Acts of violence by mentally unstable persons — violence upon others, themselves, often both — continue to make for tragic headlines across the country. In Virginia, where such headlines last fall covered the stabbing of a state senator by his suicidal son, many are expecting that the state’s annual assembly of lawmakers in Richmond will bring some significant boost to mental health-care funding.
Locally, however, a relatively small boost in funding at one of the region’s Rappahannock-Rapidan Community Services Board’s mental health clinic seems to already be making a difference.
After the Virginia Tech shooting in 2007, Virginia similarly beefed up its mental health systems, but the intervening recession years negated all that spending, and more. Around Rappahannock County, as in many rural areas where under-funded mental health initiatives are challenged further by matters of lower incomes and longer distances, the last decade has seen the closing of two hard-to-sustain community mental health clinics (one in Rappahannock, one in Madison).
Among the problems state legislators will focus are the shortcomings in finding clinical help — a bed, as most therapists call it — for psychiatric emergencies. It was the case of Austin C. “Gus” Deeds — who stabbed his father, Sen. R. Creigh Deeds (D-Bath), and then killed himself last Nov. 19, just 13 hours after being released from emergency custody for a mental evaluation — that brought the state’s process into sharp relief.
Though the circumstances of the younger Deeds’ release are unclear, as outgoing Gov. Bob McDonnell told the Task Force on Improving Mental Health Services and Crisis Response at its initial meeting earlier this week in Richmond: “This is one of those areas, like homeland security, where we should be 100 percent right 100 percent of the time.”
“It’s definitely a statewide issue, and definitely more difficult in rural areas, which often don’t have a psychiatric facility in their region,” says Sallie Morgan, who retired last year from many years with the RRCSB, and has since become executive director of the Mental Health Association of Fauquier County. (The Rapidan-Rappahannock region, for instance, hasn’t had a dedicated psychiatric facility within its five-county area since Culpeper Hospital closed its psychiatric care wing almost two decades ago.)
“One of the things that happens is that private facilities often set aside beds for people from their catchment area,” she adds. “So when a crisis therapist from our area calls, they say no beds are available. Or worse yet, they just don’t return the therapist’s call. The whole situation puts a lot of pressure of the local CSB, on hospital emergency rooms and on local police.”
“In Virginia, you cannot be detained more than six hours, even it’s determined that you need a bed — if there’s not a bed to be found in those six hours, and if you get a judge to give you a two-hour extension and there’s still not a bed, then you will get released,” says Sandra Maskas, another Rappahannock resident who spent nearly 20 years as a psychiatric social worker for the RRCSB and Fauquier Hospital before retiring — and who now serves on the RRCS board, this year as its vice president.
“And if you are released in those circumstances,” she adds, “you either get picked up again by the police, or you just go on your merry way. And you are heard from again at a later date.”
While the state debates how to better find beds for those in need, many in mental health across Virginia — and here in the Piedmont — think the best and longest-term solution lies in offering access to counseling and other longer-term forms of care.
This was what the RRCSB was thinking — has always been thinking, actually — when it proposed to Rappahannock and Fauquier officials last fall to create a pilot program that would cut down on the wait time for community mental health clinic services.
In October 2013, when the program launched, the wait time was 76 days to see a clinician at the RRCSB’s Fauquier clinic — which serves many Rappahannock clients and, like all RRCSB clinics, offers a low- or no-cost alternative to therapists in private practice. In two months, since the start of the new program — which basically allowed RRCSB to hire a “rapid access and short-term treatment” clinician — the wait time had dropped to 28 days.
“Our goal,” says RRCSB executive director Brian Duncan, “at least within our area, is: If we can get care to people when they need it, we can solve a world of hurt, and we can save a world of money.”
Rappahannock County Administrator John McCarthy said he’d hoped that Rappahannock’s contribution to the pilot (just under $10,000, with Fauquier contributing about $60,000) would make a difference in the county’s burgeoning expenses for minors, families and children in need of care, under the state’s Comprehensive Services Act.
“Our hope is that with our own initiatives, and in the General Assembly’s this year, we can help move the dial toward getting people the care they need when they need it,” said the RRCSB’s director of clinical services, John Waldeck. “Even if it’s a short intervention needed early on — the more we fail to do that, the more we complicate the system later on.
Nationwide, Waldeck noted, “we have 38,000 people a year in our country committing suicides. That’s twice the number of homicides, and it’s highest in rural areas.
“Our premise is, if you get people care when they need it, and in their own community,” he adds, “you’ll have less suicides, less emergencies.”