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by Phyllis Vine
It would be unfortunate if something as important as mental health reform in Virginia were driven by a single, albeit awful, event. Yet, that is what appears to have happened with the report released by Virginia’s Commission on Mental Health Law Reform.
Charged in 2006 with assessing how to close gaps promoting recovery in the mental health system, after Virginia Tech the commission backed down and turned its attention to civil commitment. This accounts for the bias inherent in the eagerly awaited report. Seven of nine recommendations pertain to civil commitment, including hearings, mandatory outpatient treatment, privacy issues, emergency custody. One recommendation discusses crisis stabilization; another, core services in the local community.
The blue-ribbon panel, headed by the University of Virginia’s noted mental health and legal expert, Professor Richard J. Bonnie, says it wants to see community services enhanced with a robust system that can “help prevent crises, respond to them successfully, and provide intensive services.”
Yet the commission ducked making community services their priority despite evidence that service shortages are rampant for one-third of the local communities without psychiatrists. Or in rural areas where people must drive more than an hour to get to a hospital for psychiatric help.
Neglecting to substantially improve or adequately fund community services resonates with forgotten promises of the last generation, promises that resulted in the transit from hospitals to prisons. And yes, Virginia state institutions continue to soak most resources spent on mental health.
Gov. Timothy M. Kaine’s budget proposal adds an additional $42 million to community programs. But this barely offsets the $32.5 million cut in 2003-04 budget resulting in 268 layoffs, or the steady erosion of mental health dollars in the past decade. It does little to correct the imbalance of where people need assistance when a tiny fraction of patients served on any given day are in institutional care – roughly 1,500 -- which soaks 41 percent of the mental health dollars ($327 million). What about to the others, nearly 400,000 people with serious mental illness according to a report of the Joint Legislative Audit and Review Commission.
If Virginia expands civil commitments and still invests more in its state institutions than in its communities, where will people get services? In jails? In state hospitals? In acute hospital settings? Troubling questions will surely grow about what is intended when commitment proceedings trump community services.
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