Closing mental hospitals may seem the thing to do until we think of what will happen to the patients. 

Murder by Neglect

The recent headlines about the horrific Golden Years killings show how the mental health system has failed both the mentally ill and the public. The newspaper reports tell us that Leslie Burchart, alleged murderer, had a long history of schizophrenia and assault. This story is but one example of what happens to both the mentally ill and the public when our mental health system fails us.

At first glance, Gov. Jim Gilmore's plan for the state's mental health program looks promising. Those of us with the benefit of history and hindsight, however, can see some dangerous flaws.

First, the reduction in in-patient facilities is based on the belief that there is a declining need for these services. This might seem apparent if you looked only at the decline in the state hospitals' census over the past few years. While new medications have made dramatic increases in recoveries, the real decline in numbers is due more to policy changes that began in the 1960s. These include cutting the number of beds, restricting the number and type of admissions, decreasing the length of stay and making discharge criteria more liberal.

Second, the plan is based on the concept that the communities will pick up the in-patient and residential services the state now provides. In the '60s the same promises were made. Thousands of chronically ill patients were dumped from state hospitals into the streets. The idea was that localities would pick up their care. This never happened. We all saw the result and are living with it today.

There are no facilities set up and ready to accept the almost 500 patients at Eastern State, not to mention the patients who would be turned away in the future. At the local level, Community Service Boards, which depend on our local tax dollars, do not distribute equally to all mental health diagnoses. In Henrico County, for example, while there are excellent residential services for the mentally retarded, there are no county-run in-patient or residential facilities for the chronically mentally ill. The promise of community-based residential treatment is just that, a promise, one that has not been kept in the past. Reducing in-patient facilities at the state level simply means there will be more mentally ill people on the streets and in the prisons.

To maximize the effectiveness of existing community mental health services, we should have stronger commitment laws that can help those incapable of caring for themselves and stricter laws about discharge of persons who are continuing to experience delusional thinking. As many other states have done, Virginia should have a stronger and more effective law for outpatient commitment, one which would provide for mandatory treatment for those living in the community. These laws make the limited community services that are available much more effective in preventing hospitalizations.

Third, Gilmore's plan is based on the presumption that former discharged patients are doing well in the communities. It is assumed that once patients are stabilized on medication, they will continue to self-medicate once on their own. Studies have shown that persons with delusional illnesses. who don't have structure and support frequently go off medications. What has been the fate of the mentally ill released into the communities? At least one-third of the nation's 450,000 homeless people suffer from schizophrenia or manic-depressive illness. In the streets, the homeless mentally ill are easy victims of rape, beatings, robbery and death from exposure. It is estimated that 28 percent of these people get some of their food each day from garbage cans. And even more tragically: Perhaps a third of the juveniles in correctional facilities are mentally ill. How can we justify closing our state in-patient facilities when that many young people are in correctional facilities?

Many of the persons who have committed spectacular crimes such as John Hinckley and Russell Weston had voluntarily and repeatedly sought help from local mental health facilities. They were discharged after short stays even though they admitted to having continuing thoughts about harming themselves and others. The Wall Street Journal reported that approximately 1,000 homicides a year are committed in this country by seriously mentally ill people who are not taking their medication.

Fourth, this plan is based on the assumption that monies from the sale of Eastern State will go directly to serve the needs of discharged patients. Recently, David Anderson, chair of the governor's conference on mental health, was asked about this. He said at a recent conference, "There is no way to be sure, but certainly the moral imperative would be there to use these funds for this population." We all know that government budget priorities can change quickly with administrations.

The Hammond Report on which the state's plan is based, recommends: "DMHMRSAS [Department of Mental Health, Mental Retardation and Substance Abuse Services] must continue to explore appropriate avenues to build community services and supports while continuing to reduce beds in state facilities." So beds will continue to be reduced, admissions cut and patients discharged into communities while options are explored.

Unless we want to see more headlines like the Golden Years killer, we must petition our state government to increase not decrease the number of in-patient beds and residential services available for the chronically mentally ill. These hospitals serve an urgent need. While it is also critical to improve them, they cannot be eliminated. There will always be some in the mentally ill population who cannot be cared for in the home or community. We can't allow hospitals such as Eastern State, Central State and Western State to be closed or further reduced in services unless and until other appropriate, long-term facilities are put in place.

Diane York has a master's degree in rehabilitation counseling from the Medical College of Virginia at Virginia Commonwealth University, and is a certified rehabilitation provider. She has a brother who has a long history of schizophrenia

Opinions expressed on the Back Page are those of the writer and not necessarily those of Style Weekly.

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