Virginia's backsliding on mental health care promises

By Pete Earley
Sunday, March 7, 2010; C05

In the wake of the shootings on the Virginia Tech campus that left 33 people dead on April 16, 2007, then-Virginia Gov. Timothy M. Kaine, with then-Attorney General Robert F. McDonnell standing next to him, signed legislation to improve the state's mental health-care system.

Two years after that signing ceremony, however, the much-ballyhooed reforms appear to have had little or no impact. And even though Kaine and McDonnell, now governor, endorsed the reforms, both have recently played key roles in financially undercutting them.

The two hallmarks of the 2008 mental health reform package were a loosening of Virginia's civil involuntary commitment law and the provision of $42 million in additional funds over a two-year period for state mental health services. Before the reforms, Virginia had required a showing that a person with a mental disorder posed an "imminent danger" to himself or someone else before he could be forced into a hospital for treatment. The new standard requires only evidence of a "substantial likelihood" of danger -- a significant change.

Critics feared the change would result in mentally ill people being steamrollered into state hospitals. But an internal study last fall by the Virginia Commission on Mental Health Law Reform found that there had been no sizable increase in forced commitments stemming from the new criteria.

One possible explanation is that Virginia still has a severe shortage of crisis-care psychiatric beds. Last summer, Fairfax mental health officials needed to find beds for six people who were in the midst of dangerous psychiatric crises. Because local hospitals were full, they began calling around the state and could not find a single hospital in Virginia that had an open bed. What point is there in committing a person to a hospital if there is no bed available?

The $42 million in additional spending, the other major reform, fell victim to a political shell game. While appropriating $42 million in new funds with one hand, Kaine and state legislators used another hand to impose across-the-board 5 percent cuts in services. McDonnell's just-announced budget proposal would impose another wave of cuts that would leave mental health services with less money than was available in 2007, before the Virginia Tech rampage. Making matters even worse, both Kaine and McDonnell recommended closing the state's last two adolescent treatment units, over the objection of a consortium of 19 organizations that represent state social workers, juvenile officers, mental health advocates and psychiatrists. These units serve more than 800 severely disturbed youths -- an ironic cost-cutting step given that the Virginia Tech gunman's mental problems surfaced when he was an adolescent.

What's especially tragic about these repeated budget cuts is that there are treatment programs in Virginia that have proved to be effective and that could reduce the need for tax dollars if given time. Expanding and adequately funding these programs makes better sense than roller-coaster funding that slaps on a Band-Aid when there is a tragedy, only to rip it off later. When Kaine signed the 2008 reforms, he told reporters, "It's been a difficult year, but it's been a year when people haven't [shrunk] from trying to learn and improve."

Based on spending cuts that will turn back mental health spending to pre-Virginia Tech shooting levels, we should ask ourselves: What exactly have we learned?

Pete Earley is the author of "Crazy: A Father's Search Through America's Mental Health Madness."

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