Effects of New Mental Health Laws May Be Limited, Some Say

On Tuesday, the Virginia General Assembly approved some of the most sweeping changes in mental health law in a generation, but experts across the ideological spectrum said yesterday that the bills should be considered a first, modest step toward reforming a complex system.

The changes, spurred largely by the deadly shootings at Virginia Tech last year, will bring Virginia in line with nearly every other state in key ways, including lowering the standard under which a mentally ill person can be forced into treatment.

The legislation also will expand the criteria under which a mentally ill person can be barred from buying or owning guns, require mental health officials to more closely monitor people in community-based treatment and allow the sharing of information among mental health providers and court officials to keep better track of people in treatment.

But mental health advocates and experts across the country who have followed the developments in Virginia sounded a cautionary note about whether the hard-fought changes will prevent tragedies such as the April 16 killings, in which a mentally ill student killed 32 people on campus before committing suicide, or whether significant numbers of mentally ill people will be helped immediately. Several said that the changes will do little to allow local authorities to substantially increase the number of people taken into care.

Others said that without substantially more funding, the changes will be largely cosmetic and will have little impact on a system that has had difficulty keeping up with the complex needs of tens of thousands of mentally ill people in the state. Lawmakers must still agree on a $42 million funding boost in the proposed state budget for community-based mental health treatment before their session ends Saturday.

"The proof is going to be whether this effort will be sustained over time," said Michael Fitzpatrick, executive director of the Arlington County-based National Alliance on Mental Illness. "You can pass sophisticated commitment-standard changes, but if you don't fund the treatment opportunities and resources, that doesn't get you to where you need to go as a state."

The package of bills must be signed by Gov. Timothy M. Kaine (D), whose spokesman, Gordon Hickey, said the legislation is in line with what Kaine proposed before the session started in January.

"There have been some small changes, but this is a bill that the governor wanted," Hickey said.

Lawmakers in both parties have called their work groundbreaking, though with a projected state budget shortfall of $1.3 billion over the next two years, they said they could only do so much.

One of the achievements they touted was loosening the commitment standard, which is designed to allow more people to get help more quickly. Lawmakers said other changes were smaller but will significantly affect people's lives, such as ensuring that mentally ill people are closely monitored and giving mental health evaluators more time to assess the ill.

The previous standard was a "screen" to keep the cost of mental health services "artificially low," said Sen. Janet D. Howell (D-Fairfax), who helped craft the Senate's legislation. "Families are pleading for help for the person they love, and they've been spurned. Now, we should have a more consistent standard to allow more people to get help."

But it is unclear whether that has been the case in states that have made similar changes. Maryland amended its criteria for emergency evaluation in 2003 but did not report a difference in involuntary commitments.

"All this talk of commitment-standard change is a smoke screen," said Robert Bernstein, executive director of the Bazelon Center for Mental Health Law, an organization that advocates for expanded rights for the mentally ill. "What Virginia and all states need are systems that assess what went wrong when people are rehospitalized and how we can fix these individual cases at an individual level."

There is also concern among some of Howell's Senate colleagues that lawmakers were not aggressive enough. The Senate Finance Committee shot down a proposal that would have given the state much more power in forcing mentally ill people into outpatient treatment.

"I wanted to implement a standard that . . . would have caught people with serious mental illnesses at an early stage," said Sen. Henry L. Marsh III (D-Richmond). "But this is probably all we could have done at this time."

Staff writer Sandhya Somashekhar contributed to this report.