Decades, tragedies and heartaches later, Virginia’s mental health system still struggles

It’s been decades — at least three of them — with a continuous litany of embarrassments, mismanagement, tragedy and even death that have dogged Virginia’s dysfunctional system of mental health services and hospitals.

And the drumbeat continues.

A little over a week ago, two felons broke out of the Eastern State Hospital in Williamsburg where a court had placed them. One was captured the same day. The other remained on the loose, reportedly armed and dangerous, for several days before being apprehended.

The escapes last week were the second time in 12 months patients escaped Eastern State, established in 1773 as one of America’s first mental hospitals. In March, a patient at Central State Hospital in Dinwiddie escaped from that facility for the second time in three years and drove a big rig to Maryland before he was caught. A patient with a history of violence broke free from the Dinwiddie hospital last November.

Does that rattle any cages on Capitol Square?

Virginia has lurched along for at least 32 years, in fits and starts, trying to address well-chronicled, often grim, sometimes even infamous failings in its system for helping those with mental and behavioral health and substance abuse needs. And just when there’s progress, politics interferes.

Gov. Glenn Youngkin has ordered a security review of the state’s mental hospitals after the Easter weekend Eastern State escapes. As he should. But it’s probably not his last headache over the state’s mental health system.

Consider the public policy quicksand in which previous governors have found themselves in recent decades. Felons busting out of state hospitals seems trifling in comparison.

Starting in 1990, the Justice Department began a multi-year investigation of Virginia’s mental hospitals for what it described as patient care so inadequate that it created dangerous and even life-threatening conditions. In the latter part of that decade, my friend and Associated Press colleague Bill Baskervill embarked on groundbreaking reporting that documented ghastly, almost medieval practices at understaffed, poorly managed and poorly overseen state hospitals.

Baskervill, long since retired, worked in AP’s Richmond bureau and won national accolades for his dogged investigative reporting into horrifying treatment of patients at state-run mental hospitals. Among his findings were accounts of patients who lay on their backs, bound hand and foot with heavy leather restraints for days on end; of a woman who died in such conditions after her complaints and warnings from family members that she was dying went unheeded; of allegations by the father of a 19-year-old who said his son was so savagely sodomized by staff at one hospital with an object similar to a broom handle that it tore his bowel, punctured his liver, sending him into a coma and, 14 months later, his death.

Bill’s work, along with that of Michael Martz, who still does strong accountability journalism at the Richmond Times-Dispatch, brought about a suite of cover-your-ass state government responses that subsequently became the standard after-action playbook. Reviews get launched. A few heads might roll. Some money is sprayed at the problem.

After Bill’s stories hit, a state mental health commissioner resigned and the director of one of the hospitals was transferred. Policies severely limiting the profligate use of full-body restraints were enacted. Lawsuits were settled. Millions were appropriated in the name of fixing problems the news reports disclosed and, notably, triaging the resulting reputational injuries.

Ten years later, a Virginia Tech student whose violent delusions were so disturbing that they triggered dire warnings from university faculty slipped through the state’s sieve-like mental health infrastructure. He legally bought two handguns he used to carry out the deadliest campus massacre in U.S. history.

Gov. Tim Kaine empaneled a blue-ribbon commission led by former U.S. Homeland Security Secretary Tom Ridge and retired Virginia State Police Superintendent Gerald Massengill, and it produced a scathing report on system’s incompetencies at identifying, treating and tracking those in mental crises.

Laws intended to tighten the safety net were enacted, particularly those that required people judged to be dangerous to themselves and others be added to a registry of people who can’t buy firearms. And, of course, more money — $42 million, to be exact – was added to shore up the system.

The monetary commitment was disrupted by the great recession of the late 2000s which ate deeply into Virginia’s tax revenues and resulted in years of spartan budgeting.

It only took six years for Virginia’s next heartbreaking mental health services failure.

In November 2013, state Sen. R. Creigh Deeds, D-Bath, was nearly killed in a knife attack by his son Gus who was in the throes of a mental health crisis. Gus, only 24, fatally shot himself after repeatedly stabbing his father at their Bath County home. Four years earlier, he had traveled the state campaigning with his dad, the 2009 Democratic nominee for governor, in an unsuccessful campaign.

The day before the attack, a magistrate had issued an order for Gus to undergo an emergency psychiatric evaluation. Doctors who examined him at the Rockbridge Area Community Services agreed that he should be hospitalized, but officials said they were unable to locate a psychiatric unit bed for him in just the six hours that the magistrate’s order allowed him to be detained without his consent.

Then, as now, the governor, Bob McDonnell, responded by ordering a top-level review of Virginia’s mental health services, hell-bent to find out what happened.

If it sounds cyclical and repetitive to you, imagine how it feels to Deeds.

Still a member of the state Senate, his family’s tragedy has rendered him by far the commonwealth’s most tireless and credible advocate for bringing respectability to what has been a hot mess of a mental and behavioral health treatment system.

“When I started doing this work eight years ago or so, I thought it was just a matter of moving a few deck chairs around … and adding a few bucks to the formula and you could fix mental health,” Deeds, 64, said in an interview last week. “What I’ve come to realize is that we were so far behind the eight ball and so maladjusted in the way we spend our money. We spend way too much on hospitals and we don’t spend enough on community services.”

Deeds pushes for the sort of reforms and funding that the nation’s 12th-largest state should have, and just when he enjoys a measure of success, it gets whittled away, sometimes by a difficult budget or, as is the case today, a governor and Republican-led House of Delegates committed to putting the money into tax relief.

“We had a problem before the pandemic and the pandemic turned it into a crisis. We were overwhelmed,” Deeds said. Now, as the budget-writing committees of the Republican House and the Democratic Senate try to reconcile differing views of what to do with a $2.6 billion surplus, the time has come to regain momentum the commonwealth lost toward demanding better from its mental health system and providing the money necessary to accomplish it.

“We’re trying to figure out how we can work together on a bipartisan basis in this budget environment,” he said. “We have an opportunity to do some things like complete the buildout of STEP Virginia,” Deeds said. The program, inaugurated during the administration of former Gov. Terry McAuliffe, would streamline and expedite services for those in need of services – as his son was – throughout the system starting at the community level.

It is the roadmap for the Department of Behavioral Health and Disability Services to continue putting a dismal past behind it, as it was doing before the pandemic’s interruptions. It’s a cause in which Deeds has invested his time, his work, his passion and, literally, his blood. It’s a modern formula, based on proven best practices, that can empower comprehensive improvement if funded, sustained and given a chance.

It’s got to be more fruitful than the old CYA playbook of heads rolling, ordering voluminous reviews that gather dust, and dispensing unaccountable millions of dollars to manage the visible symptoms without addressing the underlying malady.