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Grounds for admission to West Virginia Hospital for the Insane, predecessor of Weston State Hospital, were many and varied, according to its medical logs from the late 1800s.
"How we treat and think about mental illness has really changed," said Jack Clohan Jr., administrator of that institution's modern descendent, William R. Sharpe Jr. Hospital of Lewis County. "It's far more comprehensive -- the equipment, the medicine, the care are much better."
But a number of local mentally ill individuals and their advocates are afraid things still haven't changed enough.
Of particular concern is proposed legislation that would require mentally ill individuals who are found to be a danger to themselves or others to keep medical appointments and/or take medication to avoid hospitalization, according to Kara Prunty, project director for West Virginia Mental Health Consumers Association, Clarksburg office.
Similar legislation passed both the House of Delegates and the Senate in 2000 as House Bill 4029. A clerical error resulted in the bill's failure to become law.
With a second chance at either derailing or altering the legislation, the association has been vocal in its opposition of the involuntary outpatient commitment bill. About 14 Harrison County residents recently spoke before a Senate Judiciary Committee and have been invited to submit proposals for changes to the legislation's wording, Prunty said.
"This is about the everyday Joe being able to say, 'This morning, my medication is making me really sick and I'm not going to take it,'" Prunty said of a primary concern.
She believes the heart of the issue is who will get the best legislative representation.
"Family, consumers: That's where the split is," Prunty said. "Family members want to do something. The consumers want the opportunity to do something to get better on their own."
Prunty said another issue is cost, specifically, who will be paying for medication or therapy if a person is committed as an outpatient.
While inpatient care is generally covered by insurance, Prunty said outpatient treatment and medication coverage may fall short of what the court orders. There are also many mentally ill individuals who have no insurance.
This issue is particularly troublesome to Sheila Floyd of Fairmont. Diagnosed with anxiety and depression a decade ago, Floyd said her two medications would cost between $250-$300 per month if insurance did not reduce her co-payment to $10 per prescription.
"Medication has made a big difference for me," said Floyd, who has attempted suicide in the past. "But if you're forcing them to take medication that they can't afford, what can they do? If they can't buy it then you're going to commit them."
Floyd said she also believes more comprehensive funding could solve some problems better than outpatient commitment.
A full-time worker and a mother of five, Floyd would like to see funding to help other mentally ill individuals lead fuller lives. She would especially like to see assured funds for voluntary, short-term, inpatient commitments and outpatient therapy. She has discontinued her therapy because her insurance does not cover the $100-per-hour cost.
Prunty said some legislation opponents are also concerned about a possible increase in commitments. The proposed legislation states a person must be determined, by a physician and a mental hygiene commissioner (attorney), to be a danger to himself or others. She believes the definition of "danger" will become relaxed for the less-restrictive, less-expensive outpatient commitments.
Prunty said she is not totally opposed to the legislation if the language can be refined.
Regardless of what happens with West Virginia's involuntary outpatient commitment legislation, medical ethicist Dr. Alvin Moss said the issue will likely remain contentious.
"In other medical conditions, we don't force patients to undergo treatment that they don't want," said Moss, director of the Center for Health Ethics and Law and West Virginia University.
Moss said individual medical rights issues may grow increasingly complicated because of the 1991 federal legalization of advance directives. Individuals in most states can develop documents to speak for them in case they develop a medical condition that leaves them unable to make decisions. These documents allow patients to legally refuse even life-sustaining treatment such as nutrition supplied by a feeding tube, Moss said.
"You always have to balance the rights of the individual vs. the rights of society," Moss said of cases in which one person's illness can also effect others.
He cited mandatory reporting of communicable diseases as one example where the law has ruled in favor of society. Although a person diagnosed with an illness such as HIV might prefer complete anonymity, physicians are required to report such illnesses to the state Health Department.
"That's an incident when the public's health takes precedence," Moss said.
Regional Editor Nora Edinger can be reached at 626-1403.