Mental health: Next comes the difficult part

VIRGINIA TECH KILLER Seung Hui Cho was a reminder of the terrible consequences when someone with a severe mental disorder is ignored.

In the aftermath of the Blacksburg massacre, almost a year ago, most Virginians were willing to pay more to feel safer, and mental health reforms passed by the legislature reflect that goal. Lawmakers earmarked $42 million to increase staffing at crisis centers and passed a law making it easier to detain mentally ill people against their will.

Bipartisan support made the process appear effortless, but it wasn’t. In meetings that sometimes lasted till midnight, lawmakers sifted through more than 75 bills on an issue as technical as it is emotional.

The crucial test is whether that intensity carries into next year. Gov. Tim Kaine and General Assembly leaders acknowledged that this winter’s effort was merely a first step, but those good intentions could easily be crowded out in 2009 by new legislative fads and election-year distractions.

The next wave of reforms must focus less on safety than on the need for more humane treatment of people who present no harm to others but require help coping with their illness.

Some of the new money budgeted this year will begin to address those needs by increasing the availability of outpatient treatment. The problem is particularly acute in Hampton Roads and Richmond, according to a report last year by the state’s Inspector General for mental health.

The two regions have the lowest per capita staffing ratios in the state, with just 1.5 persons per 50,000, resulting in unacceptably long wait times for services. In Chesapeake, the report found patients waited an average of two months to see a clinician and three months for a psychiatrist.

As state leaders begin thinking about the next wave of reforms, they should consider two areas where the needs are particularly urgent.

First, fewer than half of the 40 local mental health agencies in Virginia offer team-based services. People with serious mental illnesses are more likely to stay on their medications if they are assigned to a team that offers home visits and includes a psychiatrist, social worker, nurse, substance abuse counselor and vocational instructor.

The second and more challenging goal is to solve a growing housing crisis for the mentally ill. The state offers housing grants to 6,700 people with mental disabilities, but the money can only be used for assisted- living facilities, which offer limited independence.

Many facilities, including one in Norfolk, have recently reduced or eliminated beds once reserved for mentally ill people . The advocacy group NAMI wants the grants expanded to cover rent and other housing options.

Richard Bonnie, who heads a mental health commission established by the Virginia Supreme Court, said the ultimate goal must be to reach people with help before they’re in free-fall.

“In the long run,” he said, “there will be more security and more public safety by having less coercion of mentally ill people and a caring service system to prevent crises and ameliorate them when they arise.”

Christina Nuckols is an editorial writer for The Virginian-Pilot. E-mail her at christina.nuckols@pilotonline.com.