Last in a series of occasional articles
Virginia's governor and General Assembly, responding to the severe shortage of services and housing for the mentally disabled, are planning the state's first major initiative since the early 1970s to increase community resources for the mentally ill and retarded.
Advocates and affected families have pushed hard during the past year for a $140 million initiative in the fiscal 1988-90 budget that would double the funding for community services for the mentally disabled and substance abusers. Gov. Gerald L. Baliles is expected to propose a lower but still substantial figure, perhaps half to three-quarters of that amount for the two years, according to sources.
Baliles' office would not comment on how much he plans to propose for social and mental services in his biennial budget, to be unveiled Wednesday.
"He recognizes it as a priority," similar to transportation and economic development in previous years, said Chris Bridge, the governor's press secretary.
"The situation looks good for a substantial enhancement," said state Sen. Joseph V. Gartlan Jr. (D-Fairfax), a longtime advocate of mental health funding and a senior member of the Senate Finance Committee. "A number of us felt that mental health and mental retardation had been given the short end of the stick for too long . . . . The money hadn't followed the patients."
Under the proposed community services initiative, the five Northern Virginia jurisdictions would be allotted $26.5 million for the two years, of which $9.7 million would be for mental health. Local plans for the added funding focus on more special housing for the mentally ill, particularly group homes; treatment for mentally ill people who are also substance abusers, and expanded day programs.
About three decades ago, patients not requiring intensive therapy began to be released from state hospitals, under a theory of deinstitutionalization that said the mentally ill would be better served in the community. But mental health advocates claim that funding for the comprehensive community services that were promised to replace the institutions never materialized.
As a consequence, many of those released ended up living with their families, who were often ill-equipped to deal with mental illness, or on their own -- sometimes winding up homeless and on the streets.
"The lack of adequate services for the seriously mentally ill is the major failure of American medicine and social services," concluded a 1986 report by the Public Citizen Health Research Group, which rated Virginia's mental health programs 38th in the nation.
Key members of the General Assembly have committed themselves to significant increases in funds for mental health, mental retardation and substance abuse treatment, but several said the entire $140 million initiative cannot be funded.
Officials at the Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services last fall requested a $1.1 billion budget for the 1988-90 biennium, representing a total increase of $242.6 million for mental health, mental retardation and substance abuse treatment.
That proposed increase included the $140 million initiative for community services for the two-year period, of which $52 million would be for mental health programs.
Those pushing for the added funding took heart in a positive economic report presented by Baliles to the legislature's money committees on Dec. 18, when he projected that revenue would be $378 million higher than earlier estimates for the next two years.
The governor warned, however, that his budget would be restrained by continuing uncertainty over the stock market and consumer spending.
Funding for the mentally disabled also is competing with other pressing needs, particularly education and other human resources areas, officials and legislators said.
The greatest need for the mentally disabled is in residential programs for those who do not need the intensive treatment of an institution but who cannot live entirely on their own.
In the wake of deinstitutionalization, the population at state mental hospitals has dropped from 11,561 at its peak in 1963 to 3,075 last year. That number is expected to drop to 2,800 by 1994.
State officials estimate that 65,000 mentally ill people are treated in community programs through the state's 40 community service boards (CSBs). At the same time, there are only 673 residential beds in the state to help the mentally ill, and much of that is emergency or temporary housing.
All communities report gaps in other services, whether it is in day support programs or the number of caseworkers who monitor and coordinate services for the mentally disabled.
Northern Virginia jurisdictions serve an estimated 19,000 people each year through five community service boards, one each for Fairfax-Falls Church, Arlington, Alexandria, Loudoun and Prince William.
If the entire $140 million in community funding were approved, the following allocations would be made:Fairfax-Falls Church: $7.7 million, including $2.8 million for mental health, by far the most for any of the state's CSBs.
For mental health, Fairfax County's plan includes the creation of two more long-term group homes, two short-term transitional residences for people released from mental hospitals, one crisis residence, a special group home for mentally ill people with substance abuse problems, a 24-bed apartment program, and expansion of case management, vocational and other services.
Arlington: $1.5 million, including $608,017 for mental health.
Arlington's goals include an additional six-bed group home for the chronically mentally ill, another day program for chronically mentally ill not now served, a special treatment program for mentally ill people who are also substance abusers, purchase of bed space at private hospitals for persons needing short-term hospitalization, and more resources for both children and elderly people with psychiatric problems.
Alexandria: $1 million, with $372,100 for mental health.
In Alexandria, the CSB's priorities are 39 more spaces in day programs, long-term supervised housing for 13 more people, a home for eight adults with three full-time counselors, more case managers and another social worker to make home visits and help families in crisis.
Prince William: $2.3 million, with $807,991 for mental health.
Prince William County would put its funding into a facility for mentally ill people in crisis or who need drug or alcohol detoxification, beds for children and adolescents in intensive treatment, and more therapists.
Loudoun: $674,232, with $265,334 for mental health.
Loudoun County would add clinicians to care for outpatients, a new supervised apartment program, two six-bed group homes, expanded day programs and purchase of beds for acute care at private hospitals.
Meanwhile, state mental health officials would like to add community projects for mentally ill people who are also deaf or blind, services to Alzheimer's disease patients, and five bilingual mental health specialists to be assigned to areas with large immigrant populations, including Fairfax, Alexandria and Arlington.
In addition to funding for community services, state officials have proposed money to help recruit and retain nurses, therapists and physicians at state hospitals, to maintain national accreditation standards at all facilities and to add special inpatient programs for adolescents.
Increased funding is approved as part of the state budget, which goes through one money committee in the Senate and two in the House.
State Sen. Hunter B. Andrews (D-Hampton), chairman of the Senate Finance Committee, told community service board officials last fall that they would get a "very substantial increase" but not the full $140 million.
Del. Dorothy S. McDiarmid (D-Fairfax), chairman of the House Appropriations Committee, said in a telephone interview last week that she supports added funding but believes that $140 million is an unrealistic amount.
"I doubt there will be $140 million. That is a terrific amount," McDiarmid said. "We will begin to climb back."