“We’re going to investigate the circumstances that led up to Austin Deeds’s release at the expiration of the emergency custody order,” said G. Douglas Bevelacqua of the Office of the Inspector General.
This all comes 6 years after the Virginia Tech Shooting, when a gunman killed 33 people (himself included). The massacre caused the entire state of Virginia to willingly throw their friends, family, and neighbors in a psych ward without the same restrictions as before, and millions of dollars in funding were used for a “wholesale evaluation and revamping” of the mental health care system.
Virginia’s DHHS secretary Bill Hazel promised to push for “changes” if further “deficiencies” are discovered, but this probably means that nothing about the system or the amount of power it holds over the public will change, just that they will learn how to scare the public into submission and acceptance of it better.
“I’ve still got two more weeks before I’ve got to submit the budget, and if there are glaring problems I can address those,” McDonnell said in an interview at the Republican Governors Association conference in Scottsdale, Ariz. “What we need to do now is to see why there was a breakdown” in communication.
Police say that the sheriff’s office had been called to Sen. Deeds’ home on Monday for a “non-emergency call for assistance”, but wouldn’t tell the media if the purpose was to transport Austin to a facility for a psych eval. There hadn’t been any other 911 or non-emergency calls made before that.
Also, an autopsy by the Office of the Medical Examiner in Roanoke “confirmed” that the gunshot wound was self-inflicted and “fired from a rifle”. However, the toxicology results have not come back yet and won’t for possibly weeks.
Mira Signer from Virginia’s NAMI chapter said Wednesday that it was “crucial that officials figure out where things fell apart in a system that is often difficult for families to navigate”:
“Generally our feeling is that if a family with resources and know-how has difficulty accessing and navigating the mental-health system, it speaks volumes about what happens to people who don’t have resources,” she said.
According to the law:
In Virginia, mental-health authorities can hold people for four to six hours after such an order is issued. After that, the magistrate must issue a temporary detention order to allow a person to be held for 48 to 72 hours for further evaluation and treatment. But the order cannot be issued without an available bed.
Rockbridge Area Community Services
July 2003 – Present (10 years 5 months) Lexington VA
Provide services to prevent and treat mental illness, developmental disabilities, and substance abuse, to individuals who experience these conditions in the Cities of Buena Vista and Lexington and the Counties of Rockbridge and Bath, Virginia
Director of Adult Services
New River Valley Community Services
February 1982 – June 2003 (21 years 5 months) Blacksburg VA
Managed programming for adult Mental Health, Substance Abuse, and Intellectual Disability Services for the New River Valley area
East Arkansas Regional Mental Health Center
January 1980 – January 1982 (2 years 1 month) Wynne, AR
Provided Mental Health Therapy to all ages and problems
North Central Arkansas Mental Health Center
November 1978 – December 1979 (1 year 2 months) Newport, AR
Provided mental health therapy to all ages and issues
Dennis Cropper’s Education
Texas A&M University
Doctor of Philosophy (Ph.D.), Clinical Psychology
1973 – 1976
Texas A&M University
Master of Science (M.S.), Oceanography
1969 – 1973
Officer, U.S. Navy (July, 1970 – December,1971)
University of Cincinnati
Bachelor of Science (B.S.), Zoology/Animal Biology
1965 – 1969
The Virginia Tech Review Panel’s August 2007 report made broad recommendations that included:
- campus and law enforcement security procedures at state universities;
- mental health practices and procedures relating to emergency services, temporary detention, and civil commitment processes;
- needed legislative changes;
- changes in information exchange; and
- improved coordination among involved agencies and the courts.
Seung-Hui Cho’s family made his health and school records available to the panel (not to the public), which allowed for deeper insight and led to recommendations around information sharing and coordination of efforts between and within school systems. Amazingly, Cho did well with special accommodations in school and intensive and consistent counseling outside school hours during his school years in Fairfax County, well enough to be accepted by Virginia Tech….
Within weeks of the tragedy, each of Virginia’s 40 community services boards (CSBs) had examined in minute detail its own process of emergency services response in coordinating efforts with magistrates, private and state hospitals, law enforcement, and the local court systems of special justices (attorneys appointed by the respective circuit courts to preside over involuntary commitment hearings). CSBs, the local authorities designated by the Code of Virginia, are mandated to ensure, within every Virginia locality, provision of emergency services for psychiatric issues. Among their broad spectrum of services, CSBs can recommend individuals for involuntary temporary examination, detention, diversion, and outpatient treatment. Internal scrutiny by CSBs produced revisions in local practices and additional evidence for necessary changes in the law.
True to his word, Kaine announced last fall that his biennial budget for 2008-10 would include allocations for a $42 million “down payment” to begin upgrading mental health services. It is significant that funds were designated to CSBs to improve the following community services: emergency, outpatient, case management, and crisis stabilization capability for youths and adults suffering from psychiatric disorders. Kaine specified the need for identifying problems, intervening, and treating them as early as possible, so that individuals with mental illness can engage in services quickly and begin a path to recovery that could avoid psychiatric crisis and the trauma of involuntary detention or commitment….
The omnibus bills clarified the ability to share vital information while preserving confidentiality and remaining in alignment with federal laws, including HIPAA and FERPA. Major roles and responsibilities for CSBs, the courts, facilities where individuals are detained involuntarily, and for independent examiners who recommend treatments to the courts were clarified in the bills. Additionally, a section of the bills outlined a new and quite specific mandatory outpatient commitment process (see sidebar).
Finally, the omnibus bills proposed a major change in the criteria for involuntary detention and inpatient/outpatient commitment. Virginia Code prior to July 1, 2008, had required that the person “presents an imminent danger to himself or others as a result of mental illness or is so seriously mentally ill as to be substantially unable to care for himself.” As of July 1, 2008, the language of the Code is as follows:
[T]here exists a substantial likelihood that, as a result of mental illness, the person will, in the near future, (a) cause serious physical harm to himself or others as evidenced by recent behavior causing, attempting, or threatening harm and other relevant information, if any, or (b) suffer serious harm due to his lack of capacity to protect himself from harm or to provide for his basic human needs, (ii) is in need of hospitalization or treatment, and (iii) is unwilling to volunteer or incapable of volunteering for hospitalization or treatment.
As the omnibus bills and approximately 50 other related bills proceeded through Virginia’s legislative process, changes were debated, revisions made, and compromises achieved with the culmination of House and Senate bills that could be supported by, or at least accepted by, the governor, General Assembly, advocates, providers, and most of the stakeholders in Virginia. Even as state revenues continued to plummet, Kaine and the General Assembly retained almost the entire proposed down payment for reform. Kaine signed the legislation into law on April 23, 2008.
Some voices dissented regarding the involuntary commitment criteria and the increased involvement of law enforcement and the courts. Others did not believe the law went far enough and would have preferred an outpatient commitment law more like New York State’s Kendra’s Law. Advocates on both sides of the debate did agree that in state after state, the more available appropriate community services are, the less often compulsory treatment is needed.
Individuals with mental illness proved to be exceptional advocates and successfully convinced the General Assembly that language supporting recovery should be included in the final bills, as well as language that promoted consumer preferences for treatment. These advocates were not in favor of the broadened criteria for involuntary detention and commitment. Even though the new criteria were adopted, these individuals educated legislators and others about the potentially serious and permanent side effects of psychotropic medications and what it takes to engage people in the mental health system in a positive, voluntary way.
Some may argue that the new law and the new funding reflect a propensity to detain and commit more individuals to psychiatric facilities. The governor; commissioner for the Department of Mental Health, Mental Retardation, and Substance Abuse Services, Jim Reinhard, MD; and VACSB and its member CSBs hope to offer and achieve a different approach. Our shared goal is to intervene, engage, and stabilize individuals early; provide vehicles for adequate follow-up treatment; promote recovery-oriented services; and avoid individuals’ cycling in and out of emergency rooms and psychiatric facilities.
Accomplishing our goal will be a challenge of huge proportions, even if the stigma and discrimination attached to mental illness were not ever-present:
- The down payment will have to be followed with continuing biennial “mortgage payments.” Such funding will have to remain a priority even if state revenues continue to decline.
- Such “mortgage payments” will be complex as federal actions gnaw at the delicate balance in state and federal partnerships of funding sources such as Medicaid.
- Local agencies and stakeholders will have to stretch, tug, and overcome discrete agency agendas in their efforts to coordinate and implement the new law.
- Individuals with mental illness will be asked to take some responsibility for their own disease management and recovery.
- Communities at large will be called upon to recognize that mental healthcare is a responsibility of the entire community.
Mental illness, in its complex and unique impact on each individual, does not fit neatly into a law, however thoughtful and reasoned. Almost every psychiatric crisis produces an exception that demands flexibility to meet and accommodate specific individual needs.
Um, yeah, like letting patients go home and stab their state senator father before shooting themselves with a rifle (which is tough to do, by the way)?According to this document found from a company called Magellan Health Care – a company that coordinates payments to the military/civilian mental health system in Virginia and D.C. – their new methods were to be tested “in early November”. Maybe the new “methods” include sending patients home (even if they’re homicidal/suicidal) so that the insurance companies don’t have to foot the bill for a 72-hour-or-longer-hold.
Even though the initial response from the media was rebukes about mental health funding in Virginia, the fact that the beds were available for Deeds’ son and that Rockbridge totally dropped the ball on this one puts the focus now on them. They get some funding from local governments but are licensed and overseen by the state Department of Behavioral Health and Developmental Services.
State officials – speaking on the condition of anonymity – told the Washington Post their understanding is that the Rockbridge agency made multiple calls in search of a hospital bed but ran out of time before finding one.
However, the University of Virginia is working on a study right now involving emergency mental health evaluations in the state and has found that in the vast majority of cases, beds are quickly found.
The study this year examined all 1,260 cases in which involuntary admission was recommended in a single month, April. In 80 percent of those instances, a bed was found after officials contacted one or two facilities. In 87 percent of cases, a bed was found within four hours. Officials were unable to locate a bed within six hours in 4 percent of cases.