A four-month-old psychiatric-bed registry that is supposed to provide up-to-the-minute information for Virginians who need emergency mental health treatment is being updated as seldom as once a day, state officials told a panel of lawmakers this week.
It was the first report on the registry, which was a key part of a set of reforms passed this year in response to the death of Austin “Gus” Deeds, who attacked his father, state Sen. R. Creigh Deeds, in November before taking his own life.
Deeds (D-Bath) chairs the panel, which plans to take four years to study how to fix Virginia’s long-troubled mental health system. He said that once a day is not what the legislature intended when it required the agency to set up the registry.
Debra Ferguson, who was appointed commissioner of the Department of Behavioral Health and Developmental Services in March, said Monday, “I don’t think real-time is realistic.”
“I wonder what it would take to make real-time realistic?” asked Deeds, a onetime Democratic gubernatorial candidate.
“I am not sure,” Ferguson said.
Department spokeswoman Maria Reppas said Tuesday that most of the 67 hospitals providing information to the registry are updating the list more frequently.
Some critics of the system have questioned whether the real-time bed registry, which has been in the works for years, could have helped in November, when a community mental health worker tried to find a bed for Gus Deeds before his emergency custody order ran out after six hours. When a bed was not found, Deeds, 24, who had been struggling with bipolar disorder, was released. He later stabbed his father repeatedly before shooting himself.
Afterward, other nearby hospitals said they had had beds but had not been called.
State mental health officials have long said the registry is only a tool for the commitment process, not a panacea.
“Once an available bed is located using the online bed registry, whether it is real-time or if it is updated only daily, [clinicians] will still need to take the additional step of contacting the hospital directly to ensure that the hospital is able to accept the specific individual and whether the bed is appropriate to meet the individual’s psychiatric treatment as well as any other medical needs,” Reppas said.
The bed registry’s progress has been grindingly slow since it was proposed more than a decade ago. Since then, it has been a casualty of budget fluctuations and competing priorities, according to interviews with state officials who were involved in developing the registry.
A demo version of the registry was supposed to be finished by June 2007, according to a 2007 PowerPoint presentation prepared by Deborah K. Waite, operations manager of Virginia Health Information, the contractor that hosted and operates the registry.
Inside the behavioral health department, the agency was not able, until this past year, to devote a staffer to the registry, officials said. Staff members who worked on it left for different reasons. One was detailed permanently to Eastern State Hospital in 2011 after its geriatric unit lost its federal certification. Another died.
By then, basic construction of the Web site had been completed, Reppas said. Since July 2013, the agency has been able to devote more time to it, and the pace of development has picked up. Refinements were made with input from public and private hospitals and community service boards. In early December, shortly after Gus Deeds died, live beta testing and training began. The registry went live on March 3.
Further issues with the registry came as little surprise to committee members such as Del. Joseph Yost (R-Giles), who said he had been getting complaints about the registry’s “lack of reliability.”
But he sought to put the issue in context. The registry, he said, “is not the silver-bullet solution to our ongoing mental health problems,” and he added that sustained investment in the system was more pressing.
Members of the joint committee were more alarmed to learn from Ferguson that between January and April, as they worked to shore up the commitment process, there were about 37 cases in which clinicians could not find a bed within the six-hour window. In at least six cases, the persons needing help, who were considered a danger to themselves or others, walked away without treatment.
When Del. Robert Bell (R-Charlottesville) asked Ferguson what had happened to the six, Ferguson replied that she did not know.
“It wouldn’t happen today,” she added, referring to newly passed reforms that extend the time to find a bed from six to eight hours and, in cases in which a bed is not found, require state facilities to provide a “bed of last resort.”
Bell later called the revelation “striking.”
“We didn’t hear about it while we were doing our work. There did not seem to be a sense of urgency,” he said. “It should have been fixed.”