Even as he regained consciousness in the hospital last year after his son stabbed him 13 times, state Sen. Creigh Deeds was thinking about what he’d encountered while trying to get help for his 24-year-old, Gus Deeds. “I started to figure out what we needed to do when I got out of the hospital,” he says.
The attack by and subsequent suicide of Gus Deeds on Nov. 19, 2013, both saddened and shocked Virginians, who realized that even a longtime legislator and former candidate for governor couldn’t 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 says in his Charlottesville office. He’s also working on an ambitious plan to overhaul the state’s mental health care system with bipartisan support. What’s unclear 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 Nov. 19, but he told The Washington Post, in a 6,000-word article published Nov. 1, that he wakes up every morning thinking about Gus, trying to focus on the happy images, rather than the ones from that morning, when he went out to the barn at his Millboro Springs residence. He was holding a bucket of feed when 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 secured an emergency custody order, or ECO. It’s step one in dealing with a mental health crisis, and something Deeds had done twice before, he told the Post.||
The Long Fix
Delegate John O'Bannon on what's changed in a year.
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 the University of Virginia, said they had beds and weren’t 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,” Deeds says.
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, a Republican from Albemarle County.
“Before, when you hit the six-hour mark,” Bell says, “they kicked you out.” The new law requires the state hospital — for Central Virginia, that’s Central State Hospital in Petersburg — to take the patient if nothing else can be found.
The legislature passed a real-time, online psychiatric bed registry. It also increased the time a person could be held under a temporary detention order from 48 to 72 hours.
“We tried to figure out what went wrong in the big and small picture,” Bell says.
“Those are significant changes,” Deeds says, “but they’re about 2 percent of the total pie.” Hospitalization is costly and not the best way to treat most patients, he says, which means it’s critical to provide services throughout the commonwealth way before a person’s condition becomes a crisis.
Outgoing Gov. 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.
Deeds says the most significant action the legislature took 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,” says Deeds, a Democrat. “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, Deeds says. “We’ve got to reform the existing system first.”
“We’d like to go in with a blank slate,” Bell says: “Where should decisions be made? What role does the doctor play? What role does the community services board have?” He also wants to see how other states handle mental health care.
In the let’s-do-something aftermath of the Gus Deeds tragedy, Deeds acknowledges, “Resources are an issue.”
The General Assembly, which earlier this year declined to expand Medicaid in Virginia, allotted $4.5 million for extra beds in state hospitals. Deeds says 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 Gov. 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 them have serious mental health diagnoses, Deeds says, 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,” Deeds says. “It’s hard to understand why we didn’t.”
Republicans like Bell are unswayed. “We think the [Medicaid] program is growing substantially,” says 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.”
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’d been ordered into treatment, didn’t go. “No one had the responsibility to follow up and make sure he went,” Bell says. “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 note Virginia’s dependence 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,” Bell says. Finding the funding is always a challenge, he acknowledges, but if the mental health proposals are good ones, they can be priorities, he says, 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,” Bell says. “We want to look at upstream factors before that happens, and avoid the 2 a.m. emergency-room crisis.”
Even with the groundswell of attention following the Deeds tragedy, earlier this year there were unexecuted temporary detention orders, Bell says. “At six hours they’d say, sorry, we couldn’t find you a bed. Even after all this happened, there were still unexecuted [temporary detention orders].”
Deeds is still troubled that location matters in mental health care in Virginia, and that there are disparities in services available across 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,” Deeds says.
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.
In Deeds’ backyard, Region 10, there’s been an increase in emergency custody orders and psychiatric hospitalization. “Why that is, we’re not really sure,” says Lynn Shoen, senior director of emergency and case management services.
In September 2013, Region 10 evaluated 224 people, 67 of whom were hospitalized. A year later in September, 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, Shoen says. “There could be myriad reasons. One theory is clinicians are being more conservative in terms of their evaluations,” she says. “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 University of Virginia Medical Center, funded by the Department of Behavioral Health and Developmental Services, Shoen says.
When family members or friends witness someone experiencing a psychiatric crisis and believe there’s a threat to that person or others, they can call a local magistrate for an emergency custody order. 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 says, which can be a problem for people who live in, say, Louisa County, 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 4 p.m. to midnight, as is a police officer to accept custody of the person under the emergency custody order. Short-staffed rural law enforcement departments had been concerned about extending the length of the 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 U.Va., the officer bringing the person in “can get right back to his job,” Shoen says.
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,” Shoen says. “It’s streamlined the process and is much friendlier.”
Shoen and other mental health care professionals want to see more community-based support to keep people from going into crisis. Region Ten, for example, has a Wellness Recovery Center, a two-week residential program that provides therapeutic intervention.
“We’d like to have more upstream intervention — early intervention before a crisis situation,” says 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,” she says. “But there’s enormous variability in what’s available across the state.”
A start, Deeds says, 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.
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,” says 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,” Deeds says. “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 when his father was first elected to the House of Delegates, and he traveled around a lot with him through the years. “A lot of people knew my son,” says 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 says. “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,” says the Bath County native. “I’m not going to let it go.”
The joint commission won’t make its first report until the end of 2015. “I want to make sure we’re getting it right,” Deeds says.. “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 says. “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,” Deeds says. “I’ve got to move on. I owe it to Gus and my family to try to make a difference.”
He notes that a lot of bad things happen in a lot of people’s lives. “I’m a lucky guy,” he says. “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.”
A year after unimaginable loss, Deeds sounds upbeat. “What choice do you have?” he asks.
“I’m an old-school Presbyterian,” he says. “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.”
Deeds replied, “I’m still looking for the pony.” S
Lisa Provence is a staff writer for the C-ville Weekly in Charlottesville, where this article first appeared.