DATE: Friday, May 2, 1997                   TAG: 9705020004

SECTION: LOCAL                   PAGE: B10  EDITION: FINAL 

TYPE: Editorial 

                                            LENGTH:   93 lines

STATE SYSTEM BROKEN REFORM IS NEEDED TO PROVIDE AN INDEPENDENT CHECK ON THE TREATMENT OF STATE MENTAL PATIENTS.

For many years, Virginians spoke with pride of the system designed to protect patients at state mental hospitals from abuse. In true Virginia fashion, the system assumes that cooperation works better than conflict, and that policing oneself is superior to external scrutiny.

The June 29, 1996, death of Gloria Huntley at Central State Hospital calls both notions into question. The problem with everyone being on the same team is that one team captain controls the game. If the captain is vigilant about the rights of the weak, such as Huntley, all may be well. But if he or she is unsympathetic or attention is diverted or priorities lie elsewhere or money is scarce, human rights can lapse into an afterthought. And who's to know?

Precisely where the breakdown occurred in Huntley's case is debatable. But a human rights system which allowed the 31-year-old borderline schizophrenic to spend 300 hours in the last month of her life strapped to a bed and in solitary is flawed.

Prodded by Huntley's death, a special panel appointed by the state board of Mental Health, Mental Retardation and Substance Abuse will begin next month to evaluate Virginia's human rights system for the institutionalized mentally ill.

It certainly should recommend increased funding and upgraded training for those charged with providing protection. But the most reassuring fix would be to move some responsibility for monitoring human rights to an independent body. Self-policing is fine for student honor codes; but when the lives of individuals are at stake, external checks and balances are required.

Currently, there are two basic components to Virginia's human rights monitoring system. First, one or two patient advocates are assigned by the mental health department to each institution. Those advocates are supposed to ride herd over staff actions and express the patient's point of view when treatment is prescribed and care given.

Working in tandem with the advocates are local and state human rights committees, groups of volunteers that are supposed to monitor everything from changes in individual treatment plans to broad policies on such matters as seclusion and restraint. The chain of command for those committees goes through the state mental health board to the governor.

The second part of the human rights system is a federally funded program known as Protection and Advocacy for Individuals with Mental Illness, or PAIMI. The money pays for advocates and attorneys to represent patients on specific grievances and systemwide problems. In Virginia, PAIMI funds are administered by the Department for the Rights of Virginians with Disabilities.

In some states, both parts of the human rights advocacy system are independent of state government. In other states, one is external and the other internal. But in Virginia, both operate within the confines of state government. Virginia is one of only nine states in which PAIMI funds go to a state agency.

As a result, PAIMI lawsuits on behalf of institutionalized mental patients, while routine in other states, are unheard of in Virginia. In order for the Department for the Rights of Virginians with Disabilities to sue the state, both the secretary of Human Resources and the attorney general's office would have to approve. The state suing itself isn't a concept that enjoys much popularity in Richmond; but without that clout, the effectiveness of PAIMI attorneys is seriously reduced.

The other part of the human rights system also is troubled. One or two patient advocates monitoring treatment for hundreds of mental patients per institution is, on its face, an impossible task. Add in the fact that the advocates report to the very department that administers the institutions, and the incentive for hiding problems becomes enormous. Virginia has a tradition of caring mental health commissioners, but that does not diminish the pressure to keep up appearances.

Meanwhile, mental health advocates say there are huge differences in the forcefulness and quality of various local human rights committees. Nor is there much training, even though these volunteers are making complex and critical decisions. One Northern Virginia committee member said she was in her fourth year with the group before being invited to a state-sponsored training session.

The ``attention'' given a set of proposed revisions to the human rights code may symbolize the state's commitment to improvement. Those revisions, reportedly technical, have been lost in the bureaucratic maze for almost two years. Mental health officials say they're bottled up at the attorney general's office; officials there say the stalemate is at mental health.

The sad case of Gloria Huntley may serve to cut through the bureaucratic haze. U.S. Justice Department investigators are probing her death. But Virginians, often averse to outside interference, should be able to see on their own that something is amiss. It is known that the patient advocate at Central State Hospital was informed in writing that Huntley's treatment plan called for ``10 hours minimum'' when restraints were used. The local human rights committee presumably signed off on that plan. The Department for the Rights of Virginians with Disabilities has, so far as the public knows, not initiated legal action.

Cooperation is a wonderful concept. But when one party is actually subservient to another, what actually happens can be coercion. The time has come for Virginia to provide an independent voice to protect the rights of its vulnerable mentally ill.

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