- The Washington Times - Wednesday, October 7, 2009


It’s too easy to want to throw the book at mentally ill people who commit crimes. It takes incisive forethought, consistent advocacy and deep compassion to find ways to get ill people the help they need, in advance, so they avoid not only crimes against others but also the personal anguish of losing touch with reality. The Virginia elections were ennobled last week when two statewide candidates, Robert F. McDonnell for governor and Kenneth T. Cuccinelli II for attorney general, took time away from more vote-rich topics to outline a serious set of proposals for reforming Virginia’s mental health laws.

Their proposals are useful not only for averting another public tragedy like the one that rocked Virginia Tech in 2007, when a mentally ill shooter went on a rampage that left 33 dead. They also could ward off thousands of private tragedies that wrack families whose loved ones can avoid debilitating bouts with psychosis only if they receive timely and focused assistance.

Mr. McDonnell and Mr. Cuccinelli have long records of involvement in improving care for the mentally ill and improving the legal system that deals with them. Mr. Cuccinelli in particular has focused on making it easier for afflicted persons to get intermediate care - supervised outpatient treatment for people who are not an imminent danger to self or others but still need medical assistance and guidance.

The Cuccinelli-McDonnell recommendation on this front is so important as to be worth quoting at length from the Cuccinelli Web site:

“Allow for ‘step-down’ treatment: Right now, a person who is found to be mentally ill and is committed to a facility is placed in either in-patient or out-patient care, but that person cannot be transferred between the two without a new hearing. This makes little sense…. [T]hat person should be easily removable by the doctor from in-patient to out-patient care. This reform should be accompanied by long-term case worker oversight for at least six months, since all studies show that the oversight is necessary to have a real impact on the patient’s life.”

Not only would the patient and the family receive better care rather than having the mentally ill person released immediately with no supervision, but the costs to families (or taxpayers) would be much more manageable. Mr. Cuccinelli told The Washington Times (and back-of-envelope calculations seem to confirm) that about a month’s worth of outpatient care can be provided for the same cost as just four days of hospitalization. Also, of course, supervised outpatient care is far less invasive and restrictive.

Other thoughtful proposals in the McDonnell-Cuccinelli package include easier transfer of mentally ill prisoners from jails to mental hospitals, a guarantee of a hearing on temporary detention orders between 24 and 72 hours after first requested, and allowance for qualified law students to represent petitioners in court when full legal fees for lawyers are too prohibitive.

The candidates also would boost community-based care, provide more funding and coordination for children and adolescent services and continue to give priority to the state’s “wounded warrior” program.

These plans go far beyond mere campaign boilerplate. The recommendations address specific problems with remedies precisely calibrated to current needs. Both Mr. Cuccinelli and Mr. McDonnell deserve credit for raising such important but oft-overlooked issues and for addressing them with considerable substance. No matter who gets elected governor and attorney general next month, Virginia legislators ought to pursue these reforms with thoughtful dispatch next year.

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