No vacancy? In wake of Deeds tragedy, questions focus on mental health care

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Gus and Creigh Deeds on the campaign trail in 2009. Photo: Hyunsoo Leo Kim/REUTERS/Newscom.com Gus and Creigh Deeds on the campaign trail in 2009. Photo: Hyunsoo Leo Kim/REUTERS/Newscom.com

A week after Austin C. “Gus” Deeds stabbed his father, then turned a gun on himself, scrutiny of the episode has turned to the day before the violence, when Rockbridge mental health care workers failed to secure a bed for him in a psychiatric facility.

Friends of Gus Deeds say the musically and intellectually gifted 24-year-old had been diagnosed as bipolar, as detailed in C-VILLE’s in-depth profile of Deeds, and that over the past four years his behavior had changed radically.

It’s unknown whether it was a threat of violence that led his family to seek an emergency custody order on Monday, November 18. A mental health care worker at Rockbridge Area Community Services, the public agency that handles crisis care in a wide swath of western Virginia, determined that the young man should be hospitalized, and, according to that agency’s top administrator, unsuccessfully sought placement at psychiatric facilities.

Instead of receiving inpatient treatment, Gus Deeds went home that night, and the next morning, according to Virginia State Police, he stabbed his father in the head and upper torso near a barn on the Bath County property. Then, he went inside the house and fatally shot himself. His father was airlifted to UVA medical Center where he underwent surgery and was released on Friday, November 22.

In the wake of the tragedy, the suggestion that there aren’t enough beds for the mentally ill in Virginia prompted calls to hospitals from news outlets, who reported that several—including UVA—had beds on their psych units available on Monday night.

Senator Deeds had not responded to C-VILLE’s efforts to reach him by press time Tuesday, but in an e-mail to The Daily Progress, he excoriated the mental health care system he blames for the tragedy, describing the day before his son’s death as a “nightmare of frustration.” Deeds promised to work for change “to make sure other families don’t suffer what we are living.”

The question is, what needs to change? Is it more beds? Greater communication between agencies? New laws?

Mental health administrators say current standards mean even if there were beds open, the younger Deeds might not have been welcome at any of the state-run or private psychiatric hospitals in Virginia, none of which are required by law to accept patients.

“A hospital can find ways to deny admission,” said Buzz Barnett, emergency services director for Region Ten, the agency that provides mental health services to the Charlottesville area. “If a person has been violent due to mental illness, some [hospitals] are less likely to take that person,” Barnett explained.

The circumstances of the tragedy and the senator’s high profile position as a state politician popular on both sides of the aisle mean the issue of mental health care in Virginia will be front and center as a new governor comes into office and the legislative session begins in January.

“Obviously, Virginia will do a review of what happened and if there is a lack of capacity where someone who is decompensating and has been ordered into treatment can’t find treatment, that’s an issue that needs to be addressed,” said Delegate Rob Bell.

Barnett notes that there are far fewer psychiatric beds around the state now than in the past, in part due to budget cuts in 2009, which all but erased a bump in state funding for mental health care in the wake of the 2007 Virginia Tech shooting.

In Charlottesville, according to Barnett, the number of beds for the acutely mentally ill has plummeted from around 80 some 20 years ago, when there were three facilities—UVA, Martha Jefferson Hospital, and Charter Behavorial Health Systems—to the current number: 23, all of them on UVA’s “Five East” psychiatric floor.

A 2011 study conducted by Virginia’s Inspector General G. Douglas Bevelacqua found that over a 90-day period, 72 people who met the requirements for a temporary detention order were turned away. (That number is 1.5 percent of the 5,000 TDOs that were successfully executed.) Bevelacqua’s office is now leading an investigation into the Deeds tragedy.

“There is some sense that there are not enough beds,” said Delegate David Toscano, who is a close friend of Senator Deeds and spent time with him at the hospital following the incident. But Toscano, like Barnett, suggested that it’s not just the reduced number of beds in the state that’s the problem.

“One of the things that you find out very quickly is that the word ‘bed’ means a different thing to different people at a different time, because it really has more to do with the services around the bed than the bed itself,” said Toscano. “An institution or a hospital might have a bed available, but not a bed available for the kind of person who needs it,” he said.

Dennis Cropper, executive director of Rockbridge Area Community Services agency, declined to comment on the specifics of the fruitless bed search for Deeds, but said rural mental health care workers face particular challenges as they work to assess and then place patients within the four- to six-hour limit set by the state. The clock starts when a patient is picked up by police, and if there’s an hour transport before he can be seen, the clinician treating him is already an hour into that window before an assessment is conducted. Then come the calls.

“It’s not a matter of just calling hospitals and saying, ‘Can you take this patient?’ We call the hospital, we have to fax them information for a prescreening. They may later call back and say, ‘Now we need medical information,’” Cropper explained. “They take it to a staff review committee or admissions review committee and say yes or no.”

The process for each hospital can take up to an hour, and Cropper said there have been occasions when the one staffer on duty has called 13 hospitals to find a bed. Even with those challenges, overwhelmingly, Cropper said, patients find placement.

In the wake of the tragedy, both Barnett and Toscano said they’d be interested in exploring a central database for psychiatric beds.

“If you can determine at the click of a button whether there’s a bed available in a hotel where you can stay for the night, you ought to be able to figure out or easily determine whether there are beds for mental health patients,” said Toscano, noting that such a database exists but that it is not currently well maintained.

Questions would need to be answered before mental health care workers could rely on it, however.

“Let’s say the website says there’s a bed. The next question becomes what does the bed come with? Does it come with some kind of security? Does it come with a different level of service in terms of medication? You [the Community Service Boards] still have to make that call and find out,” said Toscano.

Barnett noted that listing beds on a database wouldn’t help unless hospitals were required to take all patients. He contrasted the ease of placing a patient with a heart condition or cancer with the difficulty finding placement for the mentally ill and suggested that discrepancy, evidenced by Gus Deeds’ tragic death, highlights society’s failure to provide adequate care for those suffering from mental illness.

“It’s a sad commentary of the condition that we’re in,” he said.

Gus and Creigh Deeds on the campaign trail.

“One of the things that you find out very quickly is that the word ‘bed’ means a different things to different people at a different time, because it really has more to do with the services around the bed than the bed itself,” said Delegate David Toscano.

 

  • John Giuliano

    Abolish detention without charges. Abolish torture. Get rid of tyrants.

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