Category Archives: Mental illness and substance abuse

Fewer Children Seeking ER Treatment for Cannabis Ingestion

Cannabis-Related Pediatric Emergency Department Visits by Month. Source: Virginia Hospital Association

by James A. Bacon

The number of pediatric patients visiting hospital emergency rooms in cannabis-related incidents fell 21.5% in the first half of 2023 compared to the same period the year before, a decline that some attribute to bipartisan legislation regulating the production, sale, and potency of tetrahydrocannabinol (THC) in marijuana-related products.

A Virginia Hospital & Healthcare Association analysis shows that the volume of cannabis-related visits among pediatric patients had been trending higher over the past several years, peaking in late 2022 and early 2023 before dropping sharply in June 2023.

“This law was introduced to protect Virginia children and families from being harmed by ingesting unregulated, intoxicating products that can pose serious health risks,” said Delegate Terry Kilgore, R-Gate City, who sponsored the bill to regulate THC-infused products. “So, it is certainly welcome news to see that this policy change appears to be having a positive effect in terms of declining pediatric emergency department visits due to cannabis exposure.” Continue reading

Lost Kids of Southwest Virginia

Kingsolver, Barbara. Demon Copperhead.  Harper, 2022

 A review by Dick Hall-Sizemore

Barbara Kingsolver is an award-winning author who lives on a farm in Washington County, Virginia. Her latest novel, Demon Copperhead, is what she calls her “great Appalachian novel.” It was awarded a Pulitzer Prize for Fiction this year.

Kingsolver grew up in Appalachia, in eastern Kentucky. After graduating from college in Indiana, she spent several years backpacking around Europe. Upon returning to the United States, she wanted to see the West, and ended up in Tucson. She says that she did not go to Arizona with the idea of settling there, but life happens. During her two decades there, she published several well-received novels. She began to feel the pull of Appalachia and, thus, several years ago, she and her family moved to a farm in Washington County. Continue reading

School Closures Resulted In Spike In Suicide Attempts Among Kids

by Kerry Dougherty

How is it that those of us without fancy degrees from prestigious universities or medical training intuitively KNEW that the Covid-19 lockdowns and school closures would have a profoundly negative effect upon kids?

I watched one of my nieces, who graduated from high school in 2021, spend her junior year at home, isolated from her friends and extended family. A future physician and excellent student, she sat alone, doing class work off of a computer screen. On top of that, her entire social structure was dismantled. There were no sleepovers or parties, no sports, dances or proms. When schools finally reopened she was seated more than 6 feet away from the nearest other student at lunch and if they dared speak to each other, a teacher would scream, “NO talking!”

All for a virus that barely affected kids, as we all knew from the earliest weeks of the pandemic.

I worried about her and her friends. Turns out, she’s OK. Some of her classmates? Not so much.

Last week, UVA Today published a study showing a sharp increase in the number of attempted suicides by children ages 10 to 19 from 2020 on.

The rate of suspected suicide attempts by poisoning among children and adolescents ages 10 to 19 reported to U.S. poison centers increased 30% during 2021 – the COVID-19 pandemic’s first full year – compared with 2019, a new UVA Health study found.

Attempted suicides continue to climb.
Continue reading

Central State Hospital – the State’s Only Maximum Security Mental Health Facility, a Legacy of Jim Crow and Not Nearly Good Enough



By James C. Sherlock

I have written often about the state of mental health support in Virginia. The Governor has a major initiative to improve it.

But it does not go far enough.

The state maximum security mental health facility at Central State Hospital needs to be disbanded and the duties dispersed across the state.

The legacy of that hospital is indefensible, and carries over to today.

The video published showing the death in Central State Hospital (CHS) of Irvo Otieno showed an almost entirely Black group of people — victim, sheriff’s deputies, and CHS staff.

It turns out not to be an anomaly.

Before integration, Central State was Virginia’s Black mental hospital.

Based on records provided by the Virginia Department of Behavioral Health and Developmental Services, Central State Hospital, the state’s only mental hospital built to maximum security standards, is today:

  • a largely Black institution;
  • with a largely Black staff. Of 930 current staffers at CHS, 649 are Black; 77 are “other” races and 204 are White;
  • providing services to a largely Black patient population. Of 264 patients, 160 are Black, 80 white and 24 other races.

That arrangement is not working, even it you think it should, because in the current location it cannot.

And the victims of substandard treatment and their families, as in the death of Mr. Otieno, tend by the relative numbers of patients to be Black as well.

Continue reading

Continuing Turmoil at Danville and Martinsville Hospitals Raises Questions of Oversight – Again

Sovah Health Danville Hospital

by James C. Sherlock

Beckers Hospital Review reports that Sovah Health hospitals in Danville and Martinsville have eliminated the Chief Operating Officer (COO) positions at both hospitals.

Sovah announced that the responsibilities of those two positions will now be absorbed by “other members of the existing team.” Whatever that may mean.

Management turmoil at Sovah is hardly a new issue. But those changes just never seem to work.

Not even a little.

The timing and structure of these current changes are especially unusual given Sovah’s plea agreement with the Food and Drug Administration that is still in force. Seems employees were dealing drugs from the hospital supply.

Similarly unusual, unfortunate actually, are the weak-to-non-existent oversight activities of the Virginia Department of Health and the Accreditation Council for Graduate Medical Education (ACGME).

You read that right.

Sovah Danville is a teaching hospital. Continue reading

Virginia Needs a Top Mental Health Research Hospital – UVa is Positioned Provide It Statewide

UVa Hospital

by James C. Sherlock

The Commonwealth has an ambitious and promising program to improve behavioral health services to its citizens.

One thing missing among the six pillars of that program is a top mental health research hospital system.

The top-rated mental hospital in the United States is Mass General Brigham’s McLean hospital. Many of the doctors are Harvard Medical School faculty.

Of the remaining top 40 on that list, none is in Virginia.

Virginia’s two leading mental health research hospitals are both associated with the University of Virginia medical school and UVa Health.

  • INOVA Fairfax Hospital, partnered with the medical school; and
  • the University of Virginia Hospital in Charlottesville.

There is an opportunity, if the Board of Visitors and Virginia Health choose to exercise it,

  • to invest in bringing one or both of those facilities into the ranks of the best mental health research hospitals in America; and
  • to expand UVa Health at the Wise campus to spread the benefits to that part of the state.

That, in turn, can help the state deal with its mental hospital problems. Continue reading

A More Appropriate Management Model for State Mental Health Facilities

Central State Hospital Petersburg

by James C. Sherlock

I always find it disturbing when state agencies operate institutions that they are also responsible for regulating and inspecting.

It almost cannot work.

I have brought this up with regards to the VDOE operation of a virtual learning program when that same agency oversees private providers of the exact same services.

That is small ball compared to the issues at the state’s mental health facilities.

Now we have a very recent tragic example at Central State of decades-long problems at state-run mental hospitals including overcrowding and inadequate staffing.

A 2021 Associated Press article used Central State as the leading example of overcrowding. The reporter wrote, prophetically:

Virginia sheriffs are reporting being stretched thin after responding to psychiatric emergencies that require them to hold people and transport them for treatment.

‘I’ve had deputy sheriffs tied up for days at a time,’ John Jones, executive director of the Virginia Sheriffs’ Association, told the newspaper in an interview on Tuesday. ‘We’re at a crisis point.’

Now seven sheriffs deputies and three Central State staffers are charged with murder in that same scenario.

I view the current management model in which a single state agency oversees, operates and inspects its own facilities as untenable.

There is a proven alternative. Continue reading

Crime in Virginia — the Statistics of Race and their Causes

by James C. Sherlock

Crime, especially violent crime, is a constant topic in private conversations and in public politics, and thus here on Bacon’s Rebellion.

Comments on BR crime-related articles turn quickly to race, often without basis in fact.

I will offer below the actual crime statistics by race from 2021, the latest available year, in an attempt to cure that.

Then I will write about the causes.

I will almost certainly be called a racist. Continue reading

Public School Climate Lessons Terrorize Virginia’s Children

Courtesy of the BBC

by James C. Sherlock

A headline from the home page of Save the Children:

Climate Change Is a Grave Threat to Children’s Survival.” 

Climate change is thus not a “challenge.” Not a threat to children’s happiness. But rather a threat to their “survival.”

That is what children are being taught in many Virginia public school classrooms. Kids, being sponges, have learned that lesson, and are understandably severely depressed about it.

Parents and the Board of Education, take note. That cannot be allowed to continue.

For years, studies have shown the existence of psychological distress about climate change that has dimensions within feelings, emotions, cognition and behavior. That stress has been demonstrated to disproportionately affect young people.

The largest and most international study of climate anxiety in young people was peer-reviewed and posted in The Lancet in December 2021.

Regardless of one’s personal feelings about climate change, no caring adult would want, as revealed in that study, children feeling “very or extremely worried” (46% of children in the United States) or, worse, negatively affected in their ability to function (26% of children in the United States).

None would want near half or more than half of children reporting feeling “sad, anxious, angry, powerless, helpless and guilty” and “betrayed” about anything, much less a phenomenon that is measurable as a current event with which we are dealing but arguably is overstated by progressives as a future prospect.

Climate change can, and should, be taught to children. But it must be done without terrorizing them. That cannot be too much to ask.

Scaring children to turn them into political activists is child abuse per se.

It must stop. Continue reading

What Do We Owe To and Expect from a Special Ed Teacher?

Abigail Zwerner
Courtesy AP

by James C. Sherlock

On February 16, USA Today published a story by Jeanine Santucci. That is the latest in an excellent series of reports on the shooting of Newport News first grade teacher Abigail Zwerner.

Her article, “Virginia 6-year-old who shot his teacher exposes flaws in how schools treat students with disabilities.” raises questions that Virginians need to answer.

  • What, exactly, do we expect of special education teachers and what do we owe them?
  • What training and resources must we provide?
  • How do we keep them safe?
  • How do we get enough people to accept the challenges and risks?

Any school official or teacher will tell you:

  • That the best-organized parents in K-12 education are special-ed parents;
  • That federal law is very prescriptive and provides little room for error on the part of the schools;
  • That schools’ (meaning taxpayers’) liability for error is open-ended; and
  • That special-ed continues to get more challenging, especially after COVID accelerated the number of emotionally disturbed children and adolescents.

Few school divisions will claim to have any of that under control.

 JLARC in 2020 concurred with that assessment in Virginia.

Longstanding shortage of special education teachers persists, and many school divisions rely on under-prepared teachers to fill gaps.

IEPs are not consistently designed effectively.

School divisions are not consistently preparing students with disabilities for life after high school.

Continue reading

Government Actors Try to Deflect, Deny and “Move On” from Failures During COVID

Courtesy CBS rendering of two CDC spring of 2021 survey findings about American high school girls reported Monday, Feb 13, 2022

by James C. Sherlock

The Centers for Disease Control and Prevention (CDC) is in full self-defense mode.

CDC and the left backed, indeed insisted, upon social isolation during the pandemic.

Now they deflect and deny agency in the consequences. They continue to try to insulate themselves from the catastrophic educational and mental health effects on children and adolescents of that social isolation.

A weakened CDC Director is pledging to overhaul the agency and its culture, a backhanded admission of the unimaginably bad performance of CDC during COVID.

The entrenched bureaucracy that is that agency and its culture is admitting nothing. They are counting the days until she leaves.

So, if experience counts for anything, we pretty much know how the CDC “overhaul” will work out.

Virginia is due for the same sort of review of state actions during COVID.

The Northam administration stumbled badly at nearly every new turn after failing to either exercise or implement Virginia’s own pandemic emergency plan. Which was excellent and predicted nearly exactly the course of events.

Then they tried to cover up the existence of that plan itself.

I am not sure that such a review is forthcoming. If it is, it will be preemptively be declared political. It must be done anyway.

The federal government, under progressive management, is “moving on.”

Or trying to.

I hope Virginia government does not make the same mistake. Continue reading

Child and Adolescent Mental Health and Virginia Public Schools – Dangerous Children’s Services Act Changes Proposed

Credit JAMA Pediatrics, April 6, 2020

by James C. Sherlock

One of the key elements of state and local efforts to support children with behavioral health, educational disabilities, and other challenges is the Children’s Services Act (CSA) (the Act).

In education, its primary role has been paying for placement of children and youth with educational disabilities into private special education schools (PSES).

CSA funds support those students whose educations are judged by the public schools themselves to be too demanding for them to accommodate.

The local CSA Community Policy and Management Teams, appointed by the governing body of the participating local political subdivision, send their own children to those private schools.

I will describe Virginia’s network of PSESs in a follow-on article.

Changes proposed. In a 2020 report, the Joint Legislative Audit and Review Commission (JLARC) had found a long list of seemingly disqualifying flaws in public school special education that would prevent them from accepting students with more severe disabilities than the ones they already try to serve.

Yet there is a movement to remove some severely troubled kids from PSESs back into public schools that have already admitted that they cannot properly serve them.

JLARC, in a disturbingly superficial report in that same year, recommended CSA money be taken away from PSESs and made available to public schools, which is not currently permitted under law.

And that all of the then-fungible CSA school money be administered by the Department of Education, not the Department of Health and Human Resources.

This recommendation was made in the face of the fact that JLARC, in both 2020 reports, admitted the public schools are not equipped to handle these children, much less for the average of 271 days a year they attend PSESs.

So some combination of progressive ed-school dogma, as yet undefined fairy dust and widely non-existent qualified mental health providers and trained special ed teachers are apparently to be sprinkled on the public schools to transform them to be ready to accept children whom they have already referred out to PSESs.

Most of the proposed changes are dangerous, dogmatic and thinly researched nonsense. Continue reading

Child and Adolescent Mental Health and Virginia Public Schools – Big Complications and Major Changes

Credit JAMA Pediatrics, April 6, 2020

by James C. Sherlock

Rebecca Aman, a member of the Newport News School Board, is frustrated. She told me in an interview that:

Without sufficient discipline and access to clinical mental health services, behavioral intervention does not work to make schools safer and healthier.

She believes that Newport News schools need to improve both discipline and the effectiveness of behavioral interventions.

She is absolutely right.

But school-based mental health services offer different, very complex and rapidly changing challenges.

The profession of psychology has recognized that the one-on-one clinical treatment model is permanently out of reach for the broad communities needing assistance because the supply of qualified professionals cannot now and will never meet the demand.

So the delivery model is in the midst of profound change.

Three key changes being pursued are

  • a far bigger emphasis on prevention, much of it to be delivered by school staff;
  • better diagnosis; and
  • “school based” (their term) group treatments.

Which raises at least three questions:

  • Are the pediatric mental health delivery models changing so much that the schools are “shooting behind the rabbit” in the hunt for more services?
  • What does the profession of psychology mean when it describes massively expanded “school-based” services? The schools and parents better find out.
  • Should schools even be in the hunt for more in-school services? I say no. They are already trying to do too much.

Continue reading

Mental Health and Virginia Public Schools – Part 1 – Progressives, School Closures and Child Mental Health

By James C. Sherlock

Credit JAMA Pediatrics, April 6, 2020

We have arrived today at a situation in which huge percentages of Virginia children and adolescents exhibit mental health problems.

Both sides of the political divide acknowledge the problem.

It’s existence is not up for debate.

Both blame the soaring pediatric mental health issues, a problem before COVID, on COVID school shutdowns that caused children to lose foundational developmental experiences that depend in part on socialization in schools and in part on interpersonal relationships with friends, both of which were profoundly interrupted.

Both sides acknowledge that minorities suffered worse than white kids.

That is where the agreements end.

Conservatives blame the disparate mental health impacts largely on easily observable inappropriate responses to COVID insisted upon by progressives and executed for far too long in progressive-run school divisions — in which minority children are mostly educated in America and in Virginia.

Progressives, by dogma never acknowledging agency in any problem, have actively tried to blame those same disparate impacts on institutional racism.

The facts are on the conservative side.

This article will show what progressives did and the results.  Progressive dogma was the cause of extended school closures.  Both the closures and disparate impacts happened disproportionately in progressive school divisions and progressive states.

So progressives closed the schools, closed them disproportionately on minority kids and now bemoan the outcomes of those closures as artifacts of systemic racism.

It reminds one of the story of the young man who killed his parents and asked the judge for leniency because he was an orphan.

It takes some combination of denial, an assumption that people who hear those claims are idiots, and Olympic-level audacity.

Racism, unless it was progressive racism, had nothing to do with it.

Continue reading

Virginia Community Schools Redefined – Part 2 – Stop Trying to Provide Mental Health Services in School

by James C. Sherlock

In Part 1 of this series I described the current Virginia Community School Framework (the Framework) and found it not only lacking, but counter-productive.

Its basic flaw is that it assumes all services to school children will be provided in the schools by school employees, including mental health services.

When you start there, you get nowhere very expensively, less competently, and with considerably more danger in the case of mental health than if the schools were to partner with other government and non-profit services.

This part of the series will deal with child and adolescent mental health services exclusively.

Public mental health, intellectual disability and substance abuse services for children and adolescents are funded by governments at every level. For the federal view of the system of care, see here.

In Virginia, those services are organized, overseen and funded through a state and local agency system.

  • The state agency is the Virginia Department of Behavioral Health and Developmental Services (DBHDS) in the Secretariat of Health and Human Resources. The Department of Medical Assistance Services (DMAS) (Medicaid) plays a funding and patient management role as well;
  • Local agencies funded and overseen by DBHDS are the Community Services Boards (CSB’s) throughout the state.

Some schools and school systems seem to operate on a different planet from their local CSB’s. Indeed, the Framework mentions them only reluctantly and in passing.

The ed school establishment clearly wants to handle child and adolescent mental health problems in-house, with tragic results. They need to stop it now.

There is absolutely no need to wait. Continue reading