MORE than a month after lawmakers completed work on reforms to Virginia's mental health system, a man sits in a three-room, white, cinder-block unit at Western State Hospital, where he has been in solitary confinement for most of the past 20 years.
His food is pushed through a slot in a locked door with a Plexiglas window. His only access to the outside is a small, fenced-in porch.
Hospital administrators say extraordinary measures are necessary because the patient has a history of aggression, but such seclusion would drive a mentally healthy person to violence. It is hard to imagine how this repressive environment could be considered an effective treatment technique for a man who suffers from a schizophrenic disorder.
The shocking case underscores the reality that this year's reforms are only a modest first step in creating a more humane system of care for mentally ill Virginians. Inadequate funding exacerbates already poor conditions in too many mental health facilities, but there is also a crying need for improved training and a commitment to non-restrictive treatment.
A local human rights committee concluded last week that Western State administrators violated a law limiting solitary confinement to short periods and only when other measures have failed. Sadly, the U.S. Department of Justice rebuked the hospital a decade ago for its treatment of the same patient cited in the more recent report.
If this were an isolated incident, it would be unacceptable, but the terrible scope of the problem becomes obvious with a brief walk from the Staunton mental hospital for adults to the adjacent Commonwealth Center for Children and Adolescents.
An inspection by the state's Inspector General, released in February, found 735 incidents in which staffers subjected young patients to seclusion last year. On 165 occasions, youngsters were held in a prone restraint, in which they were forced face down onto the floor.
Virginia's only other hospital for mentally ill children, the Southwestern Virginia Mental Health Institute, bans this practice because of the danger to the child and the staff. The states of Maryland, California, Pennsylvania, Ohio and New York also prohibit prone restraints.
Again, the problems at CCCA are not new. The Inspector General first raised identical concerns in 1999. Thus, a pattern emerges. State and federal watchdogs have demanded more humane treatment of patients, and they have been ignored.
CCCA administrators have agreed to eliminate the use of prone restraints, and they are training staff in non-restrictive methods for handling aggressive patients. Those actions are appropriate, but history suggests the state's top mental health leaders must take greater responsibility to ensure the reforms are permanent. They must mandate a significant reduction in the use of seclusion and restraint, and hold accountable any administrators who refuse to comply.