DATE: Sunday, June 22, 1997                 TAG: 9706200025

SECTION: COMMENTARY              PAGE: J4   EDITION: FINAL 

TYPE: Editorial

                                            LENGTH:   97 lines

MENTAL HEALTH SYSTEM IS BROKEN

Last July 18 an advocate in the Department for Rights of Virginians with Disabilities (DRVD) sent a perfunctory note to Gloria Huntley, who as a mental patient at Central State Hospital had complained about abusive treatment.

``Since we have not heard from you in over 90 days, I am assuming that you have no new concerns regarding your treatment by staff at Central State Hospital,'' began the three-paragraph letter. ``Therefore, there is no further advocacy issue at this time and we will close your case with us.''

Unfortunately, on the date the letter was written, Huntley had been dead for 19 days.

She died after suffering an asthma attack while strapped by arms, legs and waist to a hospital bed at Central State. A staff psychiatrist had warned almost a year earlier that strapping could prove fatal for Huntley, a 31-year-old borderline schizophrenic with a history of asthma, epilepsy and violent outbursts. Nonetheless, she spent more than 300 hours in the last month of her life strapped in solitary.

That number - straight from the Dark Ages of mental health care - is far greater than anything recommended by state or national leaders in the treatment of the mentally ill.

The brief and only recently discovered contact between Huntley and DRVD, the state agency that is supposed to advocate for the humane treatment of mental patients, casts new doubt on the ability of Virginia's system to protect vulnerable citizens.

DRVD's performance did not serve Huntley well in life or in death. Neither did a bureaucratic structure that confuses the interests of those who would protect the system with those who would challenge it.

The one-year anniversary of her death is next week, yet the DRVD is only now poised to begin interviews at Central State about the episode. That is partly because a federal probe has taken precedence this spring. But, according to department Director Sandra K. Reen, it is partly because of the need to negotiate access with the attorney general's office, which represents Central State and its employees.

That explanation is troubling for two reasons. First, if the DRVD were - or had ever been - an activist agency, the right to access would have been established long ago.

And second, the fact that the current advocacy system is housed within state government militates against aggressive oversight. For example, lawyers in the DRVD serve at the pleasure of the attorney general, who must approve their hiring. Both of the current DRVD attorneys previously worked in the attorney general's office.

In effect, the attorney general is charged with protecting the legal interests of state mental hospitals and with approving the lawyers whose job it is to ride herd on them.

Furthermore, the DRVD director serves at the pleasure of the governor, who may have more than passing interest in avoiding embarrassing scandals at mental health hospitals.

This is a design that has been in effect through both Democratic and Republican administrations. It is a bad design that turns watchdogs into lap dogs.

The delay in investigating Huntley's death is bad enough. But the failures by DRVD while she was still alive are worse.

According to records recently obtained by the Virginia Alliance for the Mentally Ill with permission from Huntley's family, she contacted DRVD in the fall of 1995, alleging verbal abuse by hospital staff, lack of dental care and failure to attend to her when she experienced seizures.

An advocate for DRVD visited Huntley on November 27 and again on January 22, 1996. The notes suggest only cursory attention to her complaints. From the first visit: ``(The head nurse) states Gloria wants a lot of attention and gets it. They bend over backwards for her. . . . Says Gloria is faking her seizure/fainting. . . .''

A separate note suggests that the advocate urged staff to get Huntley to the dentist, and ``they will try to fit Gloria in soon. It seems every time they try to see her, she has behavioral problems, and they can't take her off the ward.''

The next entry cites a January 22 phone call in which Huntley alleges ``she has sores on her face and stomach. Drs. won't treat her. . . ''

The final entry notes that the advocate visited Huntley the next day. But there's no record of the outcome of that visit or of any subsequent contacts, beyond the July 18 case-closing letter.

There is no record of a resolution of Huntley's original complaints. Nor did the advocate request a copy of Huntley's treatment plan or an extensive review of her medical files, which even then would have shown above-average use of seclusion and restraints. More intensive use of restraints began a few months later.

"We should have closed the case after the visit in January because we thought the issue was resolved, or we should have stayed in touch on a monthly basis," said Reen. "One way or another we did not handle the case appropriately."

The admission, which is to Reen's credit, makes even more poignant the cheery last sentence of the July 18 letter to Huntley. "It was a pleasure working with you to resolve your complaint. I wish you the best of luck in your future endeavors," wrote the advocate.

That letter should be a clarion call to the special study commission evaluating the human-rights protection for Virginia's mentally ill. The committee should investigate the degree to which seclusion and restraints are being used by various mental institutions. They should demand improved performance by DRVD and recommend a structure that makes patient advocacy independent of state control.

Send Suggestions or Comments to webmaster@scholar.lib.vt.edu