Commission Targets How State Treats Mentally Ill

By Tom Jackman
Washington Post Staff Writer
Wednesday, October 11, 2006

As the population in Virginia has grown in recent years, especially in Northern Virginia, the capacity to help the mentally ill has declined steadily. The number of psychiatric beds in Northern Virginia has plummeted from 402 in 1990 to 196 today, and those who can't find treatment often wind up in the court system, either through civil commitment hearings or criminal charges and jail.

A recent state study showed that 11 percent of the people in Northern Virginia jails are on psychotropic medications, and many more need mental health services. The study also estimated that about 25 percent of those held on temporary detention orders have no previous connection to the public mental health system.

"That tells me two things -- that it's getting harder for people to get the help they need when they're in crisis," said Mary Zdanowicz, executive director of the Treatment Advocacy Center, "and there's a large number of people who are getting no help."

Now, Virginia's system of helping the mentally ill is being targeted for reform from a powerful source: the chief justice of the Virginia Supreme Court. Tomorrow, Chief Justice Leroy R. Hassell Sr. is launching a commission to revise Virginia's mental health laws and judicial processes, with five task forces meeting to begin developing recommendations for "reform legislation" that would be presented to the 2008 General Assembly.

"I care. The courts care," Hassell said in a speech in December. "We care because we are committed to improving the quality of mental health services provided to those Virginians who are least able to care for and help themselves."

Richard J. Bonnie, director of the Institute of Law, Psychiatry and Public Policy at the University of Virginia, will chair the commission, which will be launched in Williamsburg.

"The question is, how can we use the law most effectively to get people the help they need, when they need it?" Bonnie said. "That's basically the question, and that's what we're going to try to do."

Mental health experts have welcomed the commission, but some question where it will lead -- and when. Zdanowicz, whose national nonprofit group is based in Arlington, noted that there have been many commissions and reports in the past. "Something needs to be done now," she said. "There are people dying here, for lack of attention to serious mental illness."

Among other things, Hassell wants the commission to study the criteria for placing someone in emergency treatment, which requires that people be an "imminent danger" to themselves or others. The commission will consider whether eliminating "imminent" in the definition, along with allowing longer periods of temporary evaluation, would allow people to get treatment when they can't recognize the need themselves. Diverting people out of the criminal justice system into the mental health system is another avenue for study, as well as modifying criteria for civil commitments.

Bonnie said the commission also wants to provide a legal foundation for "recovery" for patients who can participate in their choice of treatment and provide a broader range of choices.

"Try to engage them in treatment, make the services attractive, and you will have a better chance of stabilization," Bonnie said. "And if you do that, you will reduce the need for commitment."

The commission wants to target cracks in the system -- places where care is not provided, either during treatment or after.

"I hope we will be able to do evaluations of what the various policy options will cost," Bonnie said. He said the commission will point out to legislators that "if we fill in gaps in service, that is going to reduce the cost of commitments, and also reduce costs in the legal system."

Ron Honberg, legal director for the National Alliance for the Mentally Ill, said Virginia has been steadily transforming its system from a focus on inpatient treatment to community-based treatment.

"The end results may be very positive, but a lot of people have fallen through the cracks," Honberg said. "Virginia desperately needs something like this."

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