Virginia has made great strides in providing for the mentally ill and mentally retarded but still needs to improve some areas, especially services to emotionally disturbed children, Virginia's new commissioner for mental health and mental retardation said last week.
Lee E. Kirven12r., who was appointed commissioner of the Virginia Department of Mental Retardation in Januay by Gov. John Dalton, outlined a number of changes in Virginia's mental health system at a conference of mental health information officers in Alexandria last week.
Those changes, he said, have included reducing the number of patients in Virginia's 16 mental institutions and attempting to provide them with treatment in their own communities. At the same time, the state has tried to better protect the rights of more seriously ill patients remaining in state institutions, Kirven said.
He said the patient population in Virginia's mental institutions has been decreased from about 16,000 to fewer than 9,000 since 1970.
But more changes need to be made in treatment of children, Kirven told about 50 members of the National Association of Mental Health Information Officers, who were among those participating in the organization's 16th annual meeting at Alexandria's Ramada Inn.
The state is lacking services for emotionally disturbed children and a preventative approach to mental illness, Kirven said.
"We've gone very slow in the area of emotionally disturbed children, and probably in part because I'm personally opposed to the institutionalization of children," said Kirven, an 8-year veteran in the mental health field in Virginia. "We need to find alternatives to putting children in institutions, which are not effectively treating them."
In addition, he said. Virginia needs to establish systems "in the classroom and on the playground" that will detect mental disorders early in the children to prevent them "from ever being classified as a mental patient."
He cited trends towaed deinstitutionalization and strengthening patient rights as the two foremost changes in Virginia's approach of the mentally ill.
"Even the type of patient being admitted is different than a few years ago," Kirven explained. "No longer is the guy who talks to himself on the street being sent away to an institution. Instead it is the person whose behavior (usually violent or antisocial) conflicts greatly with the society."
He said the trend toward deinstitutionalization will continue, adding that most patients can be treated as effectively and more cheaply in their communities rather than in institutions.
Concerning patient rights, Kirven said the state has just finished a complex, two-year procedure of drawing up detailed regulations outlining the rights of mental patients.
The regulations call for prompt and regular evaluations of a patient's mental condition, both on entering an institution and while residing there, to prevent patients from languishing in a mental facility - a situation which has occurred in the past.
Also, patients may not be subjected to experiments for research without written consent, and they are entitled to treatment in "the least restrictive environment," a phrase which means that treatment close to home must be sought before confinement in an institution.
Patient advocates, who are paid professionals, have been hired at all state mental hospitals to guard the rights of patients. In larger institutions, these advocates have been able to appoint a staff so that no advocate serves more than 50 patients, Kirven said.
Human rights committees, made up of both professionals and citizens, recently have been established in communities with mental institutions to hear the complaints of patients who feel their rights have been infringed upon by the institution, Kirven said.
Most complaints, which usually have been directed at individual hospital employes (for example an attendant who refuses to let a patient watch television) have been resolved within the human rights committees. A state human rights committee, with nine professional and citizen members, also has been established to act as an appeals board for complaints that are not resolved on the community level, he added.
"The committees look for unusual vindictive action on the part of (an institution's) employes - people who have the authority to totally control the lives of those under them (the patients)," Kerven said.
In addition, legal centers on behalf of patients' rights have been set up at several state universities, Kirven said.
But most of these changes, he added, have been harder to accomplish in private mental facilities, of which Virginia has more than most states.
"That's an area we still have to work on," Kirven said. "Who's going to pay for the salaries of advocates and other services in a private facility, where such things cut into profits? As a result, we've had some problems doing the same things in the private sector."
Welfare workers from around the state also gathered in Alexandria last week for the Northern Fall Conference of the Virginia Council on Social Welfare. Specialists in a variety of social welfare fields spoke at the three-day conference that included seminars on such topics as the economic situation of the elderly, child abuse, adolescent behavioral problems, food stamp regulations, group homes, battered women and hospices.