Va. Lawmaker`s Stabbing Spotlights State Mental Health Issues

Nov. 20--Just 13 hours after being released from an emergency custody order for a mental health evaluation, Austin Creigh "Gus" Deeds was dying of a gunshot wound and his father, state Sen. Creigh Deeds, D-Bath, was staggering for help with multiple stab wounds.

Gus Deeds, 24, was released from the emergency custody order at Bath Community Hospital at 6:30 p.m. Monday, according to the community services board that conducted the evaluation.

The order had expired under a state law that allows emergency custody for four hours, with an additional two-hour extension, to determine whether the person should be detained further for up to 48 hours for psychiatric evaluation and treatment.

"He was free to go," said Dennis Cropper, executive director of the Rockbridge Area Community Services Board, one of 40 local and regional mental health agencies mandated to provide emergency mental health services. He did not specify whether Deeds had been held for four hours or six.

Cropper said Deeds was released because mental health workers were unable to find a psychiatric bed for him, despite checking eight hospitals from Radford to Winchester and east to Richmond.

"There were no psychiatric beds at all," Cropper told the Richmond Times-Dispatch.

The next morning, at 7:25 a.m., the Bath County Sheriff's Department received an emergency call that brought them to the Deeds family home in Millboro, where they found Gus Deeds with an apparently self-inflicted gunshot wound. His father, who had been picked up by a cousin after reaching the nearby highway, was airlifted to the University of Virginia Medical Center for emergency surgery.

The attack cast a national spotlight on a problem that has come under increasing attention in the past two years in Virginia -- the release of people who qualify for involuntary detention because they present a threat to themselves or others, but cannot find room in the state's system.

"This is something that happens to families all of the time," said Mira Signer, executive director of the National Alliance on Mental Illness of Virginia. "You can't get the services you need."

It remains unclear whether psychiatric hospital beds were available in the region on Monday or not. The Daily Progress of Charlottesville reported that hospitals in Harrisonburg and Charlottesville had beds available at the time.

Cropper declined to discuss specifics of the younger Deeds' condition at the time he was held, saying it would be a violation of his privacy rights. In a statement Cropper's office issued late Tuesday, there was no discussion of Gus Deeds' condition or treatment beyond expressions of concern for the young man's death and his father's wounding.

Katharine M. Webb, senior vice president at the Virginia Hospital and Healthcare Association, said the state mental health system's problems go far beyond the availability of private psychiatric beds.

"This is hard stuff," Webb said. "There are no simple answers, and everybody is responsible for fixing it. Everybody has to work together to solve the problem."

But the availability of beds and staff has been a longstanding concern in Virginia, where the term "streeting" has become synonymous with the reality of people being released without the mental health treatment they need because services are not available.

A 2011 report by the Office of the Inspector General for Virginia's mental health system confirmed that 200 people who met the criteria for a temporary detention order, or TDO, "were released from custody because no psychiatric facility was willing to admit these people" from April 1, 2010, to March 31, 2011.

In a more comprehensive study of state emergency services last year, the inspector general found that in a 90-day period, 72 people who met the criteria for a TDO had been released because no state mental health or private psychiatric facilities would admit them.

"Each incident, in which a person is denied the level of services determined by trained mental health professionals to be clinically necessary, represents a failure of the system to address the needs of that individual and places the individual, his family and the community at risk," states the report, dated Feb. 28, 2012.

The report also found an additional 273 people had received TDOs in the period, but after the six-hour time limit imposed by state law for emergency custody.

While the numbers represented small fractions of all the 5,000 people assessed for TDOs, the study found that "the phenomenon is driven by both capacity and access issues."

The study showed a decrease in state and private psychiatric beds, as well as a striking gap between the number of psychiatric beds licensed at private facilities and the number of beds actually operated in them -- 235 licensed beds were not staffed for operation in 2010.

Richard Bonnie, director of the Institute of Law, Psychiatry and Public Policy at the University of Virginia, said his office is assessing the issue of emergency mental detentions in the state, especially in regard to the decreasing number of state mental hospitals and treatment centers.

"I think there have been improvements in the situation, but rural areas remain a problem," said Bonnie, a key member of the panel that assessed the mental health community's response to the mass shooting at Virginia Tech by Seung-Hui Cho, who had been the subject of an emergency custody order months before the April 2007 massacre.

John Jones, executive director of the Virginia Sheriffs' Association, said the bed shortage "is a statewide issue we're planning to address in the General Assembly."

"We need mental health beds, and this is just another example of why we need them."

The Arlington County-based Treatment Advocacy Center said Tuesday that Virginia has "only 15 percent of the beds available necessary to meet the needs of its population," according to a study it conducted.

The center said public beds for acutely or chronically ill psychiatric patients have decreased by 90 percent nationwide over the past 50 years as mentally ill patients have been moved into community settings.

"The elimination of hospital beds for people who are psychotic or otherwise need help in a crisis is a driving force behind a long list of terrible consequences, including preventable violent acts," said Doris A. Fuller, executive director of the Treatment Advocacy Center.

"We will keep seeing tragedies like this until we provide sufficient inpatient beds to meet the needs of people in psychiatric crisis."

The Department of Behavioral Health and Developmental Services acknowledged the problem.

"Bed availability to meet demand for temporary detention of individuals who are experiencing psychiatric crises and need to be assessed for court-ordered treatment is tight throughout Virginia," said spokeswoman Meghan McGuire.

Usually, a bed can be found in the period of emergency custody, but "it is common in all regions of the state that multiple hospitals must be contacted to find an available bed," McGuire said. Beds often become available after the initial contact with a hospital.

"As a result, nearly all people do find a bed within a reasonable amount of time, although some are found after the six-hour (emergency custody order) time frame expires," she said.

What happened with Gus Deeds is unclear. Mental health officials say a two-hour extension to four-hour custody almost always is sought and granted, especially in rural areas far from hospitals with psychiatric beds.

"Hospitals are few and far between -- hospitals with psychiatric beds," said Mary Ann Bergeron, executive director of the Virginia Association of Community Services Boards.

Bergeron said the state needs to "bridge that gap" with crisis stabilization capacity "that is not hospital-dependent."

Bath, in the western highlands, is an area where the need is great. The local mental health office in Hot Springs is open only on Mondays. Calls to the Sheriff's Office during regular business hours are referred to the Rockbridge community services board in Lexington, an hour away.

"Lots of times you wait a few hours for a psychologist or psychiatrist to make it here from Lexington. It's been a problem forever," said former Bath County schools Superintendent Percy Nowlin III, a member of the Board of Supervisors and former representative on the Rockbridge community services board.

Bath has no practicing psychiatrist. "There's just a crying, tragic need for help," Nowlin said, "and I hate to say it, but maybe this incident will help draw attention to the problem."

bmckelway@timesdispatch.com

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mmartz@timesdispatch.com

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