Opportunity born from tragedy: the Virginia Tech tragedy should motivate changes in Virginia's mental healthcare system.

The Commission on Mental Health Law Reform convened in October 2006 to study the commonwealth's existing mental health laws and make recommendations to the governor and the Virginia General Assembly. Founded and staffed by the Virginia Supreme Court, and chaired by Professor Richard J. Bonnie of the University of Virginia's Institute of Law, Psychiatry and Public Policy, this massive undertaking consists of 33 commission members supported by 138 advisors and experts. The Commission's guiding principle in all its deliberations is that "The mental health system, whatever the source of financing, should assure access to recovery-oriented services needed by persons with severe mental illness, should facilitate consumer choice, and should protect consumers and others from harm."

The Commission's comprehensive examination will produce five major Task Force reports: Criminal Justice, Access to Services, Children and Adolescents, Empowerment and Self-Determination, and Commitment.

The Commitment Task Force, by far the most controversial and the one receiving the most scrutiny and oversight, has four subcommittees:

* Emergency Custody Order, Temporary Detention Orders, and Transportation

* Training and Compensation

* Procedural Issues

* Commitment Criteria, Outpatient Commitment, and Voluntary Treatment

Although the Commission was formed long before the Virginia Tech tragedy, this event is having a major impact on the Commission's deliberations and recommendations, which are to be released in November.

Henry Smith, LCSW, director of mental health services at Cumberland Mountain CSB in Cedar Bluff and a member of the Empowerment and Self-Determination Task Force, says, "Fear is the result that lingers in everyone's thoughts. Consumers fear increased stigma, the loss of basic human rights, and overreaction from the system to this tragic event. They fear a loss of the progress made in the consumer involvement movement, such as the right of self-determination, psychiatric advance directives, provider choice, and the right to participate in their own treatment planning."

Sherry Rose, a consumer and member of the Commission's Commitment Task Force, reiterates, "The tragedy in Blacksburg has further increased the prejudice and fear of people with mental illness as shown by statements made by government officials. It has already had a traumatic effect for people with mental illness and the hate continues."

The commitment criteria and involuntary outpatient commitment continue to be the most controversial issues facing the Commission. "It is highly ironic that such an atypical case [Cho] has focused attention on such an underutilized feature of our current commitment law," says Bonnie, referring to outpatient commitment.

Adjusting the language of the "imminent danger" standard of Virginia's involuntary commitment statute is one of several changes being considered. The subjectivity in interpreting this standard is guiding the reformists to suggest changing the language to "clear and convincing evidence that there is a substantial likelihood that in the near future he or she will cause serious harm." Consumers and advocates are passionately opposing any effort to loosen the criteria that would result in additional commitments based upon the recommended language.

One central issue that the entire Commission has unanimously adopted is the decriminalization of mental illness. The emergency services staff of the Virginia Association of Community Services Boards has estimated that only 10 to 12% of commitment cases warrant or need law enforcement involvement. The great majority of cases should be completely outside of the criminal justice system.

Commission members are making important recommendations for transforming the mental health system and, fortunately, the state has key players in place to implement them. Kaine acknowledged system deficits by adding millions of dollars to the budget of outgoing Gov. Mark Warner. Kaine's EO 50 closed the loophole in the outpatient commitment law to ensure provider compliance and follow-up. Department of Mental Health, Mental Retardation, and Substance Abuse Services Commissioner James S. Reinhard, MD, and Deputy Commissioner Ray Ratke have created an atmosphere of mutual cooperation and respect that was nonexistent prior to their tenure. The commonwealth's Inspector General, James W. Stewart III, has transformed that office into a tremendous resource and asset for the entire system. His extensive study of both the emergency services system and case management pointed out glaring deficits in system resources. As an added bonus, the commissioner of Virginias Department of Medical Assistance Services, Pat Finnerty, and his entire staff have been a cooperative partner throughout his entire stewardship. Reinhard, Ratke, Stewart, and Finnerty also are members of the Commission on Mental Health Law Reform.

If Not Now, When?

The Virginia community mental health system is ripe for change. The atmosphere and attitudes are conducive for system transformation. How Virginia's government responds will demonstrate how high a priority it attaches to the mental health needs of the commonwealth's citizens. It is time for Virginia's decision makers to step up to the plate. We cannot afford to strike out.

Of course, there is no panacea, no magic wand to wave, to fix the mental healthcare system. And no matter how many resources exist, no matter how diligently we try, an incident like the Virginia Tech tragedy likely will happen again. But how many similar tragedies has the nation's mental healthcare system prevented? How many could it prevent in the future given the proper resources and support? Thankfully, we will never know.

Cumberland Mountain Community Services Board is a member of the Mental Health Corporations of America. To contact Allison, e-mail rallison@cmcsb.com.

For more coverage about the Virginia Tech tragedy, see perspectives from Mary Ann Bergeron, executive director of the Virginia Association of Community Services Boards, on page 41 and from Robert Bernstein, executive director of the Bazelon Center for Mental Health Law, on page 43.

ABOUT THE AUTHOR

Ronald A. Allison has been Executive Director of the Cumberland Mountain Community Services Board in Cedar Bluff, Virginia, since 1980. He is a member of the Commission on Mental Health Law Reform in Virginia, serving as Vice-Chair of the Commitment Task Force and Co-chair of the Subcommittee on Commitment Criteria, Outpatient Commitment, and Voluntary Treatment.