Wednesday, February 26, 2014

Mental Health Task Force Explores System Reform

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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