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| Dr. William Barker, Fauquier Hospital Emergency Department |
In November of 2013, Austin Deeds, 24-year-old son of Virginia Sen. Creigh Deeds, committed suicide after stabbing his father. This was only hours after the young man underwent a psychiatric evaluation and was found to be in the midst of a mental health crisis. His emergency custody order expired while authorities were searching for a suitable mental health facility for him. No bed was found for him and he had to be released.
The tragedy highlighted problems with the mental health
system in Virginia and presented an opportunity for state lawmakers and
clinicians to address those issues. It also prompted Dr. William Barker,
Emergency Department physician at Fauquier Hospital in Warrenton, to call Dr. William Hazel,
Secretary of Health for Virginia. Dr. Hazel listened to Dr. Barker explain the
mental health crisis from an emergency room doctor’s perspective; soon after,
he appointed Dr. Barker to the governor’s Task Force on Improving Mental Health
Services and Crisis Response. Dr. Barker pointed out that the task force was
not created in response to one incident, but events like Austin Deeds’ suicide
and the horrific slayings at Virginia Tech reinforce the need for reform.
Dr. Barker said, “It has become clear that we need to stop
treating mental illness differently than other illnesses. In the emergency
room, we wouldn’t send someone who was having a heart attack home because we
didn’t have a bed available. As an ER doc who sees these cases regularly, this
is something near and dear to me. It’s important because it affects patients,
their families and the community.”
The 37-member task force is made up of doctors and mental
health professionals, law enforcement and social services personnel,
representatives from the courts and the legislature, and individuals receiving
mental health services and their families. Members have been asked to “review
existing services and challenges in Virginia’s mental health system and make
recommendations, including legislative and budget proposals, for critical
improvements to mental health procedures, programs and services.”
The task force has already made several recommendations, and
on February 10 the Virginia Senate passed a bill, SB260, that would address
some of these. The House of Delegates passed a similar bill, HB478, the
following day.
Currently, an emergency custody order (ECO) is only good for
six hours. That’s how long someone identified as being in a mental health
crisis can be held involuntarily while a temporary detention order (TDO) is
obtained. To obtain a TDO, a member of the community services board -- a
therapist, psychiatrist or social worker -- must apply for the order, and the
order must be signed by a magistrate.
Dr. Barker explained, “What we’d really like to do is create
a seamless system where the ECO flows into the TCO and the times of each are
not as narrowly defined. Basically, we don’t want someone who needs care to
just walk away.”
Both the Senate and House bills included task force
recommendations that specify -- in cases where no bed can be secured -- a place
for the patient must be found in a state hospital, even if it means the move
will put the facility over capacity. “It means that no one will be released if
they are a danger to themselves or others,” said Dr. Barker.
Part of the problem with finding a bed for a patient is
finding an appropriate facility. Dr. Barker explained, “Maybe there is a bed
available, but it’s only appropriate for a male patient and the person is
female. Or it could be that the opening is in a non-secure facility and the
person requires a more secure placement because they may become violent or
suicidal.”
The mental health task force also recommended the completion
of a web-based psychiatric bed registry, to facilitate patient placement. Both
bills currently up for consideration in the General Assembly include this
recommendation.
The task force was specifically asked to come up with
suggestions in time for legislators to act during the current General Assembly
session, but Dr. Barker said that their job will go much deeper than custody
order recommendations. “We need to find strategies to prevent these crises from
happening. Everyone on the task force feels that we need to strengthen the
system so that people who need these services -- medication and therapies --
but don’t have insurance or other options, can get them. We need to find
ways to make the mental health system better and more accessible to all. And we
need to get mental health care more into the hands of clinicians and less in
the hands of the courts and jails.
That’s where the answer lies.”
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