How are we treating our mentally ill? Virginia's Supreme Court chief justice wants to know

Date published: 11/17/2006

Virginia's mentally ill

A new commission seeks ways to treatthe afflicted more humanely

"I CARE. THE COURTS CARE," Virginia State Supreme Court Chief Justice Leroy Hassell told a gathering in December 2005. That's just why he has established the Commission on Mental Health Law Reform.

The 26-member group, headed by Richard Bonnie, director of the Institute of Law, Psychiatry, and Public Policy at the University of Virginia, met for the first time this month in Williamsburg and plans three more conferences before receiving public comments on its findings next summer. The commission's goal is to look at how the mentally ill fare under the state's legal system, with an eye toward proposing legislative changes in 2008.

The initiative is much needed. The massive national shift toward closing state mental hospitals in the 1970s and '80s ended the long-term warehousing of patients, which is good, but it also placed many ill people back in communities with inadequate support structures. Today, services are better, but, all too often, mentally ill people wind up in jail or on the streets, unable to obtain the care they need.

The Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services shifts most of the responsibility for caring for the mentally ill to the state's 40 community services boards. Locally, the Rappahannock Area CSB does a yeoman's job of providing services both in the community and at the jail. Still, it's difficult to keep up, especially when the people targeted may be unable to make good decisions for themselves.

For example, a mentally ill person might be arrested for a minor crime, such as trespassing, and wind up at the jail. Some such inmates, especially if they refuse to take their prescribed medication, may land in isolation--an inappropriate but often unavoidable "punishment" for someone who needs psychiatric help. Furthermore, when deranged prisoners are released from jail they may lack the focus to receive help from the appropriate social-services agencies that would keep them from breaking the law again.

The current system is a lose-lose all around--for the chronically underfunded CSBs (Virginia ranks 47th among the states in per capita spending in outpatient mental-health services), for the overloaded jails, and for the patients themselves. Families, too, struggle with the difficulty of getting help for their loved ones without resorting to the wrenching process of involuntary commitment.

After sorting out due process, appropriate care, commitment procedures, and other thorny issues, the chief justice's commission aims to come up with some fresh ideas for Virginia by next summer. "This journey will at times be complex, controversial, and laced with emotion," Chief Justice Hassell says. Yet it's a necessary review already well past due.

Date published: 11/17/2006