How far can the powers that be go toward preventing acts of violence by the mentally unstable? How can we best balance public safety concerns with the very real possibility of mistreating some very troubled but innocent individuals? In addition to expanding their mental health budget by $42 million, the state of Virginia recently passed revisions to its mental health law that will certainly provoke controversy in some quarters. Due to a public demand for action following the 2007 Virginia Tech killings, legislators perceived a pressure to pass acts that would at least appear to allow for greater flexibility in controlling problem cases and preventing such tragedies.
The issue that's most likely to make waves among mental health professionals concerns involuntary commitment: who should be legally qualified to determine when individuals constitute a threat to the safety of themselves and others, and how much leeway should they be granted under the law? The somewhat vague language of the new law is key. It initially allowed for involuntary commitment only when an "imminent" danger existed and immediate action was deemed neccessary to protect all involved parties, but the newly worded law could potentially find far more liberal applications. The forced commitment of an individual may now occur whenever authorities deem that there is:
"a substantial likelihood that, in the near future, he or she will cause serious physical harm to himself or herself or another person..." or "will suffer serious harm due to substantial deterioration of his or her capacity to protect himself or herself from such harm or to provide for his or her basic human needs."
This revision essentially grants greater interpretive authority to whoever has been assigned the role of arbiter in each case - but the law also considerably expands the field of people who may qualify for that position. The decision-maker does not, under the new revisions, have to be a mental health professional, a physician, or even a doctoral student in the mental health field. It could be a social worker or an "employee of the local community services board."
The law's sponsors name convenience as the primary reason for these changes. When a potential emergency presents itself, mental health professionals may not be available to respond within an acceptable time frame, so another qualified party must act in the best interests of all involved. This is certainly a valid point, particularly in isolated or rural areas where hospitals or specialists' offices may be some distance away. But some parties see the change as an unacceptable compromise effectively lowering the state's standards for mental health care. Granting this degree of authority to those not trained for it could, in a worst-case-scenario, lead to a significant rise in the number of commited Virginians. It could also allow for more well-meaning but destructive mistakes or outright abuses of power. And the lawsuits that will surely arise from such actions, however benign their intent, are very real. A second point was raised about a possible conflict of interest involving doctors who commit patients to stays in their own institutions. But this is a false quibble, according to critics, because institutions almost always lose money on involuntary commitments.
Proponents argue that this legislation is not as troublesome as it may seem. One statistic that reframes the argument: a "substantial inability to care for oneself," rather than a threat to oneself or others, accounts for more than half of Virginia's involuntary commitments. Cases involving the unnecessary commitment of individuals who are fully capable of sustaining themselves and pose no threat to anyone are, thankfully, very rare. And they may not occur any more frequently under the new law. But these updated standards clearly provide a larger legal safety net for those who act in error. This concern may, again, be overstated, but one can never be too sensitive to the needs of the mentally ill, even when viewed in a public safety context. Comittment is unfortunately essential for some, but it also costs the taxpayer and, if performed incorrectly, could take valuable bedspace away from those who need it most. We can only hope that those who are called to make these decisions appreciate the importance of the power granted to them by the state.
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