Published November 22, 2013
The stabbing of Virginia State Senator Creigh Deeds, followed by the alleged suicide of his assailant and son Austin "Gus" Deeds are tragic events that could have been easily prevented.
According to reports, Gus was evaluated for psychiatric symptoms just one day before he allegedly attacked his father and killed himself - and was deemed in need of hospitalization. But he was sent home because there were supposedly no available inpatient psychiatry beds anywhere nearby.
First, when patients are deemed in need of psychiatric hospitalization, they are never supposed to be sent home due to a lack of inpatient psychiatry beds. Doing so is malpractice. Such patients can be held in emergency rooms overnight, or even for two nights, waiting for a bed. They can also be admitted to medical units with a "sitter" at the door to watch them and keep them safe, while waiting for a psychiatry unit to admit them.
Second, the attack on Senator Deeds and the alleged suicide of his son have unfolded against a backdrop in which horrific mismanagement of the lives of the mentally ill is commonplace. As I have written so many times recently, our mental health care system is shoddy, shattered and utterly unreliable for the vast, vast majority of people who seek access to it--even state senators and their kids.
There are two key reasons why we have come to this point.
1. When HMO insurance companies were allowed to "manage" psychiatric care, they did so in a self-serving, Draconian way completely unsupported by any data concerning the safety of their policies. They simply began to withhold inpatient treatment from psychiatric patients, even those with severe mental illness, and insist that they either not be admitted to hospitals or leave hospitals as soon as 24 hours after admission.
They lied and claimed that their refusal to pay for inpatient care did not amount to dictating the substitution of lesser levels of care, because psychiatry clinicians could ignore their decisions and still do what their consciences dictated (just not get paid for it). But everyone knew that frontline clinicians were generally taking their marching orders from those insurance company reviewers.
The insurance companies also contributed to the weakening of mental health care by compensating clinicians for psychotherapy at a level that could fund the salaries of social workers and nurses, but not doctors.
The end result has been that a psychotic person thinking of harming others can easily be sent home from an emergency room today if he "contracts for safety"--simply promising he won't kill anyone. Because once he states that he won't, the insurance company will often refuse to pay for even one night of inpatient care on a locked unit.
In the realm of psychiatry, medical insurers have literally been getting away with murder.
2. Faced with cuts in public funding and untenable reimbursement policies from third-party insurers, the community mental health centers that once formed the backbone of mental health crisis management withered and broke under the strain of extraordinary caseloads and an onslaught of severely ill patients being underserved by the system.
Sadly, this is all happening as the American Psychiatric Association watches and pays most of its attention to issuing one diagnostic manual after another.
These are the main systemic reasons why Gus Deeds is dead and Senator Creigh Deeds is recovering from being attacked - and may never recover from what must be his immeasurable