In 1773, the first public mental hospital in the Western Hemisphere was opened in Williamsburg, Virginia and for many years thereafter, this Commonwealth was a leader in the field of care for the mentally ill. We are no longer in that position today.

In the decade of the 50's, Virginia was challenged with the problem of improving its highway system. That challenge was met. In the decade of the 60's, Virginia was challenged with the problem of improving its educational system. That challenge was met. Today we are challenged with the problems of the mentally ill and the aged. When will this challenge be met? Will the 70's be a new decade of decision? Will the full resources of this Commonwealth be marshalled to meet this need? Or will the cries of shame and suffering go unheeded? The choice rests with the people of Virginia!

This Report of the Commission on Mental, Indigent and Geriatric Patients, consists of eleven broad recommendations and subsequent sections of facts and figures substantiating the individual recommendations.

This study deals with the two very broad fields of mental health and the care of aged and indigent patients needing institutional care. These fields are closely interrelated because past policies have overloaded State hospitals with geriatric patients and have not encouraged alternative facilities for them. Six recommendations deal with the mental health system, three with geriatric and indigent patients and the last two cover both fields.

The recommendations for geriatric and indigent patients are not to be considered of a lesser importance or urgency for being listed second. Old age is the fate of almost all of us. Poverty-stricken, enfeebled, disoriented, childish old age is such a painful fate for us to contemplate that people have a tendency to turn away, to refuse to see its miseries. By using State hospitals as repositories for the aged, local communities have saved themselves not only money but the trouble of caring. It is time for our localities to assist in providing care for their old people in a humane and dignified way near home and relatives and friends. It is time to free the State hospitals to devote their resources to those patients' young and old who need specialized psychiatric supervision.

With respect to the six recommendations on mental health, it should be pointed out that overriding the specific recommendations, and evolving from them, is a concept which the Commission is convinced is of paramount importance to any consideration of the Commission's Report. The essential ingredient in the improvement of Virginia's mental health services is the realization -- and implementation -- of a totally new direction and attitude. This concept has been eminently successful in many other states.

The concept, simply stated, is that the individual mental health programs must be seen as comprising a total package, rather than competing for priorities. The ultimate objective of this Report is to improve not only Virginia's mental hospitals and mental hygiene clinics and mental health centers, but to improve Virginia's mental health services and its services to the State's elder citizens who are not mentally ill, but nonetheless ill and in need of institutional care. To do so requires imagination, coordination and bold leadership; it requires appropriations; it requires a new direction. Some 250 years ago, Jonathan Westover wrote, "With land and with life, we have a choice -- to plow new ground or let the weeds grow." Today, we no longer have that choice; we have let the weeds grow far too tall ... and the hedgerows of inertia have hidden the horizons of initiative. We must plow new ground!

The Commission has tried to do so in this Report. It has reviewed the problems and the potential of the State hospitals; it has collected the facts and considered the futures of the community mental health centers; it has studied the services rendered our senior citizens; it has viewed with alarm -- but not in panic -- the increasingly difficult task of recruiting and retaining adequate manpower; but the primary concern has not been the pieces, but the package. At the risk of repetition, this Commission is convinced that the successful improvement of mental health services to both the mentally ill and the less fortunate of Virginia's citizenry requires a total commitment to the concept of a coordinated system of care focused on the patient rather than the agency or institution.

This conviction is based not merely upon feelings, but upon facts and figures collected and discussed during the course of the following activities:

(1) Site visits to Lynchburg Training School, Eastern State Hospital, Western State Hospital, Southwestern State Hospital, Central State Hospital, and the Northern Institute of Mental Health;

(2) Monthly meetings of the Commission and special meetings of the three subcommittees;

(3) Discussions with agency heads and other professional representatives of the mental health services systems in the State;

(4) Collection of statistical and other relevant information from professional mental health literature and in meetings with experts in the field;

(5) Participation in public hearings in Richmond, Danville, Hampton, Arlington, Roanoke and Abingdon; and

(6) Consultation with the Commission's staff and the Division of State Planning and Community Affairs.

From these varied sources has come the inescapable conclusion that the task before us is both difficult and long. This Commission's Report provides a blueprint upon which we can build for the future -- and it is designed so that the first steps can be taken today. But a blueprint is not a building. To bring these plans to actuality will require money -- money to raise salaries, money to train manpower, money for buildings. To bring these plans to actuality will also require the determination of the citizens of Virginia to settle for nothing less than a total commitment to excellence. This commitment must be actively conveyed to the members of the General Assembly so that necessary appropriations may be made!

We believe the people and the Assembly will accept our challenge. We understand and they understand that a successful battle for life and health will cost money. No gimmick or magic reorganization chart will produce mental health and dignity for the elderly. The answer lies in new ideas, new programs and cold, hard cash. This must become the Commonwealth's commitment.