Even as he regained consciousness in the hospital last year after his son had stabbed him 13 times, State Senator Creigh Deeds was thinking about what he’d encountered while trying to get help for 24-year-old Gus Deeds. “I started to figure out what we needed to do when I got out of the hospital,” he said.
The November 19, 2013, attack by and subsequent suicide of Gus Deeds both saddened and shocked Virginians, who realized that even a longtime legislator and former candidate for governor could not get the care he needed to save his son during a psychiatric crisis. One year later, has anything changed?
“Immediately we made changes in the processes that failed my son last year,” Deeds said recently in his Charlottesville office. And he’s working on an ambitious plan to overhaul the state’s mental health care system with bipartisan support. What’s not clear is whether reform will stick or fade away as it seemed to after the 2007 Virginia Tech massacre.
Deeds won’t talk about the events leading up to that terrible morning of November 19, but he told The Washington Post, in a 6,000-word article published November 1, that he wakes up every morning thinking about Gus, trying to focus on the happy images, rather than those of that morning, when he went out to the barn at his Millboro Springs residence. He was holding a bucket of feed and Gus walked up and began stabbing him.
Gus Deeds had been diagnosed with bipolar disorder, and the day before the attack, concerned about his son’s increasingly erratic, paranoid behavior, his father got an emergency custody order (ECO), step one in dealing with a mental health crisis, and something Deeds had done twice before, he told the Post. The Rockbridge Community Services Board said it was unable to find a bed for Gus during the six hours it could legally hold him, although later, three hospitals, including UVA, said they had beds and were not contacted. Gus Deeds was released, and killed himself the next morning.
In Virginia’s contentious, highly partisan General Assembly, there was rare unanimity to legislate the issues that led to the Gus Deeds tragedy. “The issues I dealt with last fall won’t present themselves again,” said Deeds.
The legislature increased the time a person could be held on an emergency custody order from six hours, the shortest in the nation, to eight hours. It also passed a “bed of last resort” bill carried by Delegate Rob Bell.
“Before, when you hit the six-hour mark,” said Bell, “they kicked you out.” The new law requires the state hospital—Western State in this part of the Commonwealth—to take the patient if nothing else can be found.
The legislature passed a real-time, online psychiatric bed registry. And the time a person could be held under a temporary detention order (TDO) was upped from 48 to 72 hours.
“We tried to figure out what went wrong in the big and small picture,” said Bell.
“Those are significant changes,” said Deeds, “but they’re about 2 percent of the total pie.” Hospitalization is costly and not the best way to treat most patients, he said, which means it’s critical to provide services throughout the Commonwealth way before a person’s condition becomes a crisis.
Outgoing Governor Bob McDonnell proposed spending $38 million to expand crisis care and treatment. Earlier this year, the General Assembly approved an additional $108 million in spending over the next two years, $75 million of which will go to state-operated mental health facilities. Community mental health services will pick up nearly $34 million in additional funding in the next two years.
Getting it right
The most significant action the legislature took, said Deeds, was to create a joint subcommittee to study mental health services in Virginia, and in other states. The subcommittee, upon which Bell serves, has until December 2017 to report back.
“My goal is to make Virginia the leader,” said Deeds. “I’m convinced we have an opportunity to get it right.”
The subcommittee will look at what services government should provide, how to provide those services and how to pay for them, said Deeds. “We’ve got to reform the existing system first.”
“We’d like to go in with a blank slate,” said Bell. “Where should decisions be made? What role does the doctor play? What role does the community services board have?” And he wants to see how other states are handling mental health care.
In the let’s-do-something aftermath of the Gus Deeds tragedy, “Resources are an issue,” acknowledged Deeds.
The General Assembly, which earlier this year declined to expand Medicaid in Virginia, allotted $4.5 million for extra beds in state hospitals. Deeds said it’s more than he thought he’d get, but still “a drop in the bucket.”
Virginia is one of 20 states that have refused to expand Medicaid under the Affordable Care Act. Democratic Governor Terry McAuliffe made expansion a priority and said there was a “moral imperative” to provide health insurance to the poor, but the Republican-controlled General Assembly blocked those efforts. Of the 400,000 Virginians eligible for Medicaid and without health insurance, 77,000 of those have serious mental health diagnoses, said Deeds, and $200 million of the $2.1 billion the federal government earmarked for Virginia would have gone to mental health care.
“We were foolish not to expand Medicare,” said Democrat Deeds. “It’s hard to understand why we didn’t.”
Republicans like Bell are unswayed. “We think the [Medicaid] program is growing substantially,” said Bell, who voted against expansion because the program has grown from 5 percent of the state budget to 22 percent since the 1980s. “It’s not sustainable or affordable,” he said.
Bell has been interested in mental health issues since law school, when he looked at detention orders or not-guilty-by-reason-of-insanity pleas. When 32 people died at Virginia Tech, Bell wanted to know why mass murderer Seung-Hui Cho, who had been ordered into treatment, didn’t go. “No one had the responsibility to follow up and make sure he went,” said Bell. “Massive changes took place that year.”
And then the recession hit and the state budget shrank, a familiar scenario that happened again this year with news of a $2.4 billion shortfall from cuts in federal defense spending. Both Deeds and Bell point out how dependent Virginia is on federal dollars and how hard the state is hit when Washington cuts spending.
“I hope we’d have the commitment to provide the services we really need in mental health,” said Bell. Finding the funding is always a challenge, he acknowledged, but if the mental health proposals are good ones, they can be priorities, he said, such as the $5 million that was appropriated for “bed of last resort” bills during last year’s difficult budget.
Bell agrees with Deeds that fixing the involuntary commitment procedure addresses only a tiny percentage of mental health services, and that it’s much better to catch things before a crisis erupts.
“We want to make sure there are no more events like what happened to Gus,” said Bell. “We want to look at upstream factors before that happens, and avoid the 2am emergency room crisis.”
Even with the groundswell of attention following the Deeds tragedy, earlier this year there were unexecuted temporary detention orders, said Bell. “At six hours they’d say, sorry, we couldn’t find you a bed. Even after all this happened, there were still unexecuted TDOs.”
Mental health ghettos
Deeds is still troubled that location matters in mental health care in Virginia, and that there are disparities in services available around the state, particularly in rural areas. Earlier this year, he flat-out blamed the Rockbridge Community Services Board for what happened to his son and in June filed what’s called a “notice of claim” that would allow him to sue the board.
By late October, he declined to discuss it. “I’m going to stay away from that,” he said.
Part of this year’s legislation directs the Department of Behavioral Health and Developmental Services to look at the clinicians doing the evaluations at the point of crisis. “I think we need to look at the whole system,” said Deeds.
Money to community services boards flows from the General Assembly through the Department of Behavioral Health and Developmental Services, which reviews requests from the service boards and then allots the money.
“People in Charlottesville have an embarrassment of riches compared to other parts of the state,” he said. “[Region Ten] isn’t the best funded in the state, but it is one of the better funded community services boards.”
Region Ten has undergone changes in the past year. “We certainly have seen significant increases in emergency custody orders and psychiatric hospitalization,” said Lynn Shoen, senior director of emergency and case management services. “Why that is, we’re not really sure.”
In September 2013, Region Ten evaluated 224 people, 67 of whom were hospitalized. A year later in September 2014, 321 people were evaluated and 92 hospitalized.
There are theories, such as whether people are more aware after the Deeds tragedy, or whether people are under a higher level of stress, said Shoen. “We don’t know for sure. There could be myriad reasons. One theory is clinicians are being more conservative in terms of their evaluations,” she said. “Clinicians would say that isn’t true.”
Charlottesville’s biggest change in how it handles emergency custody orders is the opening of a crisis intervention assessment center at the UVA Medical Center, funded by the Department of Behavioral Health and Developmental Services, said Shoen,
When family members or friends witness a person experiencing a psychiatric crisis and believe him to be a threat to himself or others, they can call a local magistrate for an emergency custody order, explained Shoen. The magistrate notifies local law enforcement that the person needs to be taken into custody.
Once the person has been picked up, the eight-hour clock starts ticking, she said, which can be a problem for people who live in, say, Louisa, because of the time it takes to get them to the hospital, and which was problematic for Gus Deeds in rural Bath County.
A Region Ten clinician is now on site at the hospital at night during the off-hours of 4pm to midnight, as is a police officer to accept custody of the person under the ECO. Short-staffed rural law enforcement departments had been concerned about extending the time length of the emergency custody order because it would take an officer out of commission for the six or eight hours the person could be held.
Under the new system, when the person is transferred to police custody at UVA, the officer bringing her in “can get right back to his job,” said Shoen.
Also on site with the Region Ten clinician who does the evaluation is a peer support counselor—someone who has needed mental health services in the past and is there to help the individual know what to expect. “It’s a very positive addition,” said Shoen. “It’s streamlined the process and is much friendlier,” she said.
Local police departments are receiving crisis intervention training to recognize when someone is experiencing a psychiatric crisis, said Shoen. “Region Ten, UVA and police are coming together. It’s a great development.”
Shoen and other mental health care professionals want to see more community-based support to keep people from going into crisis. Region Ten has a Wellness Recovery Center, a two-week residential program that provides therapeutic intervention.
“A person can be admitted on the early side of psychosis,” said Molly Yates, director of emergency services at Region Ten, who’d like to see more such centers opened. “They stay full,” she said.
“We’d like to have more upstream intervention—early intervention before a crisis situation,” echoed Kate Acuff at Mental Health America of Charlottesville Albemarle.
“I think in dealing with someone in crisis as Gus Deeds clearly was, things are better,” said Acuff. “But there’s enormous variability in what’s available across the state.”
She’s seen increased awareness and increased calls for help in the past year. “That’s a good thing,” she said.
A start, said Deeds, is simply talking about the issue of mental health. “We’ve begun to reduce the stigma and made it easier for other people to talk about,” he said.
Man with a mission
Does it take high-profile tragedies like the Virginia Tech slayings or the suicide of a state senator’s son when the system fails him to bring bipartisanship to the state legislature on mental health issues?
“There’s policy and there’s personal,” said Bell, who’s often on the opposite side of issues from Deeds. “Some of us have family members with mental health issues. Also, this was the child of a colleague. This was something personal for him that really brought it to our attention.”
“I have been in the legislature a long time,” said Deeds. “I’m a partisan warrior, but I also understand you catch more flies with honey than vinegar. I’m a likable guy.”
Gus Deeds was 2 years old when his father was first elected to the House of Delegates, and he traveled around a lot with him over the years. “A lot of people knew my son,” said Deeds, who said his return to the legislature after the tragedy helped get things passed. “The fact I was there every day with red eyes and a red face, we were going to have success.”
Deeds calls the joint commission “probably the most important thing I’ve worked on. This will make a difference in the lives of so many ordinary people.”
The senator said he’s read that one in four or one in five people have mental health issues, such as depression or anxiety disorder. “I’ve read that 24 percent of those incarcerated have mental health issues,” he said. “My experience is it’s a lot higher than that.”
He’s aware of the fickle nature of public interest and how quickly spending can be slashed. “I’m on this like a dog on a scent,” said the Bath County native. “I’m not going to let it go.”
The joint commission will not make its first report until the end of 2015. “I want to make sure we’re getting it right,” he said. “I’m going to be deliberate and have answers that are correct.”
Not surprisingly, the past year has been difficult for Deeds and his family. “Everyone’s struggling,” he said. “My children were very close. My girls look great but they’re all struggling. My ex-wife is struggling.
“There are no guarantees in this life,” said Deeds. “I’ve got to move on. I owe it to Gus and my family to try to make a difference.”
He noted that a lot of bad things happen in a lot of people’s lives. “I’m a lucky guy,” he said. “I had 24 years with my son. It was fantastic. I’ve got three daughters. I’ve got a wife. My life is good. I’ve got a responsibility to make change where I can so other people don’t have to suffer like my son did.”
On this day, nearly a year after unimaginable loss, Deeds sounds upbeat. “What choice do you have?” he asked.
“I’m an old-school Presbyterian,” he said. “I believe things happen for a reason. You’re put here for a reason. I knew I had a platform and I had to speak out. I didn’t think about quitting. I thought about making change, of the opportunity to use my office to make change.”
Despite the personal tragedy of the past year, Deeds displays an innate optimism—and determination—when he recalls what Tom Moss, the last Democratic speaker in the House of Delegates, said to him years ago: “Creigh-Creigh, you remind me of a little boy who wakes up on Christmas morning and finds nothing but horse manure in his stocking, and you’re looking around for the pony.”
Said Deeds, “I’m still looking for the pony.”