Bonnie Chairs Commission to Improve Virginia's Mental Health Law

October 12, 2006
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Professor Richard Bonnie

Law professor Richard Bonnie is leading a state-wide commission to recommend extensive changes to Virginia's mental health laws. The 26-member Commission on Mental Health Law Reform, appointed by Leroy Rountree Hassell, Sr., chief justice of the Virginia Supreme Court, meets for the first time today and includes officials from all three branches of state government as well as consumer and family representatives, service providers, and the bar. An additional 80 people, including several U.Va. professors, will serve on five task forces charged with developing reports for the commission.

"We plan to have recommendations a year from now that will be the basis for legislation in 2008," said Bonnie, who serves as John S. Battle Professor of Law, a professor of psychiatric medicine, and director of the U.Va. Institute of Law, Psychiatry and Public Policy. "It's been more than 30 years since the current mental health statutes were adopted and more than 20 years since the last time legislative attention was focused on this topic."

In 1982 Bonnie chaired the State Human Rights Committee, which appointed several task forces to look at the commitment process in response to citizens' complaints. At the same time, a joint subcommittee of the Virginia General Assembly examined the issue and the Institute of Law, Psychiatry and Public Policy conducted an influential study of the commitment process. The resulting legislation, which Bonnie helped draft, passed the House of Delegates but failed in the Virginia Senate by one vote in 1984.

Bonnie said complaints today from attorneys, judges, families, and advocates alike include a lack of due process for mentally ill offenders, unclear statutory requirements, and little uniformity in how judges interpret and apply those requirements.

"The result is great variation in the implementation of civil commitment, not only across jurisdictions but even within a given jurisdiction," he said. "And some problems have gotten worse, such as a shortage of beds for evaluation and temporary detention, as well as for involuntary admissions."

Many are dissatisfied by the lack of alternatives to hospitalization, the absence of effective means to mandate outpatient treatment, the unrealistic statutory time requirements for evaluating offenders, and a lack of a meaningful opportunity for those who are committed to appeal.

"It should be easier for people in crisis to get access to the mental health services they need," Bonnie said. "There are just a lot of weaknesses in the system. We can reduce the need for commitment by strengthening the community services system." Virginia is ninth among states in per capita spending in institutional care, but 33rd in spending on outpatient care.

"Mental health services have received growing attention in recent years because of a series of reports that document problems in the system, as well as a number of widely publicized tragic events that have been attributed to a lack of needed services," said law professor Thomas Hafemeister, an advisor to the commission and director of legal studies at the Institute of Law, Psychiatry and Public Policy. "There is an emerging consensus that we need to reform mental health law both in Virginia and across the country. But participants in this project will face the challenge of articulating reforms that can be embraced by all stakeholders."

Providing more services that offer crisis intervention and counseling could relieve pressure on the civil commitment system. "Making high-quality services accessible to people in need reduces the occasions for pushing them into unwanted services," Bonnie said. "We also want to empower mental health consumers to play a more substantial role in shaping the services they receive," he added. "That will also help engage people in the services system and help them function successfully in the community, reducing the need for any sort of judicial involvement."

Civil commitment hearings are too often brief and are heard and tried by low-paid attorneys appointed to serve as "special justices," Bonnie added. As a result, committed patients often feel their side of the story isn't heard. Transporting them to hospitals and hearings in shackles also can fail to respect their rights, Bonnie argued.

"We must end unnecessary criminalization of people with mental illness," he said. "The overwhelming majority of consumers of mental health services understand and accept the need for hospitalization in a crisis, even over their objection, as long as the care is of high quality; treatment choices are guided, to the maximum possible extent, by their previously expressed preferences; and their capacity for making their own decisions is respected."

The commission will also examine whether holding a hearing within 48 hours of detention offers enough time to properly evaluate mentally ill offenders. Other goals include enhancing children's and teen's access to mental health services and improving the process of involuntary hospitalization of minors.

Mentally ill offenders are often imprisoned alongside healthy inmates, instead of being offered treatment in a way that is consistent with keeping the public and themselves safe, Bonnie said. "All too often, severely mentally ill people end up in jails because of gaps in the mental health services system. That is a tragedy."

Law professor John Monahan and School of Medicine professors Bruce Cohen, Eileen Ryan, and Edward Kantor will serve on the commission's task forces, as will adjunct Law School instructors Alex Gulotta and Carolyn Clark of the Legal Aid Justice Center.

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