Commitment Rule Is Key To Changing The System

The imminent danger standard arose in several states in response to the previous governmental practice of building large asylums and then dumping the mentally ill there without due process or adequate resources. As squalid conditions and sordid practices were uncovered in the 1950s, the pendulum swung toward patients' rights: Hundreds of thousands were "deinstitutionalized," or released from the asylums, and new legal standards -- "imminent danger" in many states -- were installed.

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In 1955, 558,239 patients were in public psychiatric hospitals. By the mid-1990s, the number had dropped to fewer than 72,000. By 2002, the total had fallen below 50,000.

But the same states that implemented the imminent danger standards rejected them over the past decade, most often because of incidents that involved the mentally ill.

Because of the Tech massacre, Virginia is going through that process.

Seeking a 'Model'

Experts agree that there has been no uniform approach to the commitment standard among counties. "There's no case law on this," said George W. Dodge, for 19 years a special justice in Arlington. "There's no power; there's no codification of anybody's role. That's how barren the whole state is." He said the Supreme Court panel "has a wonderful opportunity to create a constructive model in dealing with the mentally ill."

Because there is no uniform standard, someone can manipulate the system. The 21-year-old son of another Reston man is an example of such people. The son "knows that when he wants to be admitted to a facility," the man said, "he simply states he has thoughts of committing suicide. Unfortunately, he rarely wants to be committed, and he simply states that he does not want to kill himself or others and that he is not hearing voices."

The man said his son "can be in a serious mental psychosis, but he seems to always have the ability to control his mental problems if someone is asking 'a few questions.' Especially when the 'wrong' answers to those questions will have him committed."

The result, in many counties, is that jails have become the country's repositories for mentally ill people and that police constantly encounter people who need treatment but often must commit a crime to get it.

"To use the criminal justice system to get the person into treatment, it's not fair to the county, it's not fair to the person, and it's not fair to the officer," Fairfax Maj. Thomas Ryan said. "They have to get that person off the street. They're clearly a crime victim waiting to happen. The only way the system says we can assist that person is to arrest them. That's absurd."

It appears likely that Virginia will revise its standard. The task force on commitment, headed by Fairfax lawyer and special justice Mark Bodner, has been considering suggested changes to imminent danger. Cohen, the U-Va. professor and task force member, said proposed wording such as "a substantial likelihood that in the near future" a person might cause "serious physical harm" to himself or others is probably going to be suggested to the General Assembly when the commission issues its report.

"We're trying to tighten the criteria with regard to 'serious physical harm,' " Cohen said, "but broaden the issue and loosen the time frame requirements."

Staff writer Chris L. Jenkins contributed to this report.

Virginia is going through an unprecedented examination of its mental health system after the slayings at Virginia Tech in April. This is the first of an occasional series of reports about problems in the system.