A Flawed System: Risk For Violence Overlooked Again
Failed murder-suicide attempt in Virginia highlights system failures
Posted Nov 25, 2013
Recently there was a shocking story in the news regarding an attempted murder-suicide in Virginia. The initial investigation has shown that Gus, the son of Democrat Senator Creigh Deeds, stabbed his father repeatedly, as many as ten times, and then shot himself in the head with a rifle following an argument. Unbelievably, the father survived.
The day before this horrific tragedy Virginia State Police were called to the home of Senator Deeds to respond to a “non-emergency call for assistance.’’ The result of the call was that Senator Deeds’ son, Austin “Gus’’ Deeds, was taken to a local hospital under an “emergency custody order” to undergo a mental health evaluation however he was released as the hospital had no available psychiatric beds for him. This has been contended however as three hospitals, all within two hours of the Deeds home, told CNN that they had available beds but nobody made an effort to contact them (Smith, CNN, 2013).
Following incidents such as this it is commonplace for people to question why it occurred and search for an explanation. The typical age of a first psychotic break is late teens or early adulthood. If a young person has a first psychotic break at 22, are incompetent to make decisions regarding care and at risk for dangerousness, but are not at immediate risk for danger to self or others, they cannot be committed for inpatient mental health care and parents can no longer sign him into care because the young person is no longer dependent and under age. The flaw in this rule is that due to their mental illness a young adult may still need the assistance and control of their parents or a surrogate control agent such as a hospital.
Often, a very bright, but severely mentally ill patient can regain composure in the emergency department for a short time and appear to not need urgent care, although they may decompensate after leaving the ER. He may be released and referred to outpatient care, but be unable or unwilling to follow through with outpatient mental health care.
Many mental health professionals are well versed in mental health care, but not so well versed in assessment and interventions for dangerousness. Laws in this arena are also not based on research on dangerousness. Therefore, better education of legislators, mental health professionals, and emergency room and law enforcement personnel is needed.
While there is both the single episode of violence and chronic violence, more often than not, violence is chronic, episodic, and related to a major stressful event which damages the ego and for which the person has insufficient resources to cope. This means that a person may not be in imminent danger of harming others, but is at risk for an episode of violence at some unknown point in time when he experiences a significant stressor. There are interventions such as skill building, family and trauma work which can be effective at reducing the risk when future stressors come about. Providing those interventions to unwilling clients is a problem we have not solved.
By contrast, the court orders those with a DWI to seek substance abuse treatment and those guilty of domestic violence to attend counseling or treatment. Those who pose a threat to the community should be no different, but somehow, it is at this point in time. Relying on an emergency mental health evaluation, which measures a person’s immediate and acute risk for dangerousness rather than chronicity and risk for future violence, will under-identify some portion of those at high risk for future violence. Just like identifying those that are acutely intoxicated, will not identify everyone that is at risk for a DWI. In fact, a functional alcoholic may not appear to be intoxicated at all to the untrained eye. In the same way, those at risk for violence may not appear to be at risk for violence to the untrained eye.
Training in the violence arena should be based on the research. Research tells us that clinical interview in determining future risk for violence is no better than chance. How many emergency rooms use clinical interview to determine risk of dangerousness? How many psychiatric hospitals use clinical interview to determine a patient’s risk of dangerousness before releasing a patient?
Clinical Risk and Need Assessment tools are far superior to clinical interview in determining risk for future violence and they should be used in every emergency room and psychiatric hospital for patients that are both mentally ill and dangerous, which is a very small portion of all people that are mentally ill. Prisons and jails and parole and probation departments can reduce violent recidivism by providing effective interventions while inmates are incarcerated and can make treatment and assessment mandatory. There is more we can do by changing our paradigm about assessment and treatment for those at risk for violence.
This murder-suicide attempt in Virginia could have been easily avoided had the proper and appropriate steps been taken by those involved. After Gus Deeds was taken under an emergency care order to a hospital for a mental health evaluation the officers who took him there should have ensured he was kept there until such time as they were satisfied he was not a danger to anyone. Those who preformed the evaluation in the hospital, if in fact no beds were available there, should have ensured he was transferred elsewhere if they deemed it necessary. The failure to take the appropriate steps needed in this case showcases, yet again, a system that is deeply flawed and one, which is suffering from a severe lack of communication between various agencies in the process.
Written by: Dr. Kathryn Seifert
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