Mentally ill patients, and their families, deserve better from Virginia government

July 19, 2021 12:01 am

(Stock photo via Getty Images)

By Margaret Rood

The Mercury’s  story on mental health hospitalizations in Virginia evokes some worrisome questions concerning the direction our legislature intends to pursue in addressing the commonwealth’s mental health crisis. Sen. George Barker, D-Fairfax, said “Right now, I think the sense is we don’t want to build more beds if that’s not what we want to do long-term … What we want to do is prevent situations where there’s a mental health breakdown.”

How will the commonwealth prevent hospitalization? According to the article, by “using state money to fund community services to keep patients out of the hospital altogether.”

The problem is that this is already what is supposed to be happening. Deinstitutionalization, the movement that closed large psychiatric hospitals in the 1980s and 1990s was supposed to be followed by the provision of comprehensive, community-based mental health services so that the needs of people with mental illness could be managed in a less restrictive environment closer to friends and family. The movement was partly premised on the idea that new generations of psychiatric drugs could allow people who might have required long-term residential treatment to live independently with adequate supports.

The outcome was disastrous.

The legislature and localities rarely established services equal to the needs of the thousands of people exiting the institutions. The psychiatric drugs that were supposed to keep patients stable enough to live independently proved variable in effect and effectiveness, while achieving compliance with medication protocols was far more difficult when patients were not under the direct supervision of medical personnel.

Truly stabilizing a patient can take years or decades. Patients had easy access to illegal drugs and alcohol, exacerbating their mental health problems and creating a disincentive to cooperate with social service organizations that might seek to limit their access to them. The homeless population swelled, while parents of children with mental illness struggled under the weight of caring for unstable, sometimes abusive or aggressive, kids while being simultaneously required to keep them in school the legally required number of days.

There is no magical state of being “kept out of the hospital.” At its most benign, there is a transition of caretaking to loved ones who may already be exhausted and whose financial and emotional resources are likely depleted. At its most callous, there is no transition of caretaking at all, just a return to the streets.

Note that it can take up to 30 days just to get a bed in a Fairfax County homeless shelter.

Citizens should be every bit as skeptical as the experts quoted in the Mercury article of our leaders’ claims that community services will now be funded and organized in a way that keeps people with mental illness out of the hospital. Even if there is follow-through, it cannot occur quickly enough to justify slowing the growth of psychiatric hospital beds until those services are in place. And our leaders need to be realistic about what community services are required to keep people with mental illness in their community and how much they will cost. Those services include:

  • respite care, including residential respite care, so that caretakers are not required to manage patients without relief
  • crisis care teams that are trained in subduing or restraining aggressive patients and that are adequately staffed so that they will be available on a timely basis
  • trained in-home aides
  • public, community-based therapeutic schools
  • recruiting programs to bring qualified mental health professionals to under-served areas, plus greater financial support to families in areas where few mental health professionals accept insurance

That’s hardly an exhaustive list, yet the price tag for it would be enormous. Providing anything less, however, would mean that what our leaders are contemplating is simply Deinstitutionalization Round II. Virginia’s families and friends who care for people with mental illness will watch our legislature’s proposals eagerly – and anxiously.

Margaret Rood is a systems engineer from Falls Church and the mother of a child with a psychiatric disability.

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