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Mental Health At A Loss For Money

June 23, 2007

By Bill McKelway

FREDERICKSBURG, Va. — Fixing shortcomings in Virginia's mental-health system may come down to one word. Money.

At a daylong conference yesterday, dozens of members of a commission set in motion almost two years ago by the state's chief justice of the Supreme Court were far more at a loss for dollars than words.

"In my opinion, the need for reform is irrefutable," said the project's leader, Richard Bonnie, a University of Virginia professor with a national reputation for expertise in mental health. "No one is satisfied with the current situation; the only question is how sweeping the reforms should be."

Translation: How much money there will be.

While discussions flared pitting differing views on commitment criteria, mandatory medication regimen and the merits of outpatient treatment, most debates moved to nonresolution over the issue of cost.

The commission, formally called the Commission on Mental Health Law Reform, had its origins when Chief Justice Leroy R. Hassell Sr. learned of broad problems within the state's mental-health system, especially regarding commitment procedures.

Yesterday, meeting for the first time since the Virginia Tech massacre April 16, commission members got a glimpse of how strained Virginia's mental-health system is. It lacks people, community facilities and political support.

Until Hassell's involvement, for instance, no one had a clear idea of how many special justices existed in Virginia; they are the people, usually lawyers, who decide who gets committed and under what conditions. Court officials now believe there are 187.

For decades, there were no clear mandatory criteria for assuming the post, and even today the justices are required only to watch a videotape made 11 years ago.

"You could get appointed and start hearing cases the next day," said William Miller, a respected special justice in Williamsburg who has been at the job more than 20 years.

Each case — there are about 25,000 hearings a year across the state — pays $86.25, a figure that hasn't changed since 1998. This July for the first time, the justices will be appointed for six-year terms.

Once the Supreme Court was able to determine who and where the justices are, the commission polled them about their cases.

More than 60 percent of people are committed because they are unable to care for themselves, not because they are a danger. Only 4 percent of commitment hearings last more than 30 minutes.

At a time when community-based care is the norm across much of the country, only about 4 percent of patients who underwent commitment hearings were released for outpatient treatment during the time of the polling last month.

Virginia Tech gunman Seung-Hui Cho was an example of a person receiving outpatient care, despite having been declared mentally ill and a danger to himself. Special justice Paul Barnett, whose career in mental-health care and law dates back three decades, made the determination in Cho's case.

But the ways in which Cho was assessed and released in December 2005, Bonnie said, "express the deficits [of the commitment process] in every report we've seen."

Cho was examined by a psychologist for only 15 minutes; held in detention for about one-third the time allowed by law to assess him; and released for mandatory counseling with no provision for monitoring what care he may have received.

Nor was the hospital where he was detained sharing information in a timely way with those involved in determining the terms of his release, the state's inspector general for mental health, James W. Stewart III, has reported.

Even as commission members hailed the need for crisis intervention centers in every community across the state — there are currently nine — and the need for changes in the commitment process, others said the reforms are pointless without adequate resources in communities.

And in a stern warning that seemed to fly in the face of project leader Bonnie's hope for an omnibus mental-health reform bill, state Sen. Ken Cuccinelli, R-Fairfax, told commission members that they should be prepared to prioritze their legislative hopes.

"We need to understand where the most important needs are," he said, referring to legislative budget writers.

James Reinhard, the state's commissioner of Mental Health, Mental Retardation and Substance Abuse Services, ticked off a list of past mental-health reform efforts. In a near whisper, he said those priorities have been known for more than 30 years.

"It comes down to resources," he told reporters later.

Contact Bill McKelway at bmckelway@timesdispatch.com or (804) 649-6601.