Safety net in the balance

Among Lee Ann Novak's six children, her 16-year-old daughter stands out.

In her first year of high school in Virginia Beach, she scored 1,200 on her PSATs. She has been lauded for her virtuosity on the violin and piano and has carried an A average.

But on a May night two years ago, Novak shivered with fear when she found her daughter standing at the bedroom door wearing only a T-shirt, holding a broom stick and muttering incoherently.

Journals revealed a despairing hidden life of suicidal thoughts and fear. Months of local hospitalizations left her in a drugged stupor.

In Staunton last summer, Julie Irvine saw her son's anxious and fretful temperament erupt in threats or attacks on teachers, friends, family and himself.

After five emergency hospitalizations, some of them hours from his home, 9-year-old Gabe found help in his own hometown.

In a preview of the intense wrangling that will envelop some of the most severe budget cutbacks in state history, Novak, Irvine, other parents and mental-health groups across the state are fighting cuts in mental-health funds that they say portend disaster.

Proposed by Gov. Timothy M. Kaine, the cuts would close by July a mental hospital in Staunton for juveniles and an adolescent unit by March 1 at a hospital in Marion.

The two treatment centers -- the Commonwealth Center for Children and Adolescents in Staunton and a unit of the Southwestern Virginia Mental Health Institute in Marion -- are the only remaining public facilities in the state for seriously disturbed children.

Kaine promises that future patients, as well as those at the centers now, can be absorbed by private hospitals.

"We get the kids in here that private hospitals can't handle," said Wayne Rankin, a registered nurse and day-shift supervisor for 18 years at the Commonwealth Center.

"We're the one place that can't say no," added Jeffrey Aaron, a clinical psychologist who stressed the need to address behavioral and mental problems early on, when treatment is more effective.

Others predicted that juvenile-detention facilities will be overloaded with mentally ill offenders who will not have access to doctors and medications.

Rankin has seen children who cut themselves and who are suicidal, angry, violent, schizophrenic, paranoid and psychotic. He has held them, fed them, medicated them and been forced to restrain them.

He fears that if the center closes, children will die.

"They're too violent. We get autistic children [whom other hospitals] don't know how to deal with and psychotic kids in here because of drugs. . . . We've got a lot of experience dealing with these kids," said Rankin, a Staunton native. "If we close, I see a higher incidence of death."

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The cuts would close the 48-bed Commonwealth Center, as well as a 16-bed adolescent unit at the Marion facility. The $7.6 million net savings would erase about 0.26 percent of the state's $2.9 billion shortfall.

Raising controversy as well is the proposed closing of the Southeastern Virginia Training Center in Chesapeake, where 472 employees could lose their jobs and 165 adult residents would be moved to communities or one of the state's four other training centers.

The proposed closure, by June 30, has the backing of many advocacy groups, largely because nearly all of SEVTC's $25 million budget would go toward community care.

The closings of the state's last two centers for mentally ill youth would come even as both facilities are registering increased admissions, as reimbursement and insurance woes mount for private hospitals, and as community-based mental-health care likely will be trying to absorb 15 percent to 20 percent cuts in local-government contributions.

"The damage that will be done to children and families is far disproportionate to the amount of money involved," said Dr. Brian Meyer, a clinical psychologist and fomer director of VCU Medical Center's Virginia Treatment Center for Children.

Novak's daughter, who has been at the Commonwealth Center since October, has no place else to go. "Our insurance will not cover another private hospital stay until next year," said Novak, a single mother who works online from home.

"I have never known a staff to be so entirely committed, available, attentive and passionate about finding a solution for my daughter," Novak wrote a Staunton-area legislator recently. "I do not know what I would do for [my daughter] without it."

Irvine said her son, Gabe, found a long-sought sanctuary at the Commonwealth Center this winter when private hospitals wanted to turn him away or send the family hours from home for emergency help. He has since been able to transfer to a private facility in central Virginia that treats severely autistic children.

Now that the facility, which proved so critical to her son's well-being, may be shut down, Irvine is walking the halls of the General Assembly campaigning against the cuts.

"Commonwealth saved my son's life this winter when no one else would help," she said. "But what happens when he comes back home and he needs emergency care with people who really understand his problem?"

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A 16-member coalition of physician, mental-health and disabilities groups is fighting the cuts. The members range from the American Academy of Pediatrics and the Virginia chapter of the National Alliance on Mental Illness to the Virginia Coalition for Juvenile Justice and the Virginia Poverty Law Center.

The Commonwealth Center also serves as the state's key site for training those who take care of the mentally ill. Dewey Cornell, a University of Virginia professor of education and a clinical psychologist, sends his doctoral students to the Staunton facility.

"It's a prime training site," he said. "It offers valuable training, and there's no other option."

"To take all of that experience and dissipate it and lose it, that in itself is a huge loss," he said.

The closings would remove a remnant of the state's much-maligned reliance on institutional care but also a critical safety net for families that have run out of options in their homes and communities.

Kaine told the Richmond Times-Dispatch that "the overwhelming majority" of youths treated in Marion and Staunton "will be treated by private providers."

"We believe that this is a service for which there is a substitute -- a high-quality substitute -- available at a number of localities around the commonwealth."

Kaine said the plan hinges in part on financial incentives for private hospitals and changes in regulations that govern the services that private hospitals can provide.

Few private hospitals accept patients as seriously ill as those at the two adolescent facilities targeted for closure. Getting the fixes in place by the end of June could prove difficult.

A study of the Commonwealth Center, released last month just before Kaine announced his budget proposal Dec. 17, bemoaned the shortage of accessible adolescent psychiatric beds in communities across the state. Private facilities around Virginia now offer about 290 acute inpatient beds and 1,646 residential beds.

Admissions increased at the Commonwealth Center from 479 in fiscal 2004 to 605 in fiscal 2008, suggesting that the reliance on the state's limited institutional care is increasing at the same time the cuts would close the two state facilities.

In his December report, the state's inspector general for mental health said accessible community-based help is lacking.

"Many of these individuals could be successfully stabilized in the community if more appropriate community-based crisis-stabilization services, including psychiatric services, were available," the report said.

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While a primary focus of Mental Health Commissioner James S. Reinhard has been to reduce the state's reliance on institutional care -- an effort that has won the admiration of most mental-health advocates across the state -- the proposed closings set up a difficult turnaround time to get community facilities up to speed.

"Too much, too soon is a big part of the problem," said VCU Medical Center's Meyer, noting that Ohio took years to establish acceptable community facilities once it had decided to reduce institutional care for juveniles.

When announced last month, the proposed cuts were accompanied by mandates that Marion and Staunton immediately stop taking new patients. The ultimatum was rejected hours later after a storm of political and grass-roots protests.

Irvine's son initially was refused treatment at the Commonwealth Center, she said, because of the short-lived patient embargo.

"We were told [by another hospital] we had to go to Roanoke," she said.

Children served by the Staunton and Marion facilities come from across the state.

Patients from Prince William County in Northern Virginia logged more bed days in 2008 at the Commonwealth Center than any other locality; one of every six bed-days recorded at the facility last year was for a patient from Richmond or the counties of Henrico, New Kent, Goochland, Powhatan and Chesterfield.

"There has got to be other areas where cuts can be made," said LaShawnda Reynolds, a psychiatric nurse in Danville and the mother of a 12-year-old patient at the facility. "By the time children make it to the Commonwealth Center, they're obviously so sick nobody else can support them. So where else would these children go?"

Cornell, the U.Va. professor, sees the closings as countering rather than aiding the statewide budget shortfall.

"Prevention is invisible," he said. "The center is saving us millions of dollars in acts of violence that they have prevented. There is just no accounting system to register it."

Contact Carlos Santos at (434) 295-9542 or .

Contact Bill McKelway at (804) 649-6601 or .