SD3 - Report of the Commission on Deinstitutionalization
Executive Summary: The Commission was established for two years by Senate Joint Resolution No. 42, agreed to by the 1984 Session of the General Assembly. The Commission is to review the status of Virginia's deinstitutionalized citizens to examine the roles and responsibilities of state institutions and community services in serving these citizens. In September, 1983, the Human Resources Subcommittee of the Senate Finance Committee met with officials of the Department of Mental Health and Mental Retardation to review the budget proposed by the Administration. At that time, the proposed 1984-86 general fund target was about $20 million less than needed to maintain current services at the four large mental hospitals. The Department's plan to accommodate this shortage included accelerated discharge of patients and reductions in employment. The Subcommittee's resulting discussions with departmental officials revealed a lack of comprehensive information on services to discharged patients as well as the difficulties involved in gathering this information. In subsequent meetings, it was determined that special surveys would be required to obtain follow-up information and that privacy issues would have to be addressed. The Subcommittee called increased attention to the issue of deinstitutionalization in background papers prepared during legislative budget hearings and in its final report to the Senate Finance Committee during the 1984 General Assembly. These papers showed that the patient population of Virginia's state mental institutions has decreased since the 1960's. In 1971-72, the average daily number of patients in state institutions was 13,529. The projected census for 1985-86 is only 6,717, a fifty percent decline over fourteen years. During the same period, however, the number of institutions has increased from six to sixteen, and the total number of employees will have increased from 6,718 to 10,384. As of November, 1983, the major hospitals were operating at only 66.5% of rated capacity. In response to a shift in emphasis from institutional to community care, funds for community services boards have risen from $45.6 million in general funds in the 1978-80 biennium to $122.9 million in 1984-86. The Subcommittee was informed that, even with these increases in funding to communities, some localities are unable to provide adequate support for patients released from hospitals. Testimony presented to the Subcommittee by the City of Richmond in January, 1984, indicated a disproportionate share of homes for adults in that city, a large number of unlicensed boarding homes, and a lack of coordination for predischarge planning between Central State Hospital and the local community services board. A review of literature and reports from other cities and states indicated such problems were not unique in Richmond. Concurrently with Senate activities, Delegate Richard M. Bagley, Chairman of the House Appropriations Committee, was encouraging efforts to secure funding for a replacement mental hospital at Marion. On January 9, 1984, a group of legislators and representatives of the executive branch visited Southwestern State Hospital. The group considered the options of building an entirely new hospital on a different site in Smyth County or erecting a new building on the existing site in Marion. As a result of the tour, a consensus emerged to provide a modern psychiatric institute on the existing campus, and to provide additional funds for demolition or renovation of existing buildings. The group also visited a home for adults on Route 11, several miles south of Marion. There was concern that some patients may have been transferred from buildings on the Southwestern State campus to a converted motel next to a busy highway, with no improvement in the quality of care, and that similar situations may exist across the State in perhaps as many as a dozen localities where former mental patients are residing. The visit generated a discussion of deinstitutionalization and the quality of care available to patients discharged from facilities for the mentally disabled. A follow-up meeting was held to discuss a capital budget amendment for Southwestern State Hospital. However, in view of concerns about discharged mental patients in general, it was determined that a commission was needed to assess the results of the policy of deinstitutionalization. The commission would address such issues as the effectiveness of discharge planning, the availability of suitable housing and day support services, coordination of mental health and social services, the problem of the deinstitutionalized who become "street people," and the future of state institutions. The Department of Mental Health and Mental Retardation alone cannot resolve the issue of future use of facilities that may not be needed. The General Assembly may have to authorize consolidation of programs, buildings, or even entire institutions so that units which are no longer needed can be used for other purposes. Senate Joint Resolution 42 was introduced as a result of this meeting. |
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