VA Gov To Inject Millions Into Community Services, Millions More For New Institutions

By Dave Reynolds, Inclusion Daily Express (subscribe)

RICHMOND, VA--VA Gov. Mark R. Warner's upcoming budget, to be unveiled Dec. 16, will include a record-breaking $170 million in new funds for community services for people with intellectual disabilities and mental illnesses.

That is a cause for community living advocates to celebrate, since hundreds of Virginians will be moving out of four, aging state-run institutions and into the community.

"We're certainly delighted at the infusion of money in communities," Heidi Lawyer, director of the Virginia Board for People with Disabilities, told the Richmond Times-Dispatch.

Much of the money will come through the state's Medicaid Home and Community Based Waiver program.

The flip side is that -- in a highly unusual move -- Warner plans to spend $290 million to fully replace two aging psychiatric hospitals and two institutions that house people with intellectual disabilities.

"Unless we can step up and bite the bullet on some of our aging institutions now when we have some financial resources, when we can make the significant transition investment in community-based care, then it's our belief . . . it might be another decade before we have a chance to do what we are proposing today," Governor Warner said at a news conference.

"Let me offer this assurance to advocates and family members: we believe everyone who needs a bed in a state facility will have one, but whenever possible, we will serve people in the community as our first option."

Many advocates said they are waiting for the details of Warner's proposal, which is to be published on December 16.

Few states have built new institutions in the past 20 years, as advocates have lobbied for systems changes that support smaller, community-based services.

The facilities to be replaced are Western State Hospital in Staunton; Eastern State Hospital in Williamsburg; Southeastern Virginia Training Center in Chesapeake; and Central Virginia Training Center in Lynchburg.

A new institution with 100 beds would replace Southeastern Virginia Training Center, which now has 200 beds.

Central Virginia Training Center currently houses 544 people, and employs about 1,700 workers. According to the News & Advance, about 200 of the current residents would move into the community. The new facility would house about 300.

CVTC, which began as the State Colony for Epileptics and Feebleminded in 1910, housed nearly 3,700 people in 1972. It is estimated that about one-half of the 8,300 Virginians who were legally sexually sterilized during the height of the eugenics movement, between 1927 and 1972, were residents of CVTC.

"Mental health hospitals to be replaced" (Washington Times)
"'Dream' scenario for mental health" (Times-Dispatch)
"New facility proposed for CVTC" (News & Advance)

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December 13, 2005 - News Department | Email this story


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Rethink: Outlining an alternative to the pain of psychiatric in-patient care
Thu, 08 Dec 2005

Rethink today challenged the mental health world to consider a future without psychiatric beds.

Its new research report, Future Perfect, set out a vision of mental health - as seen by service users and carers.

Service users and carers identified hospital in-patient care as amongst their worst experiences, and called for an alternative built around prevention, telephone helpline support, community-based crisis intervention and short-stay "sanctuary" in high quality non-hospital environments.

Rethink Director of Public Affairs Paul Farmer said: "This research is important in setting out a vision for mental health services and highlights the voices of those people who really matter - service users and carers themselves.

"Future Perfect supports the need to make mental health a mainstream issue and shift care away from compulsion in hospital to care in the community. There are powerful lessons here for the government's white paper on out-of-hospital care which is due to be published in the New Year.

Mr Farmer said: "We also need an open debate about helping people access preventive services as well as sustain high quality care for people in need of immediate help."

Future Perfect, builds on the Mental Health in the Mainstream project carried out with the Institute for Public Policy Research earlier this year, which sought an inclusive, community-based solution to mental health care.

Faced with the scenario of a world without inpatient beds:

Service users and carers articulated retaining a 'place of sanctuary' away from home and the need for a secure place for service users during a crisis.

These 'places of safety' should be small, purpose built homes to help service users recover from a crisis episode.
Users talked of a therapeutic environment with open spaces, gardens, complementary therapies and private rooms.

Services should be person-centred, holistic and included the provision of therapeutic and recreational activities as well as one-on-one time with staff.

Service users articulated a strong sense that 'prevention is better than cure' and access to the right services at the right time was crucial in preventing crisis.

There was a need to remove cultural barriers enabling people from minority ethnic groups to access mainstream mental health services.

Service users clearly articulated the need for more community health centres which were accessible at all times for support to avoid hospitalisation.

Such centres were described as needing to be open and accessible at all times so users can access support during evenings, nights and weekends, able to provide information on 'self-management' for users and education in mental health for carers.

When asked how services might better help support people into employment, the focus groups called for:

Support in adjusting to full time work by means of trying volunteering and part-time options.

Both service users and carers spoke of the need to have a single designated worker to help the service user gain employment and subsequently support them in the workplace.

Carers emphasised the need for the government of the future to allow employers the ability to provide flexible working hours for service users with the benefit of financial recompense for employers.

Crucially however, service users stated their main concern was the ongoing stigma and discrimination faced by employers and a drastic need to significantly change employer attitudes.

When envisioning what would support a better quality of life for carers; the research uncovered that:

Carers wanted better information, communication, support and inclusion into the care system.

Carers expressed a need to feel valued and respected by professionals who acknowledged that they held valuable information about the person in their care.

Carers wanted training in communication and negotiation to allow them to engage with health care professionals on an equal footing.

Both service users and carers identified the need for respite care.

Many carers expressed strong views that the mental health system of the future must offer addiction management services in order to help carers deal with the ongoing and increasing challenge of dual diagnosis.

The vision put forward by service users and carers leads Rethink to suggest the following recommendations for the future of mental health:

A comprehensive and fully funded national anti-discrimination programme owned by the mental health community.

New and accessible routes into care: innovative and comprehensive day or 'community health' centres where service users and carers can access information and advice and help in a crisis.

Alternatives to inpatient care: new therapeutic environments in the form of crisis houses, retreats or hotels.

Modernising day services: A more open, accessible and engaging form of day or resource centre where people can access help, information and support.

Support and recognition for carers.

Opportunities for employment.

Making a difference: both service users and carers wanted to have more say on the future of mental health services and in the planning and delivery of care. Service users expressed dissatisfaction with the current system for involvement and consultation and felt they were often tokenistic.

To read more about the views of Rethink click here

Posted by: Michael Nelson on December 21, 2005 11:14 AM

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