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Thursday, March 7, 2013
Given all the recent articles, editorials and bloviating (a fitting word here) from elected officials in The Roanoke Times concerning the plight of mental health in Virginia, one would think we are beginning to move in a progressively proactive manner. Yet, we are not. There are several factors that lead me to my conclusion.
Historically, Virginia was on the forefront of managing mentally ill people. In 1773, three years before our nation was founded, the first public mental hospital in North America was constructed in Williamsburg. If one reads the original legal documents concerning the rationale for this building, one is struck with the fact that it was built to keep insane, mentally deficient and grossly intoxicated people away from “normal” colony settlers. In a more subtle fashion, Virginia has continued to perpetuate the meretricious philosophical stance of hiding and treating mentally ill people poorly.
For example, on the surface, the historic movement of mentally ill patients from state facilities in the name of “census reduction” seemed like a progressive idea, but the results have been disastrous. With minimal planning and preparation, we have moved scores of mentally ill individuals from hospital settings — where they were getting their basic mental health and social needs met — to substandard housing with restricted community mental health oversight and treatment.
Virginia does not have, nor has it ever had, a seamless consolidated mental health system. Virginia has a bifurcated mental health system that lacks connection. On the one hand, we have the mental health and mental retardation facilities under the control of the governor’s office, overseen by the Department of Behavioral Health and Developmental Services. On the other hand, Virginia has 40 local community services boards. The mental health facilities are operated by the state; the 40 local community public mental health programs are under the control of local city and county governments. Seldom do they agree. The state department has little to no control or influence over the local CSB programs, and the local mental health programs are operated like independent fiefdoms — limited cooperation among the parts.
Virginia has historically played a shell game with mental health funds. The money moves from the state health facilities to the CSBs depending on the tenor of our state elected officials and who is sounding an alarm of public fear. This year, Gov. Bob McDonnell announced he was earmarking $5 million in his budget proposal for “specific adult and child crisis services.”
Upon closer inspection, this proposal is to keep those with intellectual and developmental disabilities from being institutionalized as required by the Department of Justice. Playing the shell game, the money proposed by the governor was to be taken from the mental health facilities.
Virginia is a reactionary state when it comes to mental health reform. There is little in the way of actually planning for long-term mental health reform; we simply react. Beyond reacting to the DOJ, which is monitoring how we treat mentally ill individuals, we react to the political sympathies and fears of the day.
For instance, on the heels of the senseless shooting in Newtown, Conn., the governor wanted to appoint a group specifically established to allegedly work on mental health reforms. (Seemingly, it takes the killing of small children in another state to get the old mental health ball rolling in Virginia.)
This is a variation on the shell game called sleight of hand: Virginia elected officials like to set forth study groups to assess the situation and make recommendations. I have lost track of the myriad studies, along with the vast amounts of money Virginia has wasted to commission study groups to assess and make recommendations as to how to improve mental health care in this state — all is to no avail.
Finally, except for minor wording changes in civil commitment statutes, the general intent related to committing dangerous individuals for inpatient or outpatient treatment has remained substantially unchanged since 1773. Only after the shootings at Virginia Tech in April 2007 was a change in the statute for civil commitment made from “imminent” to “substantial” danger to make it slightly easier to have someone committed to a mental health facility without his or her agreement. Some minor changes were added to strengthen outpatient commitment, but the oversight and monitoring is still limited and questionable.
The plight of mental health in Virginia might improve if our leadership stopped following our state tourist motto of “Virginia Is for Lovers” and adopts the Missouri state motto of “Show Me!”
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