Mentally ill: Who cares enough to give the very best?

Galvanized by a pair of shocking incidents a year and a half ago — one involving a dead infant, the other a severely retarded woman who became pregnant after being raped — the Illinois House moved quickly to create a Special Committee on Patient Care to investigate abuse and neglect at state mental hospitals and licensed nursing homes in general.

Standing alone, either incident was deplorable. In one, a newborn infant was found face down in a toilet bowl at the Chicago Read Mental Health Center, after the child's mother, a 34-year-old chronic schizophrenic, delivered the child by herself in a communal bathroom. In the other, a long-time resident at a licensed nursing home was 7 1/2 months pregnant before her condition was diagnosed, despite receiving regular medical care. She obviously had been raped; her impaired mental condition made it impossible for her to consent to such activity.

These were not isolated cases, the panel concluded in a report issued last spring, but "symptomatic of the more general problem of abuse and neglect." In its report, the committee offered concrete remedies for the ills it found, and with strong support from advocacy groups, a measure embodying the reforms (H.B. 1571) was approved by margins of 108-5 in the House and 58-1 in the Senate.

One of the bill's most significant points called for the Department of Mental Health and Developmental Disabilities to develop statewide, uniform training for direct care workers. Now, the panel said, training largely is left up to officials at each state facility, where its scope, quality and intensity vary considerably.

The proposal also called for mandatory pregnancy tests for female patients of child-bearing age, prompt removal from patient contact of staff suspected of abuse, stepped up reporting of abuse and neglect, and enhanced monitoring and review of the department's response to incidents.

"It was a bipartisan effort with a lot of compromise," said Rep. Woody Bowman (D-4, Evanston), panel co-chair with Rep. Tom Ryder (R-97, Jerseyville). "There was not a single dissenting vote in the committee. It was 100 percent consensus."

But the legislative unanimity failed to impress Gov. James R. Thompson. Citing concerns with the measure's "practical implementation," the governor used an amendatory veto to water down some of the key changes urged by the panel, including the mandate for standardized training. "Since sufficient funds were not appropriated to provide this training, I am amending the language to make this training permissible," wrote Thompson, who earlier slashed $8.9 million of the $16.4 million lawmakers added to the mental health budget he requested.

To establish two training offices, as the bill provided, would cost about $1 million, said Pat Alvarez, the agency's legislative liaison. "The department agrees that standardized training is useful," she said. "We already have a good core of standardized training. . . . But quite frankly, it's a money question." Bowman, though, dismissed the cost of argument. "I really think that's a smokescreen," he said. "$1 million is not a make-or-break item in an $800 million budget." Instead, he believes, the resistance to uniform training stems from central office reluctance to challenge autonomy of facility superintendents, most of whom are "kings in their independent kingdoms." By eliminating the training mandate, "The governor pulled the teeth of the bill," said Bowman, who added he will try to override the amendatory veto when the legislature returns for its fall session.

The setback for standardized training also disappointed Ryder. While there may not be money for extensive new training programs, complete with staff, office space and other overhead costs, he said, the department does have the ability to ensure that all direct care workers receive a minimum amount of uniform training, regardless of where they work. "There are

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certain basic things I want every mental health technician to know as a minimum, anywhere in the state," Ryder said. "I'm not convinced that they do."

Mental health advocates, who are long used to hearing that there's no money whenever reforms are proposed, also criticized the amendatory veto. "Part of the problem now is that training is permissive," noted Jerome L. Blakemore, executive director of the Illinois Mental Health Association. "The department leaves a lot of training up to the facilities, and there are differences between them. . . . If you want staff to do a decent job, you have to give them adequate training." The training mandate "was one of the most critical pieces to come out of the report," added C.J. Dombrowski, executive director of the Alliance for the Mentally Ill.

That the current controversy is nothing new is driven home forcefully in a remarkable publication from the Mental Health Association of Greater Chicago. At once enlightening and disheartening, the work summarizes a host of previous studies, task force reports and other inquiries into the quality of care given the state's mentally ill, and it shows that report after report over the last two decades has raised concern about the competence of direct care workers in state hospitals. Nor is the call for better trained staff the only constant theme; overcrowding and understaffing are other woes consistently cited by those seeking to improve care and prevent abuse and neglecct of the mentally ill. "We have been surprised at the frequency with which suggestions and solutions have echoed through the years," wrote its editor, Ann Boisclair, in an introduction to the publication.

The conclusion one draws from the document is inescapable: What needs to be done is no secret, but what's been lacking has been a governor and a legislature that care enough to pay for it. Boisclair, too, was troubled by Thompson's rewrite of the panel's work. "These studies come up with all the things everybody already knows," she said. "Why bother to document once again how awful these problems are if you're not willing to face up to the solutions?" That's an appropriate question for legislators to ask themselves before they cast their votes on the motion to override the amendatory veto of H.B. 1571. □

Charles N. Wheeler III is a correspondent in the Springfield Bureau of the Chicago Sun-Times.

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