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A positive response to a terrible tragedy

August 1, 2008
by Mary Ann Bergeron
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Virginia stakeholders have worked together to craft legislative solutions in the wake of last year's Virginia Tech shootings

Virginia Gov. Tim Kaine with Mary Ann Bergeron, VACSB executive director; photo by Michaele White, Virginia Governor's Office

The life of every Virginian, perhaps every American, changed as a result of the tragedy and loss of life at Virginia Tech on April 16, 2007. Those individuals who were killed and wounded will be remembered with reverence and honor, not only by their families and friends but by all citizens throughout the Commonwealth.

Immediately following April 16, Gov. Timothy Kaine named a panel of experts with broad powers, the Virginia Tech Review Panel, to conduct a thorough investigation of the tragedy. During those hearings, the poignant testimony from parents and families, even in their pain and grief, contained their overwhelming requests to ensure that within the public mental health system people receive the treatment they need. Perhaps, just perhaps, Virginia has begun the task of creating the most significant legacy to the individuals who died: a vital and dynamic system of mental health services.

The Virginia Tech Review Panel's August 2007 report made broad recommendations that included:

  • campus and law enforcement security procedures at state universities;

  • mental health practices and procedures relating to emergency services, temporary detention, and civil commitment processes;

  • needed legislative changes;

  • changes in information exchange; and

  • improved coordination among involved agencies and the courts.

Seung-Hui Cho's family made his health and school records available to the panel (not to the public), which allowed for deeper insight and led to recommendations around information sharing and coordination of efforts between and within school systems. Amazingly, Cho did well with special accommodations in school and intensive and consistent counseling outside school hours during his school years in Fairfax County, well enough to be accepted by Virginia Tech.

Kaine, in his initial response to the panel's report, publicly affirmed that community mental health services, when provided appropriately, work well. There was near universal acknowledgement that the public mental health system is severely underfunded. The governor stated that Virginia must be prepared to invest in community services that work and produce results. A legislative response from the Virginia General Assembly echoed the need for investment in such services.

As has been the history of most community mental health systems, Virginia's community system has not only been severely under-resourced but, in hard economic times, a target for budget reductions or budget conversions. Such policy actions have been complicated given Virginia's stringent Medicaid eligibility criteria; Virginia has one of the country's least inclusive state systems for people with disabilities. More than 20 legislative studies conducted in Virginia, from the 1950s up to this century, reflect the same systemic issue: Scarce and fragmented resources, and varying levels of these scarce resources across the Commonwealth, contribute to an uneven and often piecemeal service system, even for mandated services.

As the panel worked tirelessly on its report to Kaine, the Virginia Inspector General for Mental Health, Mental Retardation, and Substance Abuse Services, as well as the Commission on Mental Health Law Reform, initiated by the Virginia Supreme Court, were formulating reports and recommendations regarding reform. The commission, at work since 2006 through five well-organized task forces, included all stakeholders in its review of the entire process of involuntary civil detention and commitment. It is noteworthy but not surprising that the recommendations in all the reports were similar, if not identical, in terms of the needed legal reforms, services, clarity of roles and responsibilities, and changes in practice by courts, providers, public safety officials, facilities, and evaluators.

Within weeks of the tragedy, each of Virginia's 40 community services boards (CSBs) had examined in minute detail its own process of emergency services response in coordinating efforts with magistrates, private and state hospitals, law enforcement, and the local court systems of special justices (attorneys appointed by the respective circuit courts to preside over involuntary commitment hearings). CSBs, the local authorities designated by the Code of Virginia, are mandated to ensure, within every Virginia locality, provision of emergency services for psychiatric issues. Among their broad spectrum of services, CSBs can recommend individuals for involuntary temporary examination, detention, diversion, and outpatient treatment. Internal scrutiny by CSBs produced revisions in local practices and additional evidence for necessary changes in the law.

True to his word, Kaine announced last fall that his biennial budget for 2008-10 would include allocations for a $42 million “down payment” to begin upgrading mental health services. It is significant that funds were designated to CSBs to improve the following community services: emergency, outpatient, case management, and crisis stabilization capability for youths and adults suffering from psychiatric disorders. Kaine specified the need for identifying problems, intervening, and treating them as early as possible, so that individuals with mental illness can engage in services quickly and begin a path to recovery that could avoid psychiatric crisis and the trauma of involuntary detention or commitment.