Psychologist Shortage Puts Mentally Ill Out on Street

By Tom Jackman
Washington Post Staff Writer
Monday, November 6, 2006

Severely mentally ill people in Fairfax County whose families are trying to get them emergency help are being released without receiving treatment -- or even a hearing -- because there are not enough independent psychologists to examine them.

Nineteen people held involuntarily on temporary orders have been released from hospitals since mid-October, authorities said. Fairfax mental health experts and police are trying to keep track of those let back out on the street.

But with each release, lawyers and police officers are becoming increasingly concerned about the danger to the public. Mentally ill people in Fairfax have become violent in the past. In May, a mentally ill teenager, whose family had repeatedly tried to get him help, drove into the Sully police station parking lot and fatally shot two officers before being killed himself.

"There is a very serious public safety issue here," said Kaye Fair, director of emergency services for the Fairfax-Falls Church Community Services Board, which provides mental health services. "People that, by definition, are dangerous to themselves or others are being released without a hearing."

Faced with the shortage, the Community Services Board began using its own psychologists and social workers for the examinations. That prompted a new interpretation of Virginia law by three special justices in Fairfax that the board's employees were not independent, and they began dismissing cases.

Fairfax hopes to have two more psychologists in place soon, which should ease the situation in the county. But the practice of using board employees, rather than private psychologists, to do independent examinations is widespread elsewhere in Virginia. If judges or special justices elsewhere adopt Fairfax's opinion that they cannot be used, there could be massive upheaval in the involuntary-commitment process, mental health officials said.

The officials said they might try to have the law changed. Also, Virginia Supreme Court Chief Justice Leroy R. Hassell launched a commission last month to study problems with the state's mental health system and devise solutions.

Under the involuntary-commitment process, the special justices are lawyers trained in mental health issues and then appointed by the circuit courts to preside over involuntary-commitment hearings for those deemed mentally ill.

When mentally ill people are picked up by the police or brought in by a family member, they are examined by a psychologist or a clinical social worker from the local Community Services Board. Those ordered held on a "temporary detention order" must be given a commitment hearing within 72 hours to determine whether they should be held for up to six months of treatment. Under Virginia law, a second "independent examination" must be done before the hearing.

For years, Fairfax's Community Services Board has hired outside psychologists for these examinations. But last month, the number of available psychologists dropped from four to one when two decided not to renew their contracts and one went on vacation, and the county had difficulty finding applicants for the somewhat specialized job. Fair said she didn't know why. One of the psychologists who didn't renew said the county wasn't paying an acceptable rate.

When the board began using its own employees, lawyers for the mentally ill argued that they weren't independent because they were employed by the same facility that did the initial evaluation and could ultimately be involved in the person's treatment. On Oct. 19, the three special justices in Fairfax -- Jose E. Aunon, Mark H. Bodner and James G. Kincheloe Jr. -- agreed that the employees did not meet the definition of independent, lawyers involved in the process said.

Fair said the board advertised the positions widely in the mental health community and then among Community Service Boards across the state but got few responses. The job pays about $100 an hour.

The task involves visiting mentally ill people in a hospital, interviewing them, preparing a short report and appearing at the commitment hearing to testify. Judy Rumreich, one of the psychologists who did not renew her contract, said psychologists who do such work typically receive $150 to $250 an hour.

Rumreich said she had been doing the examinations for Fairfax for 21 years and had planned to continue. But when her contract was about to expire, Fairfax sought to negotiate a new rate. "Then, we couldn't agree," Rumreich said, and she moved on.

John S. Lawrence, a lawyer who has represented the mentally ill for 30 years, said that using board employees creates "an inherent conflict of interest." In addition to doing the initial evaluation, the board "is making the evaluation that the people need to be treated, and then they are the ones that may be involved in the treatment," Lawrence said.

Fair said there was a conscious effort to ensure that employees who did the independent examination were not involved in the first screening or the treatment. She said there was no financial gain in recommending that someone be held for treatment.

John C. Whitbeck Jr., a Leesburg lawyer, runs a clinic for George Mason University law students who represent the families of mentally ill people at Fairfax commitment hearings. He does not believe the board's practice posed a conflict. State law doesn't specifically prohibit it, and many other counties use board employees for both evaluations, he said. The law specifically allows the practice for juveniles.

For now, "it's devastating" for the families in Fairfax whose cases are being dismissed, said Samuel N. Smith, a lawyer who represents mentally ill clients in the hearings. "The families go through this process, and then it's out of their control."

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