Mental mess

Virginia is getting closer to an agreement with the Department of Justice over the state's inadequate treatment of the mentally and physically disabled. On Monday, State Health and Human Resources Secretary Bill Hazel told the House Appropriations Committee that he believes the ongoing negotiations with federal officials will lead to a settlement by June.

The Department of Justice sent Gov. Robert McDonnell a letter in February summarizing the state's civil rights violations, threatening to sue if changes were not made.

"What I think this is going to boil down to is what we feel the state can afford to do and the timetable in which the state can afford to do it," said Hazel, who could not provide details of the confidential meetings.

Officials from the Department of Justice, who are meeting with Virginia officials every other week, have expressed pleasure in the state's desire to correct the problem. Virginia has already set aside $30 million to implement changes. The money will be spent once a settlement has been agreed upon between the two sides.

"We want to know what the DOJ needs us to do so that money will be there for those purposes and to facilitate that process," said Hazel. "There's no shortage of places we could spend that money."

In addition to funding changes to the mental health service system, Virginia will likely need to pay for federal monitoring.

"I don't think it's likely that we'll just say we'll do it and they'll say good luck and go on, so we'll have to address that as well," Hazel said.

The investigation began in August 2008, when federal officials conducted on-site tours of the Central Virginia Training Center in Lynchburg. In April 2010, the Department of Justice began to investigate Virginia's compliance with the ADA and the Supreme Court's Olmstead v. L.C. decision.

"We conclude that the Commonwealth fails to provide services to individuals with intellectual and developmental disabilities in the most integrated setting appropriate to their needs as required by the ADA," stated the February letter, signed by Assistant Attorney General Thomas Perez.

Virginia is one of only five states still using centralized mental institutions, housing over 1,100 people in five institutions across the state.

The Department of Justice letter states that the number of mental health services in the community is inadequate and that the state has failed to use available resources. The waiting lists for community-based services hold approximately 6,600 people.

Virginia's centralized institutions have flawed discharge and transfer processes that do not identify the needs of individual patients. Many patients remain on a waiting list for years, sometimes more than a decade, when trying to transfer.

More problems were found inside the institutions.

Patients rarely interact with non-disabled individuals and are too often physically restrained. Personal decisions, such as what to eat and what to watch on television, are taken away from patients. The Department of Justice is concerned that patients are being instilled with "learned helplessness," making a future transfer to independent living almost impossible.

Centralized institutions are not as efficient as community-based mental services, both in results and expenses. The cost of $194,000 per year for each patient in a centralized institution is three times the cost of caring for an individual through community care.

"Reliance on unnecessary and expensive institutional care both violates the civil rights of people with disabilities and incurs unnecessary expense. Community integration will permit the Commonwealth to support people with disabilities in settings appropriate to their needs in a more cost effective manner," stated the DOJ letter.

The state's mental health services came under fire again earlier this month when Voices for Virginia's Children reported that the state does not provide adequate mental health services for children. The report, conducted by the privately-funded, advocacy institution, stated that there are not enough community-based services available and that the wait lists for the services available are too long. Without adequate health care services, many children end up in psychiatric facilities or in the juvenile justice system.

"We're going to pay for high-need kids one way or another, and wouldn't it be better to meet their mental health needs early on to try to keep them in their own homes and in their own school systems?" asked Margaret Nimmo Crowe, author of the report.

According to the report, services for children are not available in all parts of the state, and parents often have to maneuver through a web of local and state programs to find the help they need.

"Ideally, whether a kid can access services should be based on the acuity level of their mental health profile. It should not be based on socio-economic factors," said Beth Rafferty, director of the Richmond Behavioral Health Authority. "The kids deserve more than what they're getting."

Read the Department of Justice letter here (via Lynchburg News & Advance).

The Associated Press contributed to this report.

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