Kaine to Overhaul Mental Health System

Utah changed its law in 2003 to remove the "immediate" criterion and allow judges to consider a person's mental history. There was an initial increase in people being ordered to treatment, said Jed Erickson, an associate director of Valley Mental Health in Salt Lake City, but that dropped off. Erickson said the publicity concerning the law's change increased awareness of the issue but didn't affect the mental health system itself.

The problem comes back to money, said Paul S. Appelbaum, a psychiatrist at Columbia University and past president of the American Psychiatric Association. The shortage of psychiatric hospital beds -- the number of beds in Northern Virginia dropped to 196 from 402 from 1990 to 2006 -- plays into the real-life consideration of where to put a person who needs help.

"In the absence of sufficient inpatient resources to meet the likely demand," Appelbaum said, "it doesn't matter how much you loosen the standards for commitment if there are no beds. Clinicians standing at the metaphorical front door have to ratchet up the standards they apply, regardless of the state's law."

So how much will it cost Virginia? The mental health department has not begun its calculations, officials said, but will do so when legislators file bills that require fiscal-impact statements.

The Virginia Supreme Court appointed a commission on mental health law reform that is about to make a series of recommendations to the General Assembly. Commission Chairman Richard J. Bonnie, a law and psychiatry professor at the University of Virginia, said the report will try to assess the costs of changing the commitment standard. He said the commission will recommend spreading the costs over six years.

Phillip A. Hamilton (R-Newport News), chairman of the Health, Welfare and Institutions Committee in the House of Delegates, said that any cost increase incurred by the state will depend on how broad lawmakers make the new standard. He said his committee had not tried to determine what any changes might cost.

"With going to 'substantial likelihood' as a commitment criterion, a case could be made that that broadens the pool [of patients] and therefore you increase the cost," he said. But he added that potential language could also include stipulations that ensure that concrete evidence is presented before someone is committed. "You have to have some evidentiary standard," he said.

Del. Robert Bell (R-Charlottesville) will head a House subcommittee on the commitment standard. He said he recognizes the need for change but also wants the state to be wary of forcing too many unwilling people into treatment. He said there would be costs, and "I don't know any way around it if we're going to keep you safe."