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Source: Richmond Times-Dispatch, Va.迷利倉Dec. 14--Virginia's top mental health official clashed with the state inspector general for behavioral health last year over a report that faulted the mental health system's handling of emergency services for people who posed a danger to themselves or others, according to documents obtained by the Richmond Times-Dispatch.The report sounded an alarm over gaps in Virginia's emergency services for people in psychiatric crisis that now grip the attention of state policymakers. Last month, state Sen. R. Creigh Deeds, D-Bath, was attacked by his 24-year-old son, Austin C. "Gus" Deeds, who then killed himself -- 13 hours after being released from emergency custody because an appropriate bed in a psychiatric hospital couldn't be found.Internal documents obtained Friday by The Times-Dispatch under the Virginia Freedom of Information Act show disagreement between James W. Stewart III, commissioner for behavioral health and developmental services, and then-Inspector General G. Douglas Bevelacqua, who is investigating the Deeds case for the Office of the State Inspector General that was created last year.Stewart told then-Inspector General Bevelacqua on March 22, 2012, that "the report fundamentally misrepresents both the behavioral health emergency services system and the data" from a three-month study conducted in mid-2011.The commissioner faulted the inspector general for focusing on a relatively few cases in which a person was not issued a temporary detention order, or TDO, despite meeting the criteria for involuntary detention, but Bevelacqua fired back that the state should provide appropriate care in all cases."Systemic quality improves by understanding failures, not highlighting success to minimize the relative incidence of the failures," the inspector general wrote Stewart on March 27, 2012.In response to the release of the documents, Stewart said Friday, "It is a serious concern if even one person in a mental health crisis cannot locate and receive the services that are needed."Stewart said the Department of Behavioral Health and Developmental Services had concurred with "the overall conclusion" in the inspector general's report "and will work toward solutions."The commissioner's statement cited a pending report by the University of Virginia that examines the problem and shows that in all but 4 percent of 1,260 emergency evaluations last April, people who qualified for TDOs were placed in beds within the six hours allowed by state law for emergency custody orders.Stewart also cited Gov. Bob McDonnell's recent decision to propose more than $38 million in new state spending on mental health services, extend the duration of emergency custody and temporary detention orders, and create a task force to address concerns raised by the Deeds case.The state is working to "improve the availability of the services that are needed when individuals are in crisis and to expand the capacity statewide of treatment and ongoing supports that will reduce and prevent mental health emergencies from occurring in the first place," the commissioner said.Last year, however, Stewart questioned the report's analysis of 72 cases of TDOs that were not issued during the study period for people who met the legal criteria of posing a threat to themselves or others, or being unable to care for themselves.The report acknowledged that the number of unexecuted or failed TDOs represented just 1.5 percent of the nearly 5,000 TDOs that had been executed successfully in the period, but concluded they represented an unacceptable danger迷你倉to the person in crisis and the public, as well as a failure to provide the clinically appropriate level of care required by state law."Each incident, in which a person is denied the level of service determined by trained mental health professionals to be clinically necessary, represents a failure of the system to address the needs of that individual and placed the individual, his family, and the community at risk," the report states.The report was dated Feb. 28, 2012, but was issued more than a month later, after the commissioner and his department responded to its specific findings and recommendations.In his memorandum, Stewart told Bevelacqua that the report "provides insufficient context" for the emergency services provided by community services boards as well as the cases that were studied.The 72 cases of unexecuted TDOs represented 0.0012 percent of all people who received emergency services in fiscal year 2011 and 0.0035 percent of all TDOs issued that year, he said."Without this and other important background information ... the report is a misrepresentation of the way the Commonwealth carries out its Code-mandated safety net responsibilities," the commissioner wrote.Among a half-dozen objections, Stewart also said the report's conclusion belied the fact that, "despite significant obstacles, a positive disposition was found in the overwhelming majority of the 345 cases reported in this study."Bevelacqua stood by his conclusions in a memorandum to Stewart on March 27, 2012, and said the state could not dispute that the 72 people "were denied the level of service deemed necessary" by local emergency services pre-screeners.He also called "settled" the report's finding that TDOs for 273 people were executed after the six-hour limit under state law for emergency custody orders.Those findings have become prominent in three state investigations of what happened to Gus Deeds, who was released Nov. 18 by the Rockbridge Area Community Services Board because the six-hour limit had expired on the emergency custody order and an appropriate bed could not be found to hold him for further evaluation and treatment under a TDO.The next morning, Deeds repeatedly stabbed his father, who survived after emergency surgery, and shot himself.Bevelacqua said the commissioner's analysis compared results of a study conducted over 90 days in one fiscal year with totals for all emergency services rendered and TDOs issued in a previous fiscal year.Besides, the inspector general said the state should take seriously the instances when the system fails for people in crisis, no matter how few cases there are.The inspector general also took issue with other comments by the state on the report that no one was released without care, because "alternative interventions ... assured the safety" of all 72 people.The report showed that 15 of those people were able to receive other community support, while 17 remained in hospital emergency departments until they could be treated, 13 were admitted to hospitals for medical reasons, one was arrested, and another received a less intensive level of care.Of the remainder, 13 were "were released with no intervention," and 12 "remained in a supportive setting, such as with family.""Is the department suggesting that assuring 'the safety of people' or that 'a positive disposition' are standards of care required by Code?" Bevelacqua asked.Copyright: ___ (c)2013 the Richmond Times-Dispatch (Richmond, Va.) Visit the Richmond Times-Dispatch (Richmond, Va.) at .timesdispatch.com Distributed by MCT Information Services自存倉