DATE: Monday, October 6, 1997               TAG: 9710020017

SECTION: LOCAL                   PAGE: B10  EDITION: FINAL 

TYPE: OPINION 

SOURCE: BY VAL MARSH and LAURIE FLYNN 

                                            LENGTH:   86 lines

VIRGINIA MUST WORK TO FIX BROKEN SYSTEM

Virginia's mental health system is clearly broken and needs to be fixed.

The resignation of mental health Commissioner Timothy Kelly, which took effect Sept. 17, provides one opportunity for a change in leadership. But a change in vision is needed as well - at every level of state government.

Why the need for a change in vision? Virginia continues to operate nine public psychiatric hospitals, despite the fact that annually these institutions serve only 7,800 individuals of the estimated 315,000 Virginians with mental illnesses. Yet, these institutions devour nearly two-thirds of the state's mental health resources.

In fact, Virginia ranks second in the nation in per-capita spending for public psychiatric hospitals. Yet such spending appears to have no bearing on the overall quality of care provided. Failure of the system can be seen in the numbers of homeless mentally ill people, the burgeoning numbers of people with mental illness in our jails and prisons, and, most horrifically, in human rights abuses that have received so much publicity lately.

Since 1993, five deaths and many reports of abuse have prompted the U.S. Department of Justice (DOJ) to investigate four of Virginia's psychiatric/mental retardation facilities for violations of human rights and basic care: Central State Hospital, Eastern State Hospital, Northern Virginia Mental Health Institute and the Northern Virginia Training Center. These DOJ investigations have revealed public institutions where our most disabled citizens have been routinely punished and ignored rather than treated.

The current situation in Virginia shows that, ultimately, a system that is hospital-centered fosters suffering instead of preventing it. The current system denies less expensive treatment that would avert the need for hospitalization in the first place.

What, then, is the solution? How do we develop a new vision for Virginia?

The first step is to look to science. The latest scientific evidence shows that mental illnesses are brain disorders (not discipline problems) and that treatment works (including new, more effective medications and supportive community services). In many cases, treatments for mental illness are just as effective as those for heart disease and cancer.

The second step is to look to our pocketbooks. If arguments that community care is more effective and humane are not persuasive enough, fiscal details should be sobering to the most skeptical. Costs of institutionalization are $90,000 per year per person.

Community care is not only effective 60 percent-80 percent of the time, but it is significantly less expensive than inpatient hospitalization. But treatment works only if it is available.

As a third step, NAMI and the Virginia Alliance jointly urge the commonwealth to make a real commitment to improving its public mental health system - by creating a comprehensive community support system of treatment and services for people with brain disorders. Within this system, there must be adequate access to current treatment imperatives, including new medications, P/ACT models (Programs of Assertive Community Treatment) and consumer/family education programs.

Although Commissioner Kelly made some progress toward creating pilot programs in community care, the time has come for less study and more action. This will require a substantial infusion of new money, as well as bridge funding to ensure a humane transitional period.

Other states have already discovered that building a community service capacity requires converting or ``reinvesting'' resources from massive hospital budgets. Virginia must have the courage to downsize and even close facilities, yet retain the saved resources within the mental health system to assist the currently unserved thousands.

This is not to say that inpatient care is not needed. Hospitals provide a vital service at the far end of a comprehensive continuum of mental health care. While Virginia must downsize its public hospitals, those remaining must be assured adequate resources to provide constitutional and humane conditions. Changes must also include strengthening the state's human rights watchdog system, which has proved to be shamefully ineffective.

We hope that recommendations along the above lines will be issued by the Hall-Gartlan Commission, a bipartisan legislative committee, later this year. There is every indication that commission members will make the dramatic recommendations for system reform that are needed. We encourage Virginia's next governor and state legislators to implement the changes that the commission recommends.

The eyes of the nation are on Virginia. Ultimately, the responsibility for monitoring the commonwealth's public mental health system should not lie with the DOJ but with public officials elected and employed at the state level. We urge Virginia's leaders to do everything they can to fix the system before more tragedies occur. MEMO: Val Marsh is executive director of Virginia Alliance for the

Mentally Ill. Laurie Flynn is executive director of National Alliance

for the Mentally Ill.

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