals and in Chester County we have none. We do have our Valley Creek Crisis Program and they manage our 988 crisis hotline. They can handle walk-in assessments and tell you where to go for more help.”

The Valley Creek Crisis Center is open 24 hours a day, 7 days a week. If you or someone you care about is experiencing a mental health or emotional crisis in Chester County, you can call 610-280-3270.

Craig admitted, “No one can deny the 302 commitment law is very confusing. Once a 302 commitment is approved, the person goes through Valley Creek and they facilitate on behalf of our office. When they facilitate the process it becomes a warrant. It is not a criminal warrant, it is a civil warrant. It is just about getting that person evaluated by a physician.”

When asked why Craig chose this career path she said, “I have always had a strong passion to help people with a mental health diagnosis. I want to give everyone an opportunity to get access to the services they need.”

Oxford Police, the Union Fire Company and Ambulance, and Craig have all worked together to provide a safe passage for those suffering with mental health issues.