Many Not Sick Enough for Services

In Richmond, for instance, the local behavioral health authority no longer provides services for mentally ill people who qualify for Medicaid and aren't considered to have serious problems. That is because city money has fallen over the past five years and all of the city's dollars are geared toward mentally ill people who need expensive monitoring.

The same goes for many other jurisdictions, particularly in rural communities. Rural agencies report that they often can't even meet the demands of mentally ill clients who have been discharged from state hospitals.

In all, mental health agencies statewide are running a waiting list of 5,700 people for these community services.

That has some advocates concerned that the state is not moving aggressively enough to make up for years of slippage. Signer has called on the legislature to add $25 million to Kaine's funding proposal.

Lawmakers said that given other funding priorities, they can make up for past shortages only incrementally.

"Would it be nice to have the revenue available to address the immediate needs as well as to strengthen other parts of the community system? Yes. But you can't turn an aircraft carrier on a dime," said Del. Phillip A. Hamilton (R-Newport News), who chairs one of the House committees reviewing much of the legislation on mental health issues.

But even before the Virginia Tech shootings, the problem of getting help to such people as Cho was a concern. The state's mental health inspector general said in a report to legislators months before the shootings: "Community-based support and clinical services provided in the community do not have adequate capacity. As a result emergency service programs deal with crisis situations that could have been prevented if the [mentally ill person] had received more intensive . . . services."

For people with mental illness, it can mean long, difficult stretches with no treatment. With diagnoses of bipolar disease, post-traumatic stress disorder and other ailments, Yukiko Moynihan, 28, an Arlington County store clerk, has cycled through five hospital psychiatric wards in the past 23 months, according to her hospital records. She has been referred to the Arlington Community Services Board twice, according to two hospital discharge documents. Each time, she was given an appointment and told that she would be able to see a therapist in three weeks.

"As soon as you're out of the hospital, waiting for your appointments, you have all this time between the time you saw your hospital doctor and a new therapist," she said.

"And all that time when you're out alone . . . there's just too much time," she said. "Things can get bad that quickly."

In 1998, the state spent $45 million for basic mental health community services and $3 million for services targeted at those with severe conditions. Now, the state spends $51 million for community services and $86 million for those with such severe conditions as schizophrenia, bipolar disorder and severe depression. That is a 9.3 percent decrease in community services funding over seven years after factoring in inflation, according to an analysis by The Washington Post based on figures provided by the state.

In Cho's case, the New River Valley Community Services Board was responsible for sending a staff member to a commitment hearing, like the one Cho had 16 months before the shooting. No staff member attended, largely because that service had been cut, said Harvey Barker, the executive director. Also, no one from the board followed up on the order requiring Cho to seek outpatient treatment. Barker said the agency didn't have the staff at the time to keep up with someone such as Cho.

"We hardly get any funding from the localities to staff these kinds of services," Barker said. "And all of the state money is used for the more serious population."

State officials acknowledge that the funding structure helps those with severe disabilities and who are poor but not those who fall in between.

"The intensive services that many individuals with serious mental illnesses need are very expensive, and that affects our ability to care for those who don't fit into that category," said Raymond Ratke, deputy commissioner of the Department of Mental Health, Mental Retardation and Substance Abuse Services. "The issue is stretching the dollars to meet the needs of people with serious mental illnesses while at the same time trying to serve those with less serious illnesses."

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