STAUNTON, VA. -- Blanche Moore is finally getting out.

Almost six decades ago, an older brother committed Moore to a state mental hospital after she had an apparent epileptic seizure or stroke. Administrators at Western State Hospital here now say she never belonged in an institution.

"I want to get away from this old place," Moore, 82, said in a recent interview at Western, the state hospital serving Northern Virginia. Social workers have been preparing her for a move to a nursing home.

This story about Moore's 58-year confinement at Western State is the first in a series of occasional articles on Virginia's mental health system. The series will examine how families deal with mental illness, what has changed in state hospitals since deinstitutionalization, why there are gaps in community services, and what solutions state officials are offering to an underfunded and overburdened system.

Virginia's mental health system is expected to be a top priority in the legislative session that begins in January.

Mental health experts estimate that in any six-month period, from 15 to 20 percent of Americans -- which would mean nearly 200,000 Northern Virginians -- need help for some sort of mental health problem, but that only about 15 to 20 percent of those seek treatment. People with illnesses serious enough to require hospitalization are a minority of those, the experts say.

At Western State, the population averages 650, down from a peak of about 3,000 in the 1950s before deinstitutionalization became a national policy. The largest reductions in the number of patients have been among long-term geriatric patients such as Moore. According to social workers, about one-third of the 140 such remaining patients at Western State could be living elsewhere.

"There were so many here that didn't need to be here," said Allison Bell, who heads the team of social workers who have placed Moore's name on a waiting list at a small nursing home in South Boston, Va. "They were shuffled off in a corner, and nobody thought about it."

A growing number of critics of deinstitutionalization say the policy went too far too fast, with few alternatives provided in the community for those who still needed more help than their families could give.

Moore is at once a living reminder of the failings of the old system and an example of a prime problem with the new: The old system led to her half-century of confinement; the new one is hamstrung by long waiting lists at the few residential alternatives that do exist.

In 1929, Blanche Moore, a frail young woman with bobbed hair and big, round eyes, became patient No. 17273 at Western State. She was 24 years old.

Her records, which are skimpy, include the admission interview she had with a psychiatrist at the hospital in September of that year. She was being transferred from what was then called the State Colony for Epileptics and Feeble-Minded in Lynchburg, Va., where she had been sent by her family when she was a teen-ager.

In the interview, Moore admitted experiencing "nervous spells" since she was about 14, when her grandmother died, but she generally answered questions reasonably. She had grown up on her grandparents' farm outside Emporia, Va. Her parents had died when she was a child. She told the psychiatrist that she never learned to read or write.

The psychiatrist asked her to tell the difference between an apple and a peach, to describe a chair and to explain the difference between a cow and a horse.

"You milk a cow, and you can't milk a horse," she replied to the last question, adding, "You are not making as big a fool out of me as you think . . . . "

The diagnosis was "psychosis, equivalent of epilepsy."

Today Moore is a small, bent figure whose bobbed hair has turned snowy white. Over the years she lost touch with her family, receiving letters only from a sister until a nephew made contact in 1975. She still cannot read -- nurses read her sister's letters to her -- but she has "a wonderful mind," a hospital social worker said.

Moore shares a room at Western State, which moved from downtown Staunton to a rural campus in the mid-1970s. While at the previous site, patients worked on a farm, picking beans and tending to cows and hogs, and they slept in large dormitory-style rooms where privacy was unknown.

" . . . It doesn't make any sense that the woman ended up in a state hospital and had her whole life taken away from her, at least any normal life," said John D. Beghtol, assistant director for community services at Western State

Moore's early hospital records indicate how easy it might be for patients to get lost in the system. The records for the first 12 years there fill little more than a single page. Typically, an entry consisted of a date and a one-sentence comment, such as, "Patient doing very well."

An October 1932 notation is followed by a gap of more than eight years, with the next line dated January 1941, noting that Moore had been moved to a different ward.

Asked recently whether she was angry at being hospitalized, Moore at first shook her head, but then said, "I don't know what I wish. Yes, I wish I had stayed on the farm." She said she has had no home to return to since her grandparents died.

"In those days, if your family wanted you away from home, they sent you {to an institution}," Bell said. " . . . People, when they came in, they stayed. It was very unusual for people to leave."

Despite the lateness of the move, administrators said Moore is a good example of the shortcomings of past mental health practices and is a fitting candidate for deinstitutionalization.

Today there are many systems in place to prevent inappropriate hospitalization, administrators say: A community screening before admission limits the time a person can be involuntarily committed, patient advocates work in each hospital, and a policy of treating people in the least restrictive setting is enforced.

In fact, some mental health experts and families of mentally ill persons say deinstitutionalization went too far too fast, and that people who need help may not get it because of current barriers to hospitalization.

One element that spurred the attempt to get Moore out of the hospital was renewed contact with some of her family in 1975.

"Mother was the only one that kept in contact," said Roscoe Lee Mitchell, Moore's nephew. They were from a poor family that lived far from Western State, so his mother had to keep in touch with her sister through letters, he said.

"People didn't talk about it," said Mitchell, 57, who lives southwest of Richmond. "She {Moore} didn't hardly exist to most of us until the past couple of years."

For Moore's part, despite spending most of her life at Western State, she said she is not afraid of leaving: "I'll take my clothes up and trip on down the road."

NEXT: A family copes with a schizophrenic son