Here's one image of mental-health care in Virginia institutions, circa late 20th century: Gloria Huntley, a 31-year-old borderline schizophrenic, in and out of hospitals from the time she was 13, died strapped by the arms and legs to a hospital bed at Central State Hospital June 29, 1996.
Even though her psychiatrist had warned of the danger, Gloria lay spread-eagled in restraints for 300 hours in the last month of her life, including two stretches of four-and-a-half days each.
Here's an image of mental health care in Virginia's more community-driven system, circa early 21st century:
"My son's bipolar, he's off his meds, he has a history of psychotic behavior. You've got to do something! He's sick! Help him please!" Pete Earley, author of the recently published book "Crazy," records a nightmarish attempt to get his mentally ill son admitted to a Northern Virginia hospital.
"Your son is an adult," the physician replies, "and while he is clearly acting odd, he has a right under the law to refuse treatment." It's only a matter of time until that son breaks into someone's home and faces two felony arrest warrants.
What unites an era of institutions for the mentally ill and an era of deinstitutionalization in which jails and prisons often wind up as default holding pens?
The awareness that mentally illness can be hell, no matter when or where.
Think we've progressed far from the era when Dorothea Dix stormed 19th-century America, exposing the abominable treatment of the mentally ill in jails and prisons? Read Earley's account of the psychiatric unit at the Miami-Dade County jail, and you'll doubt it. Naked prisoners huddled in freezing cells eating food off the floor, then and now.
The April 16 killing of 32 students and faculty at Virginia Tech by a deranged student-gunman is bringing renewed attention to the status and treatment of mentally ill Virginians.
What does it take to force treatment?
What should that treatment entail?
What is the correct balance between honoring the rights of the individual and protecting both that individual and society from the harm he might do?
At the first meeting of the blue-ribbon panel appointed by Gov. Tim Kaine to address the Tech shootings, mental illness bubbled to the fore. Kaine confirmed that sense in an impromptu press conference.
"Fairly quickly, I felt the mental health issues might come to predominate," he said.
What that panel can most likely provide is a case study in the treatment, or lack thereof, of one young man, Seung-Hui Cho, whose brooding silence apparently intensified during his college years. A more intensive probe of issues will come with a 2008 report from the Commission on Mental Health Law Reform, led by Chief Justice Leroy R. Hassell Sr.
When it was launched last year, that study spawned an unnecessary challenge from lawmakers most prominently Virginia Beach Sen. Ken Stolle who thought Hassell was invading their turf. Now, everyone should just be glad the work is under way and that the final report will carry the cachet of some of Virginia's premier minds.
Yes, as Stolle argued, the legislature has conducted study after study of mental illness in Virginia and the missing ingredient invariably winds up being money.
But timing is everything in politics. No matter how many erudite studies are collecting dust on library shelves, the intersection of the Virginia Tech shootings and the Hassell study means this one will have an audience far beyond the rest.
Moreover, it is starting from the right point the grim reality that across the commonwealth, as nationally, prisons and local jails are substituting for the mental-health hospital beds that no longer exist.
By one reading, America has simply come full circle. In the Colonial era families cared for their mentally ill as best they could, and jails picked up the slack. Spurred by horror stories, state asylums were born. Generations later, amidst new horror stories, asylums began to shut down.
Now we are back to often inadequate family- and community-based care, with jails picking up the slack and more horror stories.
That's a gross oversimplification, of course. Modern medicines, well-run group homes, Assertive Community Treatment (ACT) teams and other innovations all allow scores of mentally ill individuals to live more normal, integrated lives than ever before.
Gloria Huntley and Pete Earley's son present only two faces of care, not the full range.
Still, we deceive ourselves and badly so if we continue to shut down hospital wards while tolerating a shortage of community options, or if we dismiss the agony of families forced to watch their loved ones disintegrate into criminals before help arrives.
Anyone reviewing the long history of mental illness in America knows reform never spells panacea. But current conditions are not the best we can do. Freedom that ends in a jail cell is not preferable to custody in a hospital ward.
We can do better, and we must. SMargaret Edds is a columnist for The Virginian-Pilot, where this column first appeared.
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