Early on Tuesday morning at his Bath County home, Virginia state senator Creigh Deeds suffered multiple stab wounds, and his 24-year-old son Gus died from an apparent self-inflicted gunshot in what police are considering an attempted murder-suicide.
The events that led up to the shocking incident are still under investigation, but according to a report from the Richmond Times-Dispatch, the younger Deeds underwent an emergency mental-health evaluation on Monday. He was reportedly released hours later because there were no psychiatric beds available for him in western Virginia.
Known as “streeting,” the practice of releasing at-risk psychiatric patients for whom no bed is available is uncommon at the facility where Deeds was evaluated, says Rockbridge County Community Services Board executive director Dennis Cropper. “I would say in terms of finding a bed, it’s usually 97% of the time. It is unusual that we’d never find a bed for somebody,” Cropper tells TIME.
Rare or not, it’s an issue Virginia has struggled with before. In 2011, Virginia inspector general G. Douglas Bevelacqua released a report chastising the state for turning away in a month an estimated 200 patients determined to be a threat to themselves or others who met the criteria for a temporary detention, only because state facilities lacked the room to hold them. Twenty-three of Virginia’s 40 community-services boards acknowledged that “streeting” occurred at their facilities.
“I wouldn’t say this happens every day, but it’s more common than we’d like for it to be,” Mary Ann Bergeron, the executive director of the Virginia Association of Community Services Board, told the Washington Post.
Under Virginia’s emergency-custody-order process, the family of a patient petitions a magistrate to order an evaluation, and medical staff have a four-hour window to decide whether someone should be committed, according to Cropper, who declined to speak about the specifics of the Deeds case out of respect for the family’s privacy. The clock starts when a sheriff picks up the patient and brings him or her in for clinical evaluation. Once the evaluation is complete, physicians make a recommendation to the magistrate. If the magistrate approves, medical staff then search for an available hospital bed.
It all has to happen during the four-hour time frame. “We can sometimes get an extension of two hours on that, but beyond the six hours we cannot. So if we don’t find a bed within six hours, then an individual would have to be released. We can’t keep them,” says Cropper.
The availability of inpatient psychiatric care has decreased nationally in recent years. Research from the Treatment Advocacy Center, a national nonprofit focused on eliminating barriers to treatment of severe mental illness, found that the number of state psychiatric beds decreased nationwide by 14% between 2005 and 2010. In 2005 there were 50,509 state psychiatric beds nationwide, and in 2010 there were 43,318. It’s estimated that a person with severe mental illness is three times more likely to be in a state prison than a psychiatric hospital.
The trend is long running. In 1975, the federal government specifically excluded Medicaid payments for patients in state psychiatric hospitals as part of an effort to get Americans out of institutions, and to shift payment back to the state. But that also led to fewer available beds for emergency patients, a shortage that continues to exist today.
Tightening state budgets have widened the gap in available beds. In the wake of the 2007 Virginia Tech shooting that claimed 32 lives, Virginia’s legislature took measures to revamp the emergency-evaluation processes, updated the criteria for involuntary psychiatric commitment and raised state funding for community mental-health services. But according to a report from the National Alliance on Mental Illness, Virginia’s overall state mental-health budget decreased $37.7 million dollars from $424.3 million to $386.6 million between fiscal years 2009 and 2012.
“The consequences of not providing treatment should demonstrate the importance of the need for it,” says Kristina Ragosta, director of advocacy at the Treatment Advocacy Center. “Most people with mental illness are no more violent than the general population, but when we talk about people with untreated mental illness, they are at greater risk of committing violent acts.”
— With reporting by Charlotte Alter / New York City