The price of inconsistency

Column by David Cox
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One week ago, Western State Hospital in Staunton broke ground for a brand-new facility. Gov. Kaine was there – and much emphasis was placed on the importance of mental-health facilities in the Commonwealth of Virginia…even as a cloud hangs over the whole enterprise.

If you’ve not been there, WSH has occupied a huge campus nearly equidistant from I-81, Route 250, and Five Guys. In former days, when the mentally troubled were sent in larger numbers for long periods of time—like life—it needed the very many buildings that dot its land, most designed in the less-than-inspired humdrum of 1950s hospital architecture. As mental-health budgets decreased and notions of care changed, buildings one by one fell into disuse; yet WSH had to pay to keep them mothballed. Not efficient.

Meanwhile, the program changed and thrived: no longer aiming at warehousing people, the Hospital established a program of training and rehabilitating and preparing patients to return and contribute to their communities. To tour through the main program facility is like visiting an unusual but very active school.

What’s more, it seems to work; and for no area does it work as well as for our Rockbridge region. Thanks to the good efforts of WSH staff—many of whom have dedicated their entire vocational lives to the place—and our own Rockbridge Area Community Services folks, people needing treatment there return home in record time. That in turn is good for public budgets and even better for patients and their families.

A new, efficient building reflecting these new ways and philosophies, then, is long overdue. Kudos to those who shepherded this project through legislative and administrative mazes (including our regional deputation to the Assembly).

The sad irony is that a massacre helped to push it through. The Virginia Tech tragedy of April a year ago underscored many a deficiency in the entire mental-health delivery system, which largely depends upon public funding. Suddenly, support for mental health was all the rage; and well it should be, for Virginia ranked something like 46th in the nation for per-capita spending. If a new WSH is one result, then thanks be. It’s an advance.

Now, though, there’s a different rage in Richmond, and that’s to cut, cut, and cut some more. A lousy budget won’t allow anything but. Already, state aid to local Community Services Boards—the local agencies that provide mental health, substance abuse, and intellectual disability programs—have been trimmed 5 percent here, 10 percent there and the probability of more to come…this just 2½ years after Seung-Hui Cho unleashed his deranged violence. And if you don’t think these cuts won’t affect the degree of services that can be offered to our community, despite all efforts of a dedicated staff, think again. (I’m a member of our local board, though I speak only for myself.)

Yes, times are tough for governments—how well I know!—and even more for too many families and individuals whose lives are burdened, disrupted, and worse by this recession.

But I see two other phenomena occurring. One is the damage being done to essential programs that we as a people have constructed to maintain our society itself, particularly in our care for the weak, the troubled, the young, the old. I’m not talking about trimming fat here; there’s always some room for reduction, but any easy cuts were long ago made. From this point on, decreases truly hurt. I’m profoundly worried about core services of health, education, and safety, say to some turbulent soul heading too unnoticed toward derangement. And when (not if) another Tech or Fort Hood occurs, oh the recriminations and blame that will follow, often starting with the premise, “Something should have been done to prevent this.”

The other concerns an unfortunate but abiding reality, perhaps the greatest negative about American democracy that Alexis de Toqueville pointed out in the 1830s. “Since the majority is the only power that it is important to please, its projects enlist ardent support, but the moment its attention turns elsewhere, all efforts cease.” Legislatures, he noted, reflect majorities. When opinions change, so do legislative priorities. Note that he was writing well before the birth of Mr. Gallup and his polls.

Thus, in 2007, mental health was pushed to the top by a terrible event. In 2009, all eyes are on plugging deficits. Earlier this month, WSH begins a new hospital. Next month, or sooner, mental health will take another budgetary hit. Perhaps it’s inevitable, inescapable; but the price of such inconsistency could well be devastating, and the cost more than we can imagine.