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State of Mind

How a radical reinvestment project aims to change the way we treat the mentally ill.

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But a statewide effort aims to change all that. Gov. Mark Warner’s Community Reinvestment Project, introduced in December 2002, has shifted money from state institutions to communities for expanded and more individually tailored services. It aims not only to overhaul Virginia’s mental-health system and enable the mentally ill to live more independently, but also to recondition outsiders’ perceptions. And in less than a year, its framers say, the initiative appears to be working.

Regionally, a consortium of experts has been formed, more than $4.2 million has been spent, 30 hospital beds have been eliminated and 30 people identified as being able to live more independently in a different setting have been released from Central State Hospital. Ultimately the goal is to de-institutionalize all who can return to their communities. In the Richmond region, that means 260 people will return to their communities and receive services there.

Since the 1970s and throughout seven gubernatorial commissions, Virginia has maintained that its mental health system needs an overhaul. The problem has been how to finance and administer such changes. Efforts to close some of the state’s nine mental-health institutions have failed. In 1999, a U.S. Supreme Court decision called for states to provide community services to the mentally ill consistent with those available to other individuals. Virginia’s system historically has come up short. Nationally, the state ranks seventh in per capita income. It ranks 47th in spending for its mental-health system.

With the Community Reinvestment Project, Warner is pledging to bring Virginia up to par with other states, and perhaps even surpass them. And in the process, officials predict it will parallel the mission of the president’s New Freedom Commission on Mental Health. Last year the General Assembly endorsed the governor’s plan by committing to reroute significant money — $12 million this year, $21.7 million next year — from its institutions to the 40 community-services boards across the state.

Last week Style caught up with the members of the Richmond region’s committee of advisers responsible for charting the course the program will take: Steven J. Ashby, executive director of the Richmond Behavioral Health Authority; George E. Braunstein, executive director of the Chesterfield County Community Services Board; James W. Stewart III, executive director of Henrico Area Mental Health and Retardation Services; and Lynn Brackenridge, president and executive director of Gateway Homes of Greater Richmond.

With such ambitious goals, how are we measuring up? According to some local experts, the answer seems to be remarkably well.

“There is a culture within the institution — and I’ve worked in various places and institutions — where there isn’t always the expectation that people [who are discharged] can move as quickly into the community as some may think, particularly if they’ve had the experience of working longer term with chronic patients,” Ashby says. “One of the key things here is we’re not discharging people into the community who don’t belong there. We’re discharging people that the only reason why they’re in the hospital is because there wasn’t the alternative in terms of broader-based services in the community for them to be successful.”

Increasingly services such as specialized assisted living, day programs, supportive residential services, psycho-social rehabilitation programs, clinical services, regional-jail programs and new specialized nursing care services have been or are being developed through reinvestment. Since June, Central State Hospital in Petersburg has closed two 15-bed units, freeing $2.8 million to be reinvested in community programs for the mentally ill. The Richmond Behavioral Health Authority disburses the money and contracts with service providers like Rubicon to do what is necessary to help people progress after they are released from institutions.

“What’s different are the relationships that have been developed over the last five to seven years,” Stewart says. “People across jurisdictions and across local and state government are willing to work together in a way that’s very different from in the past. We’re not operating in silos.”

“We’ve had individuals who’ve been in the hospital for decades who now literally have jobs,” Stewart says. “It really demonstrates that we’ve been successful doing what people are afraid won’t happen, that there won’t be a place back home for people who come out of a facility — there are. There won’t be slots in a hospital when you close slots. And in fact, this demonstrates that we’ve been able to maintain those spaces. It really goes both ways.”

“There will never be enough money to meet every individual’s needs,” Braunstein says. “What this allows us to do, the economics of it, allow us to work more creatively. If you want to understand it in a broader context, we’re taking some ideas that have been successful in the private business sector and applying them judiciously in the public sector to be better stewards of the limited funds available to serve people.”

“The funds follow that person, follow the plan,” Brackenridge says. “It’s changing a culture and a perception that has been left over from seven failed commissions. ... This is a real step toward a solution.”

“There have been seven legislative studies since 1963. Every one of them has said in Virginia we now need to shrink state facilities and move people to the community where they can be cared for,” Stewart says. “There have been repeated initiatives to do that. This commissioner of mental health has taken a different approach. Instead of, ‘Let’s target a facility to close,’ he’s said, ‘Let’s look at who’s in the hospital on a case-by-case, project-by-project basis, and see if we can shrink the hospitals to a more appropriate size and literally move money out of the hospital.’ That’s what all these projects are intended to do.” Stewart continues, “We’re creating some services that haven’t been available before. And it’s exciting. It almost reminds me of playing an organ and pulling the stops.” S

Oct. 5-11 is national Mental Illness Awareness Week.

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