Rules Separate Mentally Ill From Treatment

In Northern Virginia, the number of private psychiatric beds available has plummeted, from 402 in 1990 to 196. There are none in Alexandria, forcing officers there to drive to Fairfax, or farther, to obtain help. The one state hospital in the region, in Fairfax, is nearly always full, experts said. Only 20 beds remain in Arlington for a population of 195,000.

James S. Reinhard, a psychiatrist who is head of Virginia's mental health department, acknowledged the diminished funding. But he pointed out that the state is about to pour $290 million into state facilities and another $170 million into community services, and that mobile community teams -- psychiatrists and social workers who make house calls -- which already are in use in Fairfax, should have an impact.

Reinhard noted that Virginia's mental health spending per capita -- it ranks 30th nationally -- doesn't compare to its income per capita (12th nationally). Cases such as the Fairfax police shooting "show how much of a need there is out there," Reinhard said. "People in our system are pedaling as fast as they can with the resources they have."

James Kelly, manager of emergency psychiatric services in Fairfax, noted that there have always been bed shortages. But he said Fairfax conducts crisis interventions around the clock, both at its mental health centers and in the community, and finds beds for those most in need. "I have no doubt that we see a lot of high-risk clients," Kelly said, "and we make a difference. But you're not going to catch every one."

Hospitalization shouldn't be the only option, said Mary Zdanowicz, executive director of the Treatment Advocacy Center. She said courts should be ordering more "outpatient commitments," in which mentally ill people are required by court order to take medication or other treatment -- and face legal sanctions if they don't.

Meanwhile, law enforcement officers continue to be the ones on the front lines. They receive training to deal with the mentally ill, and Fairfax Deputy Chief Suzanne Devlin said people should call police rather than let a loved one act out violently.

"It is frustrating," Devlin said. "But law enforcement is a funny thing; we do a lot of everything."

And so, people wind up in the jail instead of in hospitals.

"When I first started," Fairfax Sheriff Stan G. Barry said, "it was very, very rare that someone who was clearly mentally ill ended up in jail. Over the years, I've watched that change drastically. Now, people with mental illness get routed through the jail quite frequently. It's a game of hot potato. Nobody wants to deal with the problem."

State Sen. Ken Cuccinelli (R-Centreville), a friend of Garbarino's, proposed laws in the last legislative session that would have provided for more outpatient commitments and more legal help for families of the mentally ill. Both proposals failed, he said.

In New York state, a series of violent incidents caused lawmakers to institute involuntary outpatient treatment for certain people, under "Kendra's Law." The jail population in New York City dropped by half, Keisling said. "The shooting incident in Fairfax may result in some changes being made," he said. "It takes something like this to get the politicians motivated."