There were times during the past year, Randy Ploof thought his girlfriend’s mental illness was being managed, that at the time she was at least not going to hurt herself. Elizabeth Wright’s severe bipolar disorder caused her to attempt to end her life first when she was 14. She swallowed her bottle of lithium, the very medication she was prescribed to treat the illness.
In describing a litany of traumatic experiences for Wright, her mother says she tried to stab a police officer with his pen, tried to kill a lover with glass from a broken lamp, and would cope with heroin and alcohol. Eight months ago, she moved from Colorado to Virginia and lived with Ploof in Roanoke County.
Without insurance and a way to pay for suitable medications, he says he took her to a doctor who gave her heavy tranquilizers and pain patches. He says it only masked her symptoms.
Then early this year, Wright met another man in her apartment complex who began to give her drugs and alcohol. Her violent behaviors returned.
On Valentine's Day, she lashed out, threatened to kill herself, and when the police arrived she told Randy she would kill him.
“Speaking to the officers I said, ‘Rather than taking her to jail for struggling with you guys can you get her to a hospital?” he says.
It prompted a stay at a psychiatric bed facility. She was admitted because she posed a suitable threat to herself and others. But a few days later she was released.
Two weeks after that in early March, Randy says Kate and the other man tried to kill him.
“And yea, I was almost killed.”
Speaking from his district office in Pearisburg, Giles County Delegate Joseph Yost says a lack of consistent treatment for mental illness has been a chronic issue that, in part because of the overall stigma of mental health, continues to be “out of sight, out of mind.”
“It's been my experience - I don't think individuals are necessarily healthy enough to be released just yet,” he says. “When I look at the system as a whole, over the last decade I've been involved in it, it seems like we just filter people through.”
In order to understand the gaps in how mental health care and treatment is given to those who need it most, you need to know how the system is set up. And providers admit it is incredibly complex to navigate.
For nearly a hundred years, Virginia housed mental illness patients in institutions that were even once called "lunatic asylums."
Then in the mid-1960s the state decided it was best to return stable patients to their communities who were best equipped to provide long-term care.
Out of that, 40 community services boards were created in the commonwealth, 12 of which serve the WDBJ7 viewing area. The term reflects not just the organization at large, but also the actual boards that have public members who help decide best practices.
Aside from getting some funding and being licensed to provide care from the State Department of Behavioral Health and Developmental Services, each community services board has an incredible amount of autonomy on how to administer mental health care.
Even the names aren't standard. Some call themselves community services boards, others take off the "board.” Still, others take the word community out entirely and call themselves "Behavioral Healthcare." No matter the name, each CSB is tasked with being the conduit for those who seek treatment but can't afford private options by offering counseling and psychiatric services.
The other responsibility of a CSB is to respond to psychiatric emergencies that result in an order from a judge to place a patient into custody. First, an individual will be held by local law enforcement so a screener provided by a CSB can do an initial evaluation. It's called an Emergency Custody Order. If it's deemed necessary to hold a person longer to see if they can come out of a crisis and respond to treatment, it's called a Temporary Detention Order.
But it's not always that simple. In November, Gus Deeds had a mental health crisis. A magistrate ordered an emergency custody order and he was screened by his local CSB, the Rockbridge Area Community Services Board. It was determined Gus Deeds needed a temporary detention order as well, but his CSB could not find a willing facility with a psychiatric bed. Often a bed can be found the next morning. But in this case, Gus attacked his father, Bath County senator Creigh Deeds, and then killed himself.
When a patient is under an ECO and temporary detention is advised but is let go because no psychiatric bed can be found, it's called “streeting.” Two years ago, the inspector general for the Department of Behavioral Health and Developmental Services issued a report that foreshadowed what happened to the Deeds family. Over a three-month period, 72 people were streeted across Virginia, about 1.5 percent of the time.
Two main reasons stick out as to why people who need a psychiatric bed for intensive care don't get one: CSBs in general didn't contact every place that could have an available bed and that both state-run and private psychiatric bed facilities can't or won't accept the patient.
After the Deeds case, lawmakers saw it as an opportunity to make the process more efficient; to make sure streeting is an even rarer occurrence than it already is.
Senate Bill 260, introduced by Sen. Deeds, increases the time a CSB can look for a bed to fulfill a temporary detention order from four hours to eight, with two possible two-hour extensions. It allows for the implementation of an online psychiatric bed registry which is now live and is used by each CSB. It creates a better safety net by requiring a state facility to take a patient if there are no other options. And stakeholders say most importantly, it calls for a four-year study of our public mental health system to find other problems that need to be fixed.
But not every lawmaker supported the changes when first proposed. Grayson County senator Bill Carrico initially voted against many of the proposals, citing an increased burden on law enforcement.
“There's a lot of waiting, and that law enforcement officer cannot leave the individuals side while that waiting occurs,” he says. Carrico did vote for SB 260 when presented to the full floor for a vote, as did every other delegate and senator in the General Assembly.