Critics fear changes could worsen voluntary care

Critics fear changes could worsen voluntary care
 (Read Part One here)

Just a few days shy of the anniversary of the Virginia Tech shootings, Governor Tim Kaine signed mental health care reform legislation that some mental health care advocates and survivors say will have disastrous effects.

On April 9, Kaine signed two omnibus bills that provide the system with a little under $42 million while lowering the standard of commitment, making it easier to force people into treatment that some critics say does more harm than good. The reform legislation is meant to bring people suffering from mental illness into the system before they reach a moment of crisis. But mental health care consumer advocates say the changes may have the opposite effect.

Frank Blankenship, the chair of MindFreedom’s Affiliate Support Committee, thinks that the mental health reform will expand forced treatment with drugs at the expense of alternative care for voluntary patients.

Bringing more people into the mental health system via loosened standards of commitment will stretch the resources of a system that is already taxed, critics argue. The increased number of people involuntarily committed, they say, will take resources away from voluntary service for people who choose to enter treatment.

“We currently don’t provide voluntary services in this state at even close to an adequate level,” says Alison Hymes, who was a member of the Taskforce on Commitment of the Virginia Chief Justice’s Commission on Mental Health Law Reform.

“All this money is going to go for outpatient commitment and crisis beds. So we’re essentially saying we won’t serve you until you’re in crisis.”

Resources at community service boards like Region Ten are tight, and with more people coming into the system through involuntary commitment, patients who seek treatment are in danger of being shut out. Brian Parrish, the executive director of VOCAL, a Virginia advocate group for a mental health system that is more directed by consumers, says that the loosened standard could push out people who genuinely want mental health services.

“Currently, there aren’t enough beds for folks who want to get services,” says Parrish. “People are going to have to be put in a bed in order to be reviewed, and there’s already a lack of beds. So I think you’re going to end up with people being [temporarily detained] against their will, and there will be less beds for people who want them.”

For some advocates, more beds are not the answer. Frank Blankenship, the chair of MindFreedom’s Affiliate Support Committee, is fighting for drug-free treatment for mental illness. The more people that enter the current mental health care system, argues Blankenship, the more people will be forced into treatment that includes psychotropic and neuroleptic drugs like Thorazine and Haldol.

Blankenship says that he is concerned that bringing more people into the mental health care system will simply mean more people will be prescribed drugs. And because these people will be entering the system against their will, or will be under court-ordered treatment, drugs will be forced on them. Treatment, he says, should be drug-free and peer-based.

Hymes agrees that more people will “absolutely” be put on psychotropic and neuroleptic drugs. “The mandatory outpatient commitment is about forcing drugs on people,” she says.

State Delegate Rob Bell, who chaired the mental health subcommittee, says consumers were encouraged to talk about the effects and side effects of drugs in front of the committee.

“The pharmacology is getting better,” says Bell. “Everyone is hopeful in the future that we’ll have a better understanding of how the brain functions. But it’s not perfect.”

One of the major faults survivors and consumer advocates find with the system, and its reforms that Kaine signed into law, is that along with being woefully underfunded, it offers no alternative treatments. Parrish says that for years, there’s been a movement to make mental health services more consumer-driven. According to a 1999 Ohio Department of Mental Health study, consumers’ perceptions that their needs are being met are the best predictors of positive outcomes.

“Everybody understands that coercive [care] is not the model,” says Bell. “The vast majority of the care for the mentally ill is voluntarily delivered.”

But instead of putting money into what they see as a coercive system, some advocates want the state to fully fund voluntary services.

“That would make a huge difference,” says Hymes, “if people are getting care when they’re ready for it and needed it.”

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