Trouble brewing in Virginia
The Virginia Department of Mental Health, Mental Retardation, and Substance Abuse Services was recently allocated over $31 million for those on its Urgent Waiting List. Yet the continuing "reinvestment and restructuring" of state MH/MR institutions and the growing numbers of mentally retarded people who live at home and are on the Urgent Waiting List, combined with the continual unavailability of housing, means that despite the money, the situation will only worsen.
It would be way too much of an inconvenience for the state and its community service boards, or CSBs, to develop programs for insuring appropriate fits for different populations. The state and the CSBs should have such a program in place, but don't.
A successful program would need more housing, in the right geographic locations. It would need a strict criteria for placing individuals in appropriate assisted living arrangements. Because these populations differ in disabilities and types of treatment they require, they need different types of staff. One size doesn't fit all!
The $31 million is more funding than any for any other VA DMHMRSA program, but it only spells trouble if these deficiencies aren't begun to be corrected.
The current Virginia General Assembly session is considering a number of bills on these issues, many seemingly similar: HB 2150 requires assisted living facilities to develop individualized family service plans. HB 2362 increases oversight and regulation of assisted living facilities. HB 2512 increases oversight and regulation of assisted living facilities and increases penalties. Another version, HB 2537, also increases oversight and regulation of assisted living facilities, and increases civil penalties. HB 2545 sets education and training requirements for assisted living facilities.
The Senate has similar bills related to assisted living.
Two of the most important proposed bills are HB 2512 and HB2362. HB 2512 requires administrators of assisted living facilities to be licensed. HB 2362, among other things, "permits the Commissioner of the Department of Social Services to issue an order of summary suspension of a license to operate an assisted living facility and adult day care center in cases of immediate and substantial threat to the health, safety, and welfare of residents or participants"; "requires that medication aides be registered by the Board of Nursing if the drugs administered would otherwise be self-administered to residents in an assisted living facility or participants in an adult day care center program licensed by the Department of Social Services" and "requires that assisted living facilities employ a certified nurse aide registered as a medication aide who sees each resident once a week and is available seven days a week ...."
Although many bills refer to licensing, none makes it a requirement And more training is needed than the 32-hour course specified in some of the bills. The bills mention increasing oversight and regulation of assisted living arrangements, but none mention increasing inspectors to monitor the 2,468 mental health, mental retardation and substance abuse service locations, including group homes.
Despite some attractive features to HB 2362 this is a bad bill which should go nowhere. The Virginia Department of Social Services and the State Board of Social Services doesn't deal with mentally ill and mentally retarded people or those with substance abuse problems. It deals primarily with child support, welfare, family support....
Whether in the state mental institutions, training centers for the mentally retarded, or in the community, one thing is sure: there will continue to be a chronic lack of funding and long waiting lists. There will continue to be inappropriate placement of the disabled and criminal populations together, driven by availability of space, not criteria for placement.
Despite language of the VA DMHMRSAS, private contractors and CSBs cooperating, there is no binding legal obligation for any of these entities to provide community placement and residential supports.
In state mental institutions, the mentally ill patient is covered by CRIPA, the Civil Rights of Institutionalized Patients Act. CRIPA is federal legislation. But far as I'm aware the feds have only acted in Virginia's state mental institutions under the most egregious of abuses, such as when somebody has been murdered (or neglected to such an extent that they died).
But in the case of the Commonwealth of Virginia's "reinvestment and restructuring" initiative, CRIPA would not be involved in reviewing the adequacy of discharge planning and support services when patients return to the community -- because the state is reducing state psychiatric bed space, then purchasing privately contracted bed space for the formerly institutionalized individuals; then "discharging and diverting them". That is why there is no legally binding obligation to review the adequacy of discharge planning and necessary support services.
I had no idea until reading articles in the Virginian Pilot and the Washington Post how many of these private providers there are, the inferior "supervision" many provide, the laxity of the state in dealing with violations and inspections, and the mixing of convicted offenders with a history of violence and sexual offenses with other residents.
The CSBs are largely a public trust. But they have limited funding and can't accept every person. And it's clear that the private provider model of assisted living lacks state accountability. Deaths don't have to be reported to the medical examiner.
The federal government and the states are increasingly moving away from institutionalizing people, because it costs money. Yet at the same time they don't want to spend the money for competent public agencies, or on the subsidized housing these disabled individuals need. Nor is the state inclined to develop and implement a criteria of appropriate placement of these disabled individuals in the community.
America's jails and prisons are the nation's biggest mental institutions. Correctional officials are also frustrated, because they are not equipped to treat these people In some cases they have requested more funding for mental health services but, just as with the state mental institutions and community mental health agencies, their requests have been denied or their funding even cut back.
Let's be honest. Disabled people are society's burden. If trends continue, I can eventually see some type of government policy systematically exterminating mentally ill, mentally retarded and physically disabled people. In some cases their families, if they existed, wouldn't care. It would be a burden off them.
Even families who did care wouldn't know what caused the death of their loved one. Their child could be in a state mental institution, a training center, homeless on the streets or living in a private-provider assisted living place. Their deaths could be reported to families as "accidents," or a fake cause of death given.
In correctional institutions, mentally ill inmates could be mixed in with the general population and allowed to be more easily preyed upon and murdered. I can't imagine a more easy population to be preyed upon and systematically killed than disabled people. Imagine the monetary savings!
I admit I've outlined an extreme scenario. It's certainly not going to happen today or a year from now -- but the point I'm making is that it "could" happen. I don't know what the future holds, but things will get worse.
And yet despite the tremendous needs, all those dimwits in the Virginia General Assembly can do is argue about how they are going to cut taxes.
Posted Feb. 18, 2005
Disability advocate Michael Ragland was active in stopping a planned managed care reorganization of the Prince William County Community Services Board and has fought against allowing research on subjects whose ability to give informed consent is absent or impaired. He lives in Virginia.