HISTORY OF THE JOINT SUBCOMMITTEE

In 1977, House Bill No. 1935 created the Commission on Mental Health and Mental Retardation. The Commission conducted a comprehensive review of Virginia's system of state and community services for mentally handicapped individuals. In 1980, the Commission issued a report and recommendations to the Governor and General Assembly of Virginia (House Document 8, 1980). The recommendations adopted by the General Assembly called for sweeping changes in the delivery of services to the mentally ill, mentally retarded and substance abuser. One of the many proposals offered by the Commission and adopted by the General Assembly was the appointment of a joint subcommittee to monitor statewide implementation of the Commission's recommendations and to ensure that the intent of the legislative effort was carried out.

House Joint Resolution No. 10 of the 1980 Session of the General Assembly established the Joint Subcommittee on Mental Health and Mental Retardation. Five members were appointed to the Joint Subcommittee from the House Committee on Health, Welfare and Institutions and three members were appointed from the Senate Committee on Education and Health. Delegate Frank M. Slayton of South Boston was chosen to serve as Chairman of the Joint Subcommittee and Senator Elliot S. Schewel of Lynchburg as Vice-Chairman. Other members of the Joint Subcommittee were: Delegate Evelyn M. Hailey of Norfolk; Senator Edward M. Holland of Arlington; Delegate Joan S. Jones of Lynchburg; Senator Frank W. Nolen of New Hope; Delegate Warren G. Stambaugh of Arlington; and Delegate W. Ward Teel of Christiansburg.

The Joint Subcommittee was created for a term of two years. The recommendations of the Commission on Mental Health and Mental Retardation were to guide the work of the Joint Subcommittee in assuring that proposed administrative policies and procedures were enacted and that the improved system would provide the most appropriate treatment, training and care for individuals with mental disabilities throughout Virginia.

The Joint Subcommittee convened once in 1980 to hear from the Department of Mental Health and Mental Retardation about plans for implementation of the Commission's recommendations. In June of 1980, the Department began to establish task forces comprising department personnel, representatives of the community services boards, interest groups and the public. Each task force was charged with developing specific recommendations outlined by the Commission on Mental Health and Mental Retardation. For example, one group was responsible for defining the core services to be offered by community services boards. Another task force was charged with the study of individuals who are both mentally ill and mentally retarded. In November, 1980, the Joint Subcommittee began receiving monthly progress reports on all the activities of the Department and task forces relative to the recommendations of the Commission.

In January, 1981, the Joint Subcommittee met at Central State Hospital in Petersburg, Virginia. The Department of Mental Health and Mental Retardation presented a series of six-month progress reports on efforts to plan for and to effect the Commission's recommendations. After meeting with representatives of the Department, the Joint Subcommittee toured Central State Hospital.

In May, "The Washington Post" published a series of articles about Western State Hospital. The articles alleged that patient abuse and neglect had become daily occurrences at the hospital. The Joint Subcommittee was alarmed by the allegations printed in "The Post." Members expressed concern about the charges and agreed that the validity of the accusations needed to be investigated.

The June meeting of the Joint Subcommittee was dominated by the concerns about Western State Hospital. The Joint Subcommittee discussed the allegations with William J. Burns, Ph.D., Director of Western State Hospital, Leo E. Kirven, Jr., M.D., Commissioner of Mental Health and Mental Retardation, C. W. Brett, Deputy Commissioner and Anne S. Goodman, Employee Relations Director of the Department. The Joint Subcommittee decided to hold a public hearing in Staunton during the month of August to hear from employees of Western State Hospital regarding the charges of patient abuse and neglect and of employee unrest.

Simultaneously, the Local Human Rights Committee, a citizen's group which monitors the care of individuals in state institutions for the mentally handicapped, was instructed by the State Human Rights Committee to conduct an in-depth investigation of the situation at Western State. In addition, the Mental Health Association of Charlottesville-Albemarle began an independent investigation of Western State Hospital on behalf of the Mental Health Association in Virginia.

The Joint Subcommittee conducted its public hearing on August 10, 1981 on the grounds of Western State Hospital. Forty-six persons addressed the legislative group during the thirteen-hour hearing. The Joint Subcommittee heard the preliminary findings and recommendations of the Local Human Rights Committee. The members also received the report of the Charlottesville-Albemarle Mental Health Association. Additional documentation with regard to the patients and staff of Western State was submitted to the Joint Subcommittee prior to and following the August public hearing. An issue paper prepared by the staff for the Joint Subcommittee detailing the concerns expressed about Western State Hospital is included in Appendix B of this report.

The Joint Subcommittee held six regular meetings during 1981. Each meeting involved extensive and careful review of the progress made by the Department of Mental Health and Mental Retardation toward implementing the recommendations outlined by the Commission in 1980. The Joint Subcommittee also called on the heads of other state human services agencies, community services boards, the Secretary of Human Resources, the Secretary of Public Safety and the Secretary of Administration and Finance to review various projects relating to programs and services for the mentally handicapped. In addition, the Executive Secretary of the Supreme Court presented a report and recommendations on cost containment within the involuntary mental commitment fund.

Throughout the year, members of the Joint Subcommittee toured state hospitals and training centers to view facilities, observe programs and to meet and interview staff. These visits to the state facilities provided an opportunity for the Joint Subcommittee members to discuss the administration and operation of each institution with the directors and staff. The most rewarding experience of the visits was the opportunity to observe patients and residents participating in productive and therapeutic programs and to talk with many hospitalized individuals. Although programming for persons institutionalized in state hospitals and training centers has improved over the years, the Joint Subcommittee was disappointed to note that many individuals remain idle and are frequently unable to leave the wards. This idleness was attributed by hospital directors most often to a lack of staff and resources to provide effective programs and recreational opportunities for the patients and residents.

The Joint Subcommittee expresses its appreciation to each of the facility directors and to the staff who assisted with the visits. The frank and open communication with persons directly involved in mental health, mental retardation and substance abuse services proved invaluable to the Joint Subcommittee's work.

During the past two years, the Joint Subcommittee has worked with the Department of Mental Health and Mental Retardation and the community services boards in conducting its legislative oversight responsibilities. The Joint Subcommittee is encouraged by efforts to carry out the policies of the Commission on Mental Health and Mental Retardation. It believes, however, that a great deal of work lies ahead for the Commonwealth before the Commission's goals can be realized. The Joint Subcommittee, therefore, offers its recommendations to the Governor and 1982 Session of the General Assembly with the anticipation that these proposals will expedite the work of the Department of Mental Health and Mental Retardation, the State Board and community services boards toward achieving the policy directives that have been established legislatively for mental health, mental retardation and substance abuse services in the Commonwealth. The legislative recommendations of the Joint Subcommittee to the Governor and 1982 Session of the General Assembly are included in Appendix A of this report.

RECOMMENDATIONS

Continuing the Joint Subcommittee

Although progress has been made toward implementation of the 1980 recommendations of the Commission on Mental Health and Mental Retardation, the Department, State Board and community services boards have not yet achieved the continuum of service delivery envisioned by the Commission. Administrative changes within the Department of Mental Health and Mental Retardation over the past year, including the appointment of a new Commissioner, have slowed efforts toward realizing the policy directives and goals adopted by the General Assembly in 1980.

The Joint Subcommittee believes that continuing legislative oversight is needed to assure that these policy goals and directives are met. It is recommended that the Joint Subcommittee on Mental Health and Mental Retardation be continued for two years. The focus of the Joint Subcommittee's work shall be to provide guidance to the Department and community services boards in interpreting the intent and in refining and implementing the policies of the Commission on Mental Health and Mental Retardation.

Among the goals that still need to be achieved are: universal community services board coverage; full implementation of core services and formula funding; effective and comprehensive pre-admission screening, pre-discharge planning and case management services; appropriate accreditation and certification of all state hospitals and training centers; provision of adequate staff for all state facilities; and a determination of the most effective allocation of funds between state institutions and community programs. In its report, House Document No.8, 1980, the Commission on Mental Health and Mental Retardation documented the goals of the Commonwealth for each of the concerns listed above. The Department of Mental Health and Mental Retardation has confirmed that these policies and goals continue to be valid and timely, two years later. It is the job of the Commonwealth to strive to reach these goals without further delay. The Joint Subcommittee shall continue its legislative monitoring of these efforts to ensure that the goals are attained.

The Executive Secretary of the Supreme Court has presented a number of recommendations to the Governor and General Assembly to contain costs incurred by the Commonwealth in the process of the involuntary commitment of individuals to state hospitals for the mentally ill. Included with the cost containment proposals is the recommendation that the quality and effectiveness of Virginia's involuntary civil commitment laws be evaluated along with the actual procedures and practices followed to commit a person to a state hospital.

It is recommended that in addition to continuing its legislative oversight responsibilities, the Joint Subcommittee shall conduct an evaluation of the statutes governing commitment in Virginia. The Joint Subcommittee shall submit its recommendations regarding the commitment laws concurrently with any other recommendations it deems appropriate to the Governor and 1983 and 1984 Sessions of the General Assembly.