Auditors: Dozens of Va. Psychiatric Patients Denied Access to Care

Attack on Va. Sen. Creigh Deeds, allegedly by his son, raised new questions about lack of access to treatment

Virginia state auditors say they have opened an investigation following reports that Gus Deeds -- who sources said stabbed his father, state Sen. Creigh Deeds, before killing himself Tuesday -- was not able to find room in psychiatric treatment programs throughout much of the state.

Published reports have said Gus Deeds was released from Bath Community Hospital Monday following a mental health evaluation performed under an emergency custody order. The Richmond Times-Dispatch reported that a psychiatric bed could not be found for Gus Deeds at the time of his release over a wide area of western Virginia.

The next day, state police found Creigh Deeds stabbed multiple times in the head and torso; the son, Gus Deeds, was found dying of a gunshot wound to the head.

The attack has raised concerns the shortfalls in the state's mental health program persist. The same state auditors surveyed Virginia's program for handling the mentally ill in 2011, and reported the state's safety net for patients is "widely available, but just barely."

Dozens of mentally ill patients at risk of doing "serious harm" to themselves or others in Virginia were denied access to some psychiatric treatment in a span of just three months studied by state investigators, according to agency documents reviewed by the News4 I-Team.

An audit of Virginia's Behavioral Health and Developmental Services, performed over a 3-month span in late 2011, found 72 people "at risk for serious harm" and in need of care received less treatment than necessary, in part because of a shortage of available psychiatric beds in the state.

Internal state investigators call the shortfall "a failure of the system" and a "canary in the coal mine" warning for Virginia leaders.

Agency documents show a decline in the overall number of treatment space for the mentally ill in Virginia. A 2007 report found 1,794 available hospital beds for the mentally ill in Virginia, but the number had dropped to 1,699 beds available in 2011.

Internal investigators reported, "Acute and intensive treatment beds in … state-operated psychiatric hospitals have also decreased, while the population has grown by approximately 13 percent during the last decade."

In one instance, auditors reported an 82-year-old man, who'd shown "persistently aggressive behavior" toward family members, was denied placement in a number of psychiatric facilities over the course of a week. The report said, "In spite of multiple efforts, no hospital placement could be obtained."

Virginia auditors, in their 2011 investigation, said the reasons for some of Virginia’s shortcomings in mental health care are difficult to explain. Their audit said state funding for mental health crisis response had been largely shielded from budget cuts.

Their report also credited Virginia with expanding its ability to hold the mentally ill in "emergency custody" while awaiting necessary hospital space, in the wake of the 2007 Virginia Tech massacre.

The internal investigators cited a lack of transportation options and difficulty handling patients with special needs, including the elderly.

In its formal responses to the audit, the Virginia Department of Behavioral Health and Developmental Services (DBHDS) said it agreed with the auditors recommendations for improvements, including "developing contracts with private facilities to create" more beds for patients. DBHDS sent the following statement to the I-Team Wednesday:

In the two years since the report was written, we have been working with local services providers, and public and private hospitals to examine this issue and assess its true prevalence. The system is large and complex and the issues discussed in the report are only a part. Many improvements have been made over the past several years as part of a bipartisan effort to improve our public mental health system and it is understood more work is needed. Most notably, there have been new funds and efforts made to increase critical programs such as crisis response services, secure law enforcement assessment centers, and discharge planning.

Within the next several weeks, we expect to publish a comprehensive report in collaboration with the University of Virginia to document the current status of access to beds with precision and accuracy. Data is showing that involuntary admission was recommended by the community mental services clinician in 1260 adult emergency evaluations (emergency custody orders) in April, 2013. A bed was quickly found after contacting one or two facilities in 80% of these cases, and it took less than 4 hours to find a bed in 87% of the cases. This shows that in the majority of situations a bed can be located within the emergency custody period. It is common in all regions of the state that multiple hospitals may be contacted to find an available bed. If there is no available bed at the time a hospital is contacted, it is not unusual for space to be free later.

However, once the emergency custody period expires, legally, the individual is free to leave. This period is four hours plus a possible extension of two hours. The community services board will continue working on behalf of the individual to find a bed beyond the 6-hour period. As a result, nearly all people do find a bed within a reasonable amount of time, though some are found after the emergency custody order timeframe expires. In only 4% of the cases above was the clinician unable to find a bed within 6 hours; however, it is important to note that we do not know how many of these individuals insisted on leaving when the timeframe expired. Informed estimates put that number at less than 0.71%.

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