WHEN TRAGEDY STRUCK
Creigh Deeds remembers his son, Gus, for his musical talent and academic accomplishments, not for the 13 stab wounds that the son inflicted on his father’s face and torso in 2013.
Gus Deeds taught himself to play the harmonica, piano and guitar, and was valedictorian of his class at Bath County High School before he went off to the College of William and Mary.
“He was everything that I would want, that I would hope to be but never was,” said Deeds, a state senator who represents southwestern Virginia, including Rockbridge County and Charlottesville. “He had so much confidence that you just couldn’t imagine.”
Mental health experts say the Deeds case highlights everything that is wrong with Virginia’s mental health care system. The tragedy exposed uneven care, depending on whether a patient lives in a wealthy or poor county. It also revealed a lack of communication between mental health officials and hospitals that can have devastating consequences. It further illustrated that people who need to be hospitalized should not be left on the streets, without care.
The day Gus Deeds was assessed, the evaluator had four hours, with a two-hour extension, to find a bed before Gus Deeds' involuntary commitment ran out. After the Virginia Tech shooting, officials recommended that evaluators be given eight hours to locate a space in a mental health facility for a needy patient.
But neither suggestion was implemented until after the Deeds tragedy.
In November 2015, the senator filed a civil lawsuit in Bath County Circuit Court against Virginia, the Rockbridge Area Community Services and the pre-screener, the mental health official who was assigned to assess Gus Deeds' mental state. Deeds alleges wrongful death, negligence and medical malpractice in seeking $6 million in damages. A hearing is set for July 27.
“I want to create a system of care, a real system throughout Virginia so that people that are in trouble, that have mental illness, can get the services they need no matter where they live,” Deeds said.
Gus Deeds, 24, was suffering from bipolar disorder when his father called the local community services board on Nov. 18, 2013, seeking help. Deeds was concerned about his son’s erratic behavior and felt he needed to be hospitalized.
At least five nearby hospitals had available spots on Nov. 18, the Deeds lawsuit says. But Gentry allegedly failed to contact them.
Early the next morning, Gus Deeds walked outside his home and attacked his father while Deeds was feeding his horses. The seriously injured Deeds was airlifted to the University of Virginia Medical Center. Gus Deeds then shot himself with his father’s hunting rifle.
DISPARITIES IN FUNDING
Deeds says he is optimistic, but knows the idea is ambitious. Reinhard, medical director at Virginia Tech’s counseling center, agreed.
“The boards aren’t ready for this yet,” Reinhard said. “And the General Assembly isn’t ready to fund them.”
Gill, a top official in the behavioral health department, said it’s difficult to calculate the cost to provide all of the services that are needed.
“If I had to guess, I would say that it could cost a minimum of $200 million to get the community services boards to have similar standards,” she said.
The Virginia General Assembly appropriated $40 million to mental health efforts after the Virginia Tech shooting in 2007. But then the housing crisis struck and funding disappeared. The state made big plans for improvements, but without money, Virginia could not resolve recurring issues in the mental health system.
Even with limited state funding, the Rockbridge board is trying to make improvements.
An individual can get an appointment with a clinician or psychiatrist on the same day as part of the board’s new same-day access program that went into effect May 1. In the past, getting an appointment could take up to three or four weeks.
“The reality is that one size does not fit all,” Deeds said. “Some decisions need to be made locally and that means that there needs to be a partnership between the state and its localities.”
Crisis services include stabilizing a person during an emergency and following up with short-term counseling. Case management is run by social workers at the boards, and it encourages direct involvement in a community by helping an individual access social, legal and educational services.
But Virginia lawmakers also passed a law that will increase the mandated services from two to 10 by 2021. The subcommittee recommended this plan to the General Assembly.
'One size does not fit all'
The goal is to ensure that individuals can receive the same mental health services no matter where they live in Virginia. The subcommittee borrowed the idea for the same-day access initiative from Virginia’s STEP-VA program.
“PEOPLE WHO HAVE A SERIOUS MENTAL ILLNESS LIKE SCHIZOPHRENIA, ON AVERAGE, DIE 25 YEARS BEFORE PEOPLE WITHOUT A MENTAL ILLNESS"--Stacy Gill, state mental health official
care in the same building as mental health care providers by 2019. People with mental illness often suffer from common physical ailments, such as high blood pressure, toothaches or the flu.
“People who have a serious mental illness like schizophrenia, on average, die 25 years before people without a mental illness,” Gill said. “Their illnesses really interfere with their abilities to take care of themselves or to get the care that they need.”
She said accessing physical and mental health care should be like “one-stop shopping.” Everyone should be able to get a primary care screening, if needed, when visiting a mental health facility.
But it is unrealistic to expect that dramatic improvements will happen immediately, Reinhard said.
“To try and change it is the well worn out analogy of trying to turn a huge ocean liner. It doesn’t turn on a dime. This doesn’t get fixed immediately.” he said. “It’s gradual turns.”
Deeds looked to Rockbridge Area Community Services Board for help. A community services board is supposed to provide treatment to mentally ill people, especially those in a crisis, while maximizing their ability to live in the community rather than being hospitalized.
A deputy sheriff from Bath County transported Gus Deeds to the Bath Community Hospital, where a pre-screener, Michael Gentry, was assigned to evaluate the young man. In less than five minutes, Gentry agreed with Deeds that his son needed to be involuntarily hospitalized because he was a danger to himself and others. Gentry then contacted hospitals in the area, trying to find a spot for Gus Deeds, according to the lawsuit.
But the lawsuit alleges Gentry wasted time during the crucial six-hour window allotted for finding a psychiatric bed. When time expired and with nowhere else to go, Gus Deeds was sent home with his father.
Adding to the senator’s grief, several current and former public officials say Gus Deeds did not need to die that day, especially because the state had experienced the effects of the mental health system's shortcomings only six years before.
They say Virginia squandered a chance to make meaningful improvements in mental health care after 32 people were shot to death at Virginia Tech in April 2007.
A web-based, updated bed registry was a centerpiece of the recommendations that came out of a state investigation after the Virginia Tech shooting. The registry would have given a mental health evaluator more time to assess Gus Deeds and find him a spot in a psychiatric facility, known in mental health as a “bed.”
The behavioral health department also applies for federal grants every year to help fund the community services boards. The grant money is distributed by the state to specific boards that offer certain services that qualify for a federal grant.
Local communities are expected to kick in 10 percent of what they are allotted by the state. But many boards are located in poorer, rural counties and cannot afford to supplement mental health services.
Insurance fees, like Medicaid, make up the rest of the funding. But many people in the Rockbridge area are uninsured, especially those suffering from mental illness. This means a lot of the Rockbridge board’s funds are spent covering the uninsured, instead of expanding services.
The state behavioral health department funds each community board, depending on the number of services offered and the size of the population it serves. Smaller boards located in less populated areas, like Rockbridge, receive less from the state because they offer fewer services.
The Fairfax County Falls Church board is the largest funded community services board in the state with a $147.3 million budget in 2015. Fairfax is the most populous jurisdiction in the state with more than 1 million people.
Rural counties cannot provide their communities with the same quantity of mental health services as the state’s more urban areas, said Stacy Gill, the behavioral health department’s executive director of mental services.
Variations in size and population make it difficult for the Virginia behavioral health department to provide all boards with the same services, Deeds said.
“If you’ve seen one [board], you’ve only seen one,” he said. “It’s a loose confederation; it’s not really a system.”
Virginia’s behavioral health department received $1.75 billion in funding in 2015. The state’s 40 community services boards received over $75 million of that money.
Community services boards are funded by four main sources: general state funding, federal grants, insurance fees and local government contributions. Over half of the annual budget for mental health services comes from the state general fund.
Deeds is the chairman of the Joint Subcommittee to Study Mental Health Services in the 21st Century. The subcommittee advocates for legislation that would improve the quality and delivery of mental health services in every region of the state.
The Virginia General Assembly created the subcommittee; the leaders of the House and Senate appointed its members.
Deeds’ subcommittee played a role in the passage of a law last month that will require all community services boards to offer same-day access by 2019. Crisis services and case management are currently the only services that Virginia’s boards are required to provide.
The behavioral health department created the STEP-VA program in 2015 with a $1 million federal planning grant from the Substance Abuse and Mental Health Services Administration. Since then, the department has used an additional $2 million of its general funding to support the program.
The Deeds subcommittee hopes the law will put doctors who provide physical
Stacy Gill, Department of Behavioral Health and Developmental Services
'WAREHOUSING' MENTAL ILLNESS
Eagle’s Nest has two transitional homes in Buena Vista—one for men and one for women. Eagle’s Nest clients can live in the houses as long as they need to, said Phil Floyd, Eagle’s Nest manager. Each home houses four residents. Robinson lives in the house for women.
“The transitional house is very good,” she said. “I have friends there, and I like getting to do things on my own.”
State officials say they hope they can create similar housing systems across Virginia. “If those individuals have the placements, support services [and] the follow-ups that they need, they would not need to be in a hospital,” said Jack Barber, interim commissioner for the state health department.
Virginia has over 1,500 beds in state mental hospitals for adults seeking treatment for their mental illnesses. People who are ready to leave occupy nearly 200 of the beds, health officials say. But they have nowhere else to go.
Francis Robinson suffers from bipolar and multiple personality disorders. Twenty years ago, she walked into the Rockbridge County Community Services Board looking for help. She had suffered a psychotic break after dealing with the deaths of her mother, grandmother and children in the same year.
A social worker recommended Eagle’s Nest Clubhouse, a psychosocial rehabilitation service offered by Rockbridge Area Community Services in Buena Vista. At Eagle’s Nest people relearn skills, like renting an apartment, grocery shopping and paying taxes.
Robinson goes to Eagle’s Nest every day. She said the environment there helps her avoid stressful situations that can trigger her multiple personality disorder. Her disorder causes her to think and behave like an infant.
“In the morning, I’m a baby,” she said. “In the afternoon, I’m more like an adult.”
When states across the country began closing mental hospitals in the 1970s, people suffering from mental illness were discharged into their communities.
The intent was to help people live more independently. But some experts say the strategy has had unexpected consequences.
Police officers have encountered an increasing number of mentally ill people because of deinstitutionalization, said Sergeant Hugh Ferguson of the Rockbridge County Sheriff’s Office.
“I don’t remember doing a lot of mental health calls and servicing when I was a rookie officer,” said Ferguson, who has been a deputy for 25 years. “This is a new job that we’ve had to accept and really focus on how to train and serve the community better.”
The woman’s daughter said she wouldn’t speak and was showing signs of mental illness, he said. Welsh spent an hour trying to get into the house. When he finally got inside, he had to talk to the woman for two more hours to coax her out of her bedroom.
“She couldn’t understand why she needed to go to the hospital to get checked on,” Welsh said.
The crisis program’s training helped Welsh understand where she was coming from and know how best to help her, he said.
The sheriff’s office received 125 mental health crisis calls in 2015.
“A lot of times we’ll hear a citizen say, ‘I want to talk to a [crisis trained] officer,’ instead of an officer who is not trained,” he said. “I think that shows that we’re on the right track.”
Virginia’s crisis intervention training program uses federal grant funds from the Substance Abuse and Mental Health Services Administration. It brings together cops, emergency dispatchers, counselors and other mental health service providers in hopes of improving the multi-layered system’s response to someone in crisis.
“The program allows everybody to see each other’s side of the fence,” said John Young, executive director of Rockbridge Area Community Services.
Mental illness in Rockbridge County
When police, hospitals and pre-screeners all understand the entire process, there’s better communication and collaboration, he said.
Society as a whole should want to improve the mental health system because it affects everyone, Deeds said.
Only three to five percent of violent acts are attributed to people suffering from mental illnesses, according to the U.S. Department of Health and Human Services.
Gus Deeds fell within that percentage. But Creigh Deeds says he loves his son—and always will.
Ferguson has taught crisis intervention training classes to law enforcement officers for the past five years. Officers learn how to approach a person experiencing a crisis situation. A crisis could be anything from a domestic dispute to a psychotic break down. But many of these cases involve people suffering from mental illness.
The crisis intervention program consists of 40 hours of training over five days. Each class is capped at 30 trainees and relies on role-playing, discussion and site visits to increase awareness and sensitivity to crisis situations. Field trips include visits to local mental health service sites and state mental hospitals.
Rockbridge County Sheriff’s Deputy Dylan Welsh relied on his training when an elderly woman locked herself in her house, he said.
Francis Robinson, Eagle's Nest client
Blowing up' the system
Public health officials and legislators acknowledge that they often respond in knee-jerk fashion to a crisis. Unfortunately, public interest wanes and momentum for change is lost.
“It’s so hard to fix a huge system like this that interfaces with so many different parts of society,” said James Reinhard, medical director at Virginia Tech’s Cook Counseling Center.
In 2014, Virginia finally created a psychiatric bed registry with real-time updates on the availability of beds in both public and private hospitals. It was two years after the Office of the Inspector General originally made the recommendation.
“If they had implemented those recommendations [in the 2014 critical incident report], Gus Deeds would not have died that day,” said Doug Bevelacqua, former inspector general for behavioral health and developmental services.
Time and again, Deeds and others told investigators, “The system failed that day.” Bevelacqua wanted to include the statement in a 2014 investigative report. He resigned after his supervisors removed the line from the report.
“That statement was considered too emotional for this Report—even though this family member was the only witness to all of the events on November 18, 2013, and that, by any standard, his observation was accurate,” Bevelacqua said in his March 2014 resignation letter.
Virginia’s mental health system needs to be blown up and rebuilt from scratch, Bevelacqua said in an interview.
But nothing will happen—until the next tragedy, he said.
Dr. James Reinhard, medical director at Virginia Tech's counseling center
After the Virginia Tech shooting, experts argued that health officials needed more than four hours—even with the two-hour extension—to assess a person and find a bed.
If there are no available beds nearby, people are sent home, even if they pose a threat to themselves or others. A 2012 report suggested improving access to care to limit the number of mentally ill individuals left on the street. The report summarizes the results of a joint statewide study conducted by the Office of the Inspector General and the Department of Behavioral Health and Developmental Services.
The post-Virginia Tech recommendations also included designating regional managers to ensure every resident who meets the criteria to be detained is appropriately treated or hospitalized.
But the state blew its chance to make improvements to the system. Memories of Virginia Tech faded, as did the recommendations, until Gus Deeds attacked his father and killed himself in 2013.
Source: Rockbridge Area Community Services
More than 40,000 Virginians who suffer from mental illnesses would be eligible for Medicaid if Virginia expanded coverage, according to an article co-authored by Steven Stern that was published in the December 2016 issue of Health Services and Outcomes Research Methodology.
But with a party-line vote, Virginia lawmakers recently rejected Democratic Gov. Terry McAuliffe's bid to expand Medicaid.