Mental-health advocates fear fundamental problems in Virginia have been left to fester

After the Virginia Tech massacre in 2007, Virginia lawmakers injected tens of millions of dollars into the state’s mental-health system, including local mental-health agencies that are the first stop for people in crisis.

But last November, when Austin “Gus” Deeds needed a local agency to find him a psychiatric bed, the staff was smaller, its wait list for psychiatric services had tripled and a long-planned online registry of beds that could have speeded the search was not ready.

Once Deeds’s emergency custody order expired, he was released. The next day, he stabbed his father, one-time gubernatorial candidate Sen. R. Creigh Deeds (D-Bath), before killing himself with a shotgun.

The tragedy has become emblematic of gaps in the state’s long-troubled mental-health system, and some say it reveals a pattern of missed opportunities and narrowly tailored fixes that do little to tackle fundamental problems.

The General Assembly adjourned on Saturday after enacting modest mental-health reforms but leaving broader improvements unaddressed.

The outcome has left many to wonder whether meaningful, lasting reform will ever happen: If a school shooting couldn’t do it, if an attack involving a state lawmaker couldn’t do it, then what will?

“It is hard not to be skeptical,” said James Reinhard, a psychiatrist and former commissioner for the Department of Behavioral Health and Developmental Services. “It is a repeated pattern of making recommendations and getting a little bit of effort that is not sustained.”

The next crisis

Focused on addressing the circumstances of Nov. 18, lawmakers this session voted to give emergency clinicians more time to find a psychiatric bed, and, if one can’t be found, to require the state to provide a bed of last resort. They also mandated closer monitoring of court-ordered outpatient treatment and initiated a four-year study of mental-health services to identify additional reforms.

Del. David Albo (R-Springfield) said that broader reforms such as serious investment in community services are for future sessions.

Advocates for the mentally ill and other experts have long argued that without more services to keep people out of hospitals and give those who are hospitalized a place to go, lawmakers will keep lurching from one crisis to the next.

Reinhard recalled that in 2008, lawmakers loosened the standard for involuntary commitment at the urging of experts. But in the years that followed, the number of people committed did not change significantly, which some advocates attributed partly to a dearth of beds and other treatment options.

“For all the attention paid to wordsmithing, it didn’t change who we committed,” Reinhard said. “But it made us feel good that we were paying attention to the crisis, when really we should have been paying attention to outpatient services.”

The change to the commitment process was one of several reforms put forward by then-Gov. Timothy M. Kaine (D) . They closely followed recommendations made by a commission on mental-health-law reform set up by the chief justice of the state Supreme Court before the massacre and those of a panel Kaine assembled to look into the causes of the Virginia Tech shooting. Their findings echoed the conclusions of panels going back 40 years: Virginia’s mental-health system is woefully underfunded, in dire need of more community services, and it relies heavily on involuntary commitment.

Kaine and the legislature sought to improve community services by boosting the number of emergency clinicians at the 40 community service boards, and increasing the number of people monitoring individuals ordered into outpatient treatment, among other measures. A judge had ordered the Virginia Tech shooter, Seung Hui Cho, into outpatient treatment in 2005, but he never went, and no one followed up.

To support those reforms, lawmakers increased funding for mental-health services by $42 million.

“The feeling was the additional cash was going to help ensure there will be enough people interfacing directly with individuals,” said Andrew Goddard, whose son Colin was seriously injured in the shooting.

Then Goddard was appointed to the board for the Department of Behavioral Health and Developmental Services and, he said, his perspective changed.

“I quickly realized it was a valuable amount of money, but the place was so chronically underfunded to begin with that it didn’t do anything to take the system far forward,” he said. “And in a short time, we started going backwards, cutting and cutting.”

Even before Kaine signed the mental-health legislation, he had ordered $300 million in spending cuts to try to close a $641 million budget gap for that fiscal year. As the real estate market collapsed, the money woes grew and many agencies eventually had to slash their budgets by as much as 15 percent, including the Department of Behavioral Health and Developmental Services, which laid off a third of its workforce. The bed registry and other projects were put on hold, agency officials said.

Lawmakers, caught between grim revenue projections and a constitutional requirement to balance the budget, said they had little choice.

“We weren’t just in a recession where we had less money than we expected. We had negative growth. Everybody got cut — everybody,” Albo said.

‘Pretty much a wash’

The department and the community services boards got to keep the $42 million in new funds. But during the same time period, mental-health funding overall shrank by $45 million, state figures show.

“We were trying to spare the resources for emergency services and case management and crisis stabilization,” said Reinhard, the former commissioner. “But there is no way around the fact money was taken out of the system.”

Community service boards were left to decide how each would absorb the cuts. At the time, there were 5,700 people on wait lists for community services statewide, according to the National Alliance on Mental Illness of Virginia.

David Coe, executive director of the Colonial Community Services Board in Williamsburg, said he got to keep an emergency clinician hired with the new funds, but had to cut another emergency-clinician position. He said he also lost a nurse and an outpatient therapist. Charles Hall, executive director of the Hampton Roads-Newport News Community Services Board, said he had to stop providing services to more than 70 people with intellectual disabilities who did not have insurance.

Harvey Barker, the former executive director of the community service board that serves Virginia Tech, said he didn’t have layoffs, but his agency struggled to keep up with demand, which surged for several years after the shooting. Between the infusion of funds and the cuts, he said, “it was pretty much a wash.”

“I understand if you are in an organization you have to keep your eye on fat, but there was no fat,” Goddard said. And as the state’s population continued to grow, he said, “we were underserving more and more people every year. ”

Since 2010, which Virginia ended with a budget surplus, mental-health funding inched back up by about $16 million, state data show. Then the Deeds tragedy occurred.

Now that the legislative session is over, advocates for the mentally ill said they will be watching to see whether lawmakers sustain an interest in reform. Advocates already have cause for concern. Earlier this month, the investigator examining the Deeds case resigned in protest, sparking fears that Virginia is resisting serious scrutiny of its system.

In his resignation letter, G. Douglas Bevelacqua, the former inspector general for the Department of Behavioral Health and Developmental Services, wrote that higher-ups interfered with his Deeds report. Among the findings that he said were censored was his conclusion that state officials could have prevented the tragedy by acting on warnings he had delivered two years ago.

Sen. Janet Howell (D-Fairfax) said the difference this time is that her colleagues have a permanent reminder of what can go wrong if they lose interest in reform. “Every time you look at Creigh Deeds,” she said, “you can’t help but think of what happened.”

Rachel Weiner contributed to this report.

Annys Shin has been a staff writer at the Washington Post since 2004.
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