Virginia’s inspector general began an investigation Wednesday into why the son of state Sen. R. Creigh Deeds was released from psychiatric care the day before he apparently stabbed his father and then fatally shot himself.
And Gov. Robert F. McDonnell (R) said he has directed his top health official to conduct a review of state and local mental-health services in the wake of the incident.
Austin Deeds, who was 24, had undergone a psychiatric evaluation Monday, and officials initially said the reason he was not admitted to a hospital was that no bed was available. But multiple nearby hospitals later confirmed that they had available space but were never contacted.
Deeds, the 2009 Democratic nominee for Virginia governor, on Wednesday was upgraded to good condition at a Charlottesville hospital, where he was airlifted the previous day after an altercation outside the Deeds home in rural Bath County. Deeds, 55, was stabbed repeatedly in the face and chest, and his son was found dying of a self-inflicted gunshot wound, authorities said.
“We’re going to investigate the circumstances that led up to Austin Deeds’s release at the expiration of the emergency custody order,” said G. Douglas Bevelacqua of the Office of the Inspector General.
The scrutiny comes six years after a gunman killed 32 people at Virginia Tech before killing himself. The massacre prompted a wholesale evaluation and revamping of the state’s mental health system, including millions of dollars in new funding.
Bill Hazel, Virginia’s secretary of health and human resources, promised to push for changes if further deficiencies are discovered. McDonnell, his boss, told The Washington Post that Hazel would review the chain of events that led to the tragedy and that he would propose any necessary fixes in the coming state budget.
“I’ve still got two more weeks before I’ve got to submit the budget, and if there are glaring problems I can address those,” McDonnell said in an interview at the Republican Governors Association conference in Scottsdale, Ariz. “What we need to do now is to see why there was a breakdown” in communication.
The Virginia State Police offered new details Wednesday on the attack. Police said the altercation took place outside the Deeds home. They also disclosed that the sheriff’s office had been called to the home Monday for “a non-emergency call for assistance,” but they would not detail the purpose of the call or confirm that it was to transport Austin Deeds to his psychiatric evaluation.
There were no other records of 911 or non-emergency calls to the residence before that, police said.
In addition, an autopsy by the Office of the Medical Examiner in Roanoke confirmed that the gunshot wound was self-inflicted and fired from a rifle.
Mira Signer, executive director of the Virginia chapter of the National Alliance on Mental Illness, said Wednesday it was crucial that officials “figure out where things fell apart” in a system that is often difficult for families to navigate.
“Generally our feeling is that if a family with resources and know-how has difficulty accessing and navigating the mental-health system, it speaks volumes about what happens to people who don’t have resources,” she said.
On Monday, a magistrate issued an emergency custody order for Austin Deeds, who was also known as Gus, after he had been evaluated by officials at the Rockbridge Area Community Services Board.
In Virginia, mental-health authorities can hold people for four to six hours after such an order is issued. After that, the magistrate must issue a temporary detention order to allow a person to be held for 48 to 72 hours for further evaluation and treatment. But the order cannot be issued without an available bed.
At age 24, the younger Deeds would have been free to leave custody after the four- or six-hour window closed if local health officials had not found a bed. Even if his family had wanted to continue looking for a spot at a psychiatric hospital, they would have been powerless to do so if he did not cooperate.
In Virginia, the responsibility to find a spot for such a patient falls to one of 40 community services boards and behavioral-health authorities that form the front end of the state’s mental-health system.
It was the head of the Rockbridge Area Community Services Board, Dennis Cropper, who initially told the Richmond Times-Dispatch that his agency had called many hospitals across western Virginia on Monday seeking a bed for Austin Deeds. Mary Ann Bergeron, who leads the Virginia Association of Community Services Boards, also said that the local agency tried but could not find a bed for Deeds.
Neither Cropper nor Bergeron returned several messages Wednesday.
Initially, the attack drew rebukes about mental-health funding in Virginia, but the fact that services were available for Austin Deeds is likely to shift the scrutiny to local community services boards, which get some funding from local governments but are licensed and overseen by the state Department of Behavioral Health and Developmental Services.
State officials who spoke on the condition of anonymity to discuss a specific case said their understanding is that the Rockbridge agency made multiple calls in search of a hospital bed but ran out of time before finding one.
Experts said involuntary commitments can be particularly challenging to carry out in rural areas. Officials working against the clock might have to travel great distances to pick up a patient in need of an evaluation or wait for a therapist to travel to a rural hospital to conduct it. The clock on an emergency detention order starts ticking the moment the magistrate issues it.
“Obviously given the configuration of Virginia and its large rural regions . . . there are some localities where it’s a bigger problem,” said Richard Bonnie, a University of Virginia professor and director the school’s Institute of Law, Psychiatry and Public Policy.
Bonnie also said that calling institutions to see if they can take a patient is not like booking a hotel room. There have to be detailed discussions about the patient’s needs — whether the person will need special medical care or security — to make sure the facility is properly equipped.
“You can’t just say we’ve got somebody and we’re going to ship him over,” Bonnie said.
Bonnie said U-Va. is working on a study of emergency mental-health evaluations in the state and has found that in the vast majority of cases, beds are quickly found.
The study this year examined all 1,260 cases in which involuntary admission was recommended in a single month, April. In 80 percent of those instances, a bed was found after officials contacted one or two facilities. In 87 percent of cases, a bed was found within four hours. Officials were unable to locate a bed within six hours in 4 percent of cases.
A number of state officials and mental-health advocates said Wednesday that care for the mentally ill has improved since Virginia Tech. The General Assembly approved a package that provided $42 million in new funding for mental-health services over two years and changed state laws to make it easier to involuntarily commit the mentally ill to hospitals.
However, in a 2011 report on state funding for mental illness, the National Alliance for Mental Illness found that funding in Virginia dropped overall by $37 million from fiscal 2009 through fiscal 2012.
And a 2012 report by the nonprofit Treatment Advocacy Center found that Virginia had only 37 percent of the beds considered necessary by the group to treat its population. The report ranked Virginia 19th in total number of treatment beds per capita.
State Sen. George L. Barker (D-Fairfax), who has been a leader on mental-health issues, said Wednesday that the availability of psychiatric beds has improved in recent years as approaches to treatment have shifted toward more outpatient care.
Community-based “crisis stabilization facilities” have been established across the state to take care of patients on a short-term basis, he said. Other outpatient systems have been established to enable patients to live in their communities. And finally, he said, patients who used to cycle in and out of psychiatric hospitals are being taught how to recognize signs that they need help before reaching a point that requires hospitalization.
“By and large, the use of beds has decreased over the last 10 or 15 years, and it’s basically because the system has done a better job of getting people the help they need on an outpatient basis,” Barker said. “A lot of it is changes in philosophy and approach.”
Officials with Western State Hospital in Staunton, Rockingham Memorial Hospital in Harrisonburg and the University of Virginia Medical Center in Charlottesville — all within two hours of Bath County — confirmed Wednesday that the facilities had been in a position to accept Deeds’s son but were never asked to do so.
In addition to renewing scrutiny of mental-health care in Virginia, the incident thrust the elder Deeds back into the spotlight after several years away from it. Deeds ran for attorney general in 2005, losing to McDonnell by a mere 360 votes. He vaulted back to the statewide stage in 2009, winning the Democratic primary in an upset victory over Terry McAuliffe and Brian Moran but losing by a landslide, 17 points, to McDonnell in the general election.
After the defeat, Deeds went through a divorce and largely receded from public view, even though he stayed on in the Senate.
This week’s violence also ended what appears to have been a downward spiral for Deeds’s son, a banjo-playing former campaign volunteer for his father who dropped out of the College of William and Mary last month. He was one of the senator’s four children from his first marriage, and his only son.
Two people close to the elder Deeds who spoke on the condition of anonymity to describe family matters said Austin Deeds had struggled with mental illness in recent years.
Austin Deeds accompanied his father on the campaign trail in 2009, expressing admiration that the senator did not possess the stylized good looks of McDonnell. “He’s all natural, almost to a fault,” Austin told a reporter. “He colors his hair with early mornings and hard work and life.”
In 2009, police charged Austin Deeds with possession of alcohol as a minor, according to court records. The case was dismissed after he performed community service.
State investigators said Tuesday that after his son attacked him, Deeds, bleeding from his face and chest, walked to the end of his driveway in Bath County, about 100 miles west of Charlottesville. A cousin driving by spotted him, called police at 7:25 a.m., then drove him to a nearby farm. A helicopter flew the senator to the University of Virginia Medical Center, where doctors performed surgery.
Rosalind S. Helderman and Reid Wilson contributed to this report. Wilson reported from Arizona.