In November of 2013, the son of Virginia State Senator Creigh Deeds received a mental evaluation while under an emergency custody order. He would have been further detained but a psychiatric bed could not be found available, and he could not be held without a bed.

He was released, and in less than 24 hours, he had stabbed his father, inflicting multiple wounds, and he had taken his own life, by a self-inflicted gunshot wound. The system, with inadequate inpatient mental facilities and uncoordinated care, failed, as they are failing across the country.

While the exact timing in each state may vary, basically, if someone has a mental health issue, is acting erratic, and is refusing to seek or accept care voluntarily, the recourse is to call the police or an area community services board, to initiate some form of wellness check.

The police/health care professional, must then visit the person and determine if a temporary detention order is needed. This is generally a high bar to reach, as the person must clearly be considered a danger to themselves or to others at that moment.

If the threshold is met, they are taken to a local emergency room to be evaluated further by psychiatric staff to determine if they need to be involuntarily hospitalized. If so, they need to appear before a judge, usually within 24 hours, who ultimately decides if further commitment is necessary.

Patients can be held for periods of time up to 30 days to be released only on doctor’s orders. At this point the commitment then depends on the availability of psychiatric beds at a local hospital, or sometimes patients are transported to other jurisdictions, if space is available. The patients are generally treated for 30 days or less, which is too short of time to effectively treat many serious psychiatric conditions such as schizophrenia.

They are typically released with meds to take and follow-up appointments scheduled to continue care in the outpatient setting. In many cases, however, the meds are stopped (often because they have unwanted side-effects, or the patient does not feel they are needed) and the follow-up appointments are not kept.

The person simply fades back into the world, with no long-term improvement to their mental health achieved. They can then become homeless, suicidal and will often go through the same wellness check through short term hospital stay routine, sometimes repeatedly.  

What these patients really need is a longer time for inpatient care, up to a year in some cases, to receive consistent treatment, medication, and the development of coordinated societal re-entry plans and steps, involving community services.

The major impediment becomes a lack of beds and facilities, both short term in hospitals, and longer term in state mental institutions. With the lack of beds and staff, it often steers the process along the path towards premature release, which continues a downward mental health spiral; bad for the patients, bad for the community at large.