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Gun Control and Mental Illness, Another Tragedy

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Editor’s note: USA TODAY asked me to comment specifically about mental illness and gun control.  Here is my Op Ed that the newspaper is running on its website. (http://www.usatoday.com/story/opinion/2012/12/15/pete-earley-on-shooter-and-mental-illness/1771203/)

My adult son’s voice was rattled.

“You watching the news about Sandy Hook?” he asked.

“Yes, 20 children and six adults murdered,” I replied.

He let out a sad sigh. “I’m trying to wrap my head around this.”

Like most Americans, my adult son was distraught about Friday’s murders. How could anyone not be? But for him the news was especially unsettling. That’s because he’s one of “them.” He’s one of the ones being demonized on television. He’s been diagnosed with a mental illness. He’s been arrested. He’s been hospitalized in mental wards.

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Congratulations! You’re Well, But Can’t Be Discharged!

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How would you feel if you checked into a hospital for emergency surgery and after the operation was successfully completed, you were told that you couldn’t go home?

“But how long do I have to stay in the hospital?”  you might ask.

“Maybe weeks, maybe months, or even longer.”

For patients with severe mental illnesses in Virginia’s state mental hospitals this is not a theoretical  question. It’s what is happening every day across the state.  It also appears to be happening in other states, as well.

A new investigative report by Douglas Bevelacqua,  the Inspector General for the Virginia Department of Behavioral Health and Development Services, found that 70 patients in state mental hospitals were ready to be discharged.  But they couldn’t be released because there was no where safe for them to go!

The primary problem was a lack of affordable supportive housing. The next roadblock was a lack of community based treatment services, especially for elderly patients, those with co-occurring disorders, or those with such severe mental disorders that they require specialized care.

This bottleneck wastes tax dollars.  The average cost of keeping a patient in a state mental hospital is about $590 per day or $215,000 per year, according to the Virginia IG. The average cost of supporting that same patient in a community setting is about $120 per day or about $44,000 per year.  It doesn’t take a math wizard to see the savings. Taxpayers are shelling out $15 million for services that could be obtained for $3.3 million. That’s a staggering savings of nearly $12 million!

Bevelacqua also notes that keeping patients, who are ready to be discharged, in state hospitals takes up beds that are desperately needed by sick patients waiting to get help.

“It doesn’t make any difference which door is closed,” Bevelacqua said. “…If the hospital’s full, people can’t get in the front door. And if the community’s full, you can’t get out the back door.”

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Why Aren’t Our Elected Leaders Listening?

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Can you imagine what would happen if a newspaper reported that a hospital refused to treat someone suffering a heart attack? What would the public think if a car accident victim was turned away from an emergency room? Yet, according to a recent report by the Virginia Office of Inspector General for Behavioral Health and Developmental Services, at least 200 persons who were having a mental health crisis and met Virginia’s involuntary civil commitment standard because they were dangerous were refused treatment in the Hampton Roads area between April 2010 and March 2011. 

The practice of turning away psychiatric patients in Virginia has become so common that there is a word for it  — “Streeting.”

The IG’s report cited an example of a 66-year-old Virginia woman who needed immediate care but was turned away by 15 private hospitals. She then was driven a hundred miles away to a crisis stablization unit only to be turned away there because she did not make it through the unit’s medical clearance process due to lethargy, a medication side effect.  Forty-eight hours later she was finally admitted to a hospital emergency room.

She was lucky. At least she finally found a bed.

Where is the community outrage? Why are doctors, mental health professionals, community leaders and elected officials not alarmed?Click to continue…

Where would you draw the line?

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An investigative report recently released by the Inspector General’s Office in the Virginia Behavioral Health and Developmental Services Department is causing a stir. Each year, the IG is required to make unannounced visits to state facilities that treat  persons with mental disorders and report his findings.   

The section of G. Douglas Bevelacqua’s report that is getting the most attention, especially from the National Alliance on Mental Illness Virginia Chapter  is the IG’s discovery that “streeting” is now a common practice in Virginia. “Streeting” is the term that hospitals use when someone, who should be admitted, is turned out onto the street because there are no beds available. (More on this in a future blog.)

It’s another discovery that Bevelacqua cites that I want to discuss here. 

In his report, Bevelacqua writes that a federal regulation is being so narrowly interpreted by Virginia Attorney General Kenneth T. Cuccinelli  that as many as ten percent of patients in state run facilities are being denied access to treatment that could help them recover. 

Patients are being denied “medically necessary interventions that would allow them to participate in their treatment.”  They are being “denied palliative care” and their rights to helpful treatment are being “restricted,” the IG claims.

Kenneth T. Cuccinelli is well-known in Virginia mental health circles. When he was running for office, he talked about his efforts as a state legislator to improve mental health services. I spoke to him about the need to reform Virginia’s mental health system and he was well versed in the problems that our state faces. He sees himself as a friend of persons with mental illnesses.

So why is the IG suggesting that Cuccinelli’s office and a federal rule – that was written to protect persons with mental illnesses from abuse –are actually causing great harm to patients in Virginia?

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