The system is broken; let's fix it

Creigh Deeds’s son, my daughter and my fears about Virginia’s mental health system

I was coming home from visiting my 11-year-old daughter at a Virginia psychiatric hospital Tuesday when I heard about the stabbing of state Sen. Creigh Deeds and the suicide of his son, Austin. According to some reports, the younger Deeds had been denied admittance to a psychiatric hospital the day before. I was heartbroken. This family was let down by the same broken mental health system my family depends on.

My daughter was diagnosed with bipolar disorder at age 8. When I checked her into Dominion Hospital on Nov. 15, I was grateful there was a bed available. She’d been having violent rages — punching and kicking me and her younger brother and trying to jump out her window. Although no mother ever wants to leave her child in a psychiatric hospital, I knew it was the safest place for her.

Deeds attack shows that our system is a mess

First some facts. Since the 1970s, we have been closing down state hospitals without providing adequate services in our communities to help people who are in the midst of a mental crisis. A 2010 report found that 200 individuals in Virginia who were psychotic and either dangerous or incapable of caring for themselves were "streeted" -- slang coined by emergency room doctors for when hospitals knowingly put a psychotic patient on the sidewalk.

This is a national problem. In Iowa recently, I was told that officials sometimes had to drive patients across state lines to find beds. In Seattle, which has excellent services, individuals can spend 24 hours languishing in emergency rooms until beds in a treatment center open up. Experts recommend that 50 psychiatric beds should be available per 100,000 residents. The national average today is only 17 beds per 100,000.

HMOs are partly to blame. Psychiatric beds traditionally lose money so HMOs have been closing local psychiatric wards in favor of more profitable surgical beds. In northern Virginia where I live, 24% of public psychiatric beds were shut down in 2005.

Our legal system hampers our mental health system, too. We demand a person become "dangerous to self or others" before parents and others can intervene. This forces families to wait until it's too late to get help. It's a reason why our jails and prisons have become our new asylums. Great Britain and France have a "need for treatment" standard that allows for earlier intervention but has safeguards built in to prevent abuses.

A Son's Death Reveals Chasms In Emergency Mental Health Care

Early reports said the family had received an emergency custody order from a judge on Monday, the first step in getting a person involuntarily committed to a hospital in Virginia. But then local health officials had to find a hospital bed.

For reasons that remain unclear, that didn't happen. The custody order expired, and Gus Deeds was allowed to leave a local mental health facility. The commonwealth of Virginia has launched an investigation into the circumstances, the Associated Press reported Thursday.

When space can't be found in a psychiatric hospital, Honberg says, "families are basically left to fend for themselves."

Nationwide, states have cut spending for treating mental illness in the past decade, resulting in longer waits for outpatient care and fewer inpatient beds.

A study by the National Association of State Mental Health Program Directors found that state investments in mental health dropped by $4.35 billion between 2009 and 2012. At the same time, demand for both outpatient and inpatient services increased.

By 2010, the number of state psychiatric beds per capita was down to levels not seen since 1850, according to the Treatment Advocacy Center, a group that lobbies for more access to care. That was when the movement toward humane care of the mentally ill was in its infancy, and disturbed people were locked in prison.

Starting in the 1960s, many psychiatric hospitals were closed because treatment in the community was considered a more humane and less costly alternative. But outpatient treatment can be difficult to find, especially in rural areas. And inpatient care is still needed, especially for people considered at risk of harming themselves or others.

Last year, the Virginia Office of the State Inspector General found that over a three-month period, 72 of 5,000 people who met the criteria for receiving a temporary detention order didn't get one because no facility could accommodate them. The report also says that while the state's population has increased over the past decade, the bed capacity for psychiatric patients has steadily decreased.

For more on mental illness and its effects on individuals and their families, be sure to check out NAMI (National Alliance on Mental Illness), an advocacy group.

Until we start treating mental illness on par with physical illness, without stigma, without decreased funding due to the perceived lack of profit, we can get nowhere in trying to help people. Although the mentally ill are actually much more likely to be victims of violence rather than instigators, we see every day on the news acts of mental illness. Mental illness fuels gun violence, substance abuse, homelessness, and suicide. If affects millions of people, from all walks of life, and many more when you factor in those whose lives are touched by a loved one's mental illness. Behind the statistics are real people, real families. We need to make sure people don't suffer because of system weaknesses. No one should live with the fear that a loved one will harm himself or another person. No one shoudl suffer from their inner daemons to the point where they can no longer function in society or become a danger. They need our help. An overhaul is needed. The Affordable Care Act actually took some strides in the right direction. But there is more to be done, and policy makers need to provide support for those at risk so that events like this become a rarity. At present the system is flawed and convoluted--we need progress and simplification. And there should be no shame attached to mental illness. We are way past the days of locking a relative in the attic. My interest is personal. I am myself bipolar, yet I function, keep down a job, etc., with the proper treatment. I've seen the crippling effects of mental illness in others I've been close to. Mental illness robs people's lives in insidious ways. We as a society must do everything to make sure that there is a safety net in place for those who otherwise slip through the cracks, and bolster what works, making good therapy and medical treatments available widely--including places where a person can safely stay during particularly rough episodes. And we need to bring the idea of family-centred care to mental illness treatment. So often, families find that mental illness either runs in the family, or their are familial issues which exacerbate any organic issues, such as past abuse or neglect. It's important for those around the mentally ill to understand the illness and be aware of warning signs. We would educate a family member or friend as to what to do if someone's blood sugar drops low, or if they have a seizure. Why do we not educate those caring for or who care for mentally ill persons about things like signs of mania or psychosis? That should be done, too. We have a long way to go, but I hope we get there.