Advocates Laud Settlement in Mental Health Case

By SHERESE A. GORE
Capital News Service

RICHMOND, Va. – Calling it a “historic opportunity,” mental health advocates are awaiting a judge’s approval of a settlement agreement that would improve the lives of thousands of Virginia’s intellectually disabled citizens.

U.S. District Judge John Gibney Jr. is scheduled to make a decision on the 2012 settlement agreement filed by state and federal officials over Virginia’s non-compliance with the Americans with Disabilities Act.

Central to the federal government’s complaint was Virginia’s failure to provide services to the intellectually and developmentally disabled in the most “integrated setting appropriate to their needs,” in accordance with the ADA and the 1999 Supreme Court decision Olmstead v. L.C.

Individuals are classified as “intellectually disabled” for a combination of factors manifested before age 18, such as an IQ testing of 75 or lower and limitations in adaptive behavior such as problem-solving and interpersonal skills.

In a January letter to the General Assembly, Gov. Bob McDonnell acknowledged the state’s shortcomings.

“Although we were forced into a process and timeline we did not invite, we affirm our longstanding commitment for a stronger, more integrated system of care,” McDonnell wrote.

The settlement follows a series of federal investigations of the Central Virginia Training Center in Madison Heights, near Lynchburg, in 2008.

The CVTC is one of the state’s five “training centers” – institutions for the care of intellectually disabled people. Currently, Virginia’s training centers house more than 1,000 individuals. The CVTC is the largest, with more than 400 residents.

In its findings, the U.S. Department of Justice determined that systemic failures within Virginia “have resulted in the needless and prolonged institutionalization of … individuals in CVTC and in other segregated training centers throughout the Commonwealth who could be served in the community.”

Mental health advocates criticize the continued use of institutions by states such as Virginia to provide services for intellectually disabled citizens.

“Number one is that it deprives them of everyday liberties – most things we all take for granted: to be able to make the types of choices we make every day in terms of when to get up and when to go to bed and who to associate with,” explained Jennifer Mathis, deputy legal director of the Judge David L. Bazelon Center for Mental Health Law in Washington, D.C.

“Secondly, it perpetuates the stereotypes and assumptions that people with disabilities are incapable or unworthy of participating in society.”

The Bazelon Center is a nonprofit advocacy group for people with mental disabilities.

Federal investigators found that CTVC residents had little privacy and limited opportunities to associate with nondisabled people. They also found that because of procedural shortcomings, some residents suffered repeated injuries and the facility had slow rates of discharge and transition planning.

The Justice Department also accused the commonwealth of “misalignment of resources that prioritizes investment in institutions rather than community-based services.”

Of particular concern was the lack of availability of Medicaid Home and Community-Based Services Intellectual Disability Waivers that would provide community-based day and residential services to intellectually disabled citizens. These ID waivers, as they are called, would help satisfy the “integration mandate” of the Americans with Disabilities Act.

About 8,600 Virginians are receiving services through ID waivers. However, more than 6,000 Virginians are on a waiting list for ID waivers.

Of the individuals waiting for services, 3,500 are classified as “urgent” due to risk factors such as aging caregivers, abuse or neglect.

The Justice Department’s investigation noted that the waiting list exists even though community care is less expensive than institutionalization: Virginia spends on average $194,000 to house an individual within a training center as opposed to $76,400 for community-based services provided by an ID waiver.

“Theoretically, there’s no limit to the waivers,” said Richard Hemp, co-author of the State of the States in Developmental Disabilities, a research project administered by the University of Colorado.

“Think of it as a push-pull phenomenon, where the federal government is trying to push the waivers to the state because … they are convinced by the research that shows that waivers are clearly the most cost effective way to go.”

Mental health advocates applaud the settlement agreement as long overdue.

In April, a coalition of 70 advocacy groups signed and presented to Judge Gibney a statement saying, “The settlement affords an historic opportunity for thousands of Virginians with intellectual and developmental disabilities to live full lives in their own homes and communities.”

Among other features, the agreement would create 4,170 more ID waiver slots by 2021.

That “will make a huge difference in the lives of thousands of citizens with ID who will have access to person-centered services and better quality of life,” said Silva Bey, executive director of Community Living Alternatives, a day support and residential program in Fairfax.

In addition, the agreement calls for the closure of four of the existing training centers within 10 years, creation of crisis services and regional mobile dispatch teams, as well as vocational and housing assistance.

“Virginia has the opportunity to make things right,” said Jamie Liban, executive director of The Arc of Virginia, a leading advocacy group for individuals with intellectual and developmental disabilities.

“The settlement agreement provides a solid framework to help Virginia responsibly transition to a community-based system of care that is focused on safety, quality and community integration.”