Category Archives: Mental illness and substance abuse

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

Virginia Community Schools Redefined – Hubs for Government and Not-for-Profit Services in Inner Cities – Part 1 – the Current Framework

by James C. Sherlock

I believe a major approach to address both education and health care in Virginia’s inner cities is available if we will define it right and use it right.

Community schools.

One issue. Virginia’s official version of community schools, the Virginia Community School Framework, (the Framework) is fatally flawed.

The approach successful elsewhere brings government professional healthcare and social services and not-for-profit healthcare assets simultaneously to the schools and to the surrounding communities at a location centered around existing schools.

That model is a government and private not-for-profit services hub centered around schools in communities that need a lot of both. Lots of other goals fall into place and efficiencies are realized for both the community and the service providers if that is the approach.

That is not what Virginia has done in its 2019 Framework.

The rest of government and the not-for-profit sector are ignored and Virginia public schools are designed there to be increasingly responsible for things that they are not competent to do.

To see why, we only need to review the lists of persons who made up both the Advisory Committee and the Additional Contributors. Full of Ed.Ds and Ph.D’s in education, there was not a single person on either list with a job or career outside the field of education. Continue reading

About That 6-Year-Old’s “Acute Disability”…

by James A. Bacon

Kudos to The Washington Post for continuing to dig into the particulars of the shooting by a 6-year-old student of a Newport News elementary school teacher. The latest revelations raise urgent questions about the causes of the breakdown of discipline at Richneck Elementary School and other schools across the commonwealth.

As the Post reports, school officials downplayed repeated warnings about the boy’s behavior, dismissing a threat to light a teacher on fire and watch her die.

Speaking through their attorney, the boy’s parents said that he has an “acute disability.” In one instance, he wrote a note saying that he hated his teacher and wanted to set her on fire. In another, he threw furniture, prompting students to hide beneath their desks. In yet another, he barricaded the doors to a classroom, preventing a teacher and students from leaving.

A six-year-old terrorizing the class. I shudder to think what he’ll be like when he’s ten or twelve.

The main question consuming the media is how the child gained access to a handgun, which his parents stated they store out of reach with a trigger lock. That’s a legitimate question. But there’s another: why was that child in school in the first place? Continue reading

Right Help, Right Now

Gov. Youngkin announces his mental health budget proposals. Photo credit: Richmond Times-Dispatch

by Dick Hall-Sizemore

Probably the most important set of budget proposals made by Governor Youngkin for the upcoming General Assembly has been in the area of mental health. It has already been discussed generally on this blog. (See here and here.)  It might be helpful to examine the details of the proposal.

The Governor, and others, have called his proposals “transformational.” That borders on the hyperbolic, but every governor engages in hyperbole in describing his proposals. His proposal actually accelerates a transformation begun several years ago, while placing additional emphasis on one aspect of government’s reaction to mental health needs—crisis management. Therefore, his description of his proposal as moving “from slow evolution to accelerated revolution” is entirely appropriate.

There is another aspect of the Governor’s proposal that is unusual and admirable—a three-year plan. Most Virginia governors wait until their second year in office and their first biennial budget bill before advancing any major initiatives. As a result, they actually have only a year and a half to implement it before leaving office. In contrast, Youngkin has proposed funding for the second year of the current biennium, to be followed up with additional funding in the 2024-2026 biennial budget bill. Therefore, his administration will be in a position to get the major components of his proposal well established during his term. Continue reading

The Shooting at Richneck Elementary – Part One

Police and EMS response at Richneck Elementary.  Credit WAVY TV 10

by James C. Sherlock

There is trauma everywhere you look.

A six-year-old boy shoots his teacher in school and we first consider the trauma.

Then we look for ways to minimize its effects.

And we simultaneously ask questions about the event itself. What happened and why?

Unless we are personally involved, and even if we are, we look for all of those answers almost immediately.

This first part of a series is about what is to be done with the kid shooter and how the widespread trauma, including his own, will be dealt with. Continue reading

Why Law Enforcement Supports Gov. Youngkin’s Behavioral Health Transformation

Virginia Beach Sheriff’s Deputies

by James C. Sherlock

Updated Jan 6 at 13:10.

Virginia’s sheriffs and police chiefs are reasonably hardened by what they see every day.

They have very difficult jobs to do and are unlikely, either individually or in groups, to support nonsense.

Governor Glenn Youngkin has accepted the challenge of finally fixing Virginia’s behavioral health system. He is strongly supported in that effort by Virginia’s sheriffs and police chiefs.

This is a straightforward proposition for law enforcement.

  • They want people with mental health crises treated by professionals before they commit crimes, not after; and
  • They want them housed when necessary in facilities appropriate to the task of treating them, not in jails.

The Governor proposes to spend $341.6 million in the next fiscal year on that problem, including $123 million in new funding.

  • The law enforcement community sees that as a bargain.
  • Neither the Governor nor law enforcement are known to put up with failure.

The case is sufficiently compelling for small government conservatives to back this effort. Continue reading

Democrats Want to Raise Youngkin-Proposed Mental Health Budget Increase

Health Resources and Services Administration Mental Health Care Health Professional Shortage Areas, by State, as of September 30, 2022, data.HRSA.go.                 Courtesy Governor Youngkin

by James C. Sherlock

There is fundamental agreement in Richmond over mental health services.

From the Richmond Times-Dispatch:

Virginia’s forecasts of long-term budget surpluses mean this year’s General Assembly has a chance to catch up with years of under-funding Virginia schools and the state’s behavioral health system, General Assembly Democrats say.

To govern is to choose. “Democrats” may wish they had used different words than “years of underfunding,” considering who had control in Richmond in 2020 and 2021.

But it is actually helpful that they now think even the governor’s proposal for a 20% increase in the mental health budget approved last year is not enough. If (a big if) more money can be spent efficiently and effectively.

The governor has proposed a $230 million increase in behavioral health program spending over what was approved last year.

So, as the old saying goes, they are just discussing price.

Let’s look at the behavioral health situation to see why. Continue reading

Preparing for the Costs to Government of Virginia’s Generation COVID

John Littel, Virginia Secretary of Health and Human Resources

by James C. Sherlock

To justify her insistence on keeping schools closed, Randi Weingarten, the president of the American Federation of Teachers, said in February of 2021, “kids are resilient and kids will recover.”

She brought that same message to Virginia.

In one of the strangest choices in Virginia political history, Terry McAuliffe brought Weingarten to Virginia to campaign with him on the last weekend of his losing gubernatorial campaign.

Thus sealing his defeat.

It turns out, as it was always going to, that you can’t keep kids out of school for up to a year and a quarter, homebound, and expect all of them to “recover.”

I will call here those in K-12 during COVID school shutdowns Generation COVID (Gen C).

I wrote the other day of an estimate by a renowned educational economist that the 1.2 million Gen C kids in Virginia public schools would lose several hundred billion dollars in lifetime earnings because of un-repaired damages to their learning of all types.

His critics here argued into the night about study methodology, but none denied costs at some level would be there. They did not offer their own estimates.

John Littel, Virginia’s Secretary of Health and Human Resources, has the job of preparing his agencies for the lifetime social costs of those children. Continue reading

Public Education and the Management of Change

Freedom High Woodbridge

by James C. Sherlock

Peter Drucker’s famous five questions should always be asked by and of government.

What is the mission? Who is the customer? What does the customer consider valuable? What are the results sought and how are they to be measured? What is the plan, to include both abandonment and innovation?

So, in reviewing the 119-page JLARC report Pandemic Impact on Public K–12 Education 2022, we must inquire first what JLARC was asked to do by the General Assembly.

Then examine what they did with that charter.

Both were well intentioned but incomplete. Continue reading

How UVa Addresses Student Loneliness, Depression

A federal survey shows a 63% increase in depressive symptoms in teens and young adults in the 10 years prior to COVID. Source: “Hoos Connected: Enhancing Social belonging & Support Among UVa Students

by James A. Bacon

A new preoccupation of college administrators across the United States is how to give students a sense of “belonging.” The concern is understandable. There is increasing awareness that America is experiencing a “loneliness” epidemic, as reflected by a 40% rate nationally of anxiety, depression and other diagnosed mental illnesses among college students. If students fail to connect with classes, professors, or other students — to feel part of a community — they are more likely to fall into a state of anxiety, depression and self-destructive behavior.

The University of Virginia is trying to address the problem of loneliness and isolation with a program called Hoos Connected. Psychology Professor Joseph P. Allen, executive director, will brief the Board of Visitors tomorrow about the program.

Hoos Connected organizes weekly small-group discussions and activities for first-year and transfer students. In a pilot program, according to a PowerPoint presentation posted on the Board website, Hoos Connected participants and a control group of non-participating students started out roughly equivalent in a measure of student loneliness. Among the goals was to get students to make inter-personal connections and recognize “how much we all have in common beneath the surface.” By the end of the semester, the Hoos Connected cohort showed a decline in loneliness, while the control group exhibited an increase, according to Allen. Continue reading

Student Mental Health Crisis Explained – By The Washington Post

Freedom High Woodbridge

by James C. Sherlock

The Washington Post, in a lengthy article, “The crisis of student mental health is much vaster than we realize,” wrote about the mental health crisis facing our school children, especially adolescents.

Nationally, adolescent depression and anxiety — already at crisis levels before the pandemic — have surged amid the isolation, disruption and hardship of covid-19.

Now, the Post tells us. They even hint that more federal money may not help. Which must have taken an extra couple of days of meetings before publication.

The article did not identify the “we” who were cited in the headline as not realizing this was happening. Who indeed could have guessed such an outcome?

Other than anyone older than 12 not blinded by a “narrative” that never included the children’s mental health.

Some even wrote about the issues when recommending that kids go back to school in person. Before the start of the 2020-21 school year.

In the Post story, not a word about the “leaders” in state and local governments and the teachers union strike threats that kept some Virginia public schools closed up to an extra year.

Not a word about the Catholic schools that opened across the state in the fall of 2020.

Not a word of apology for being a big part of the problem that needs to be fixed. Continue reading

Virginia Mental Health Services in Deep Trouble – A Survey

Eastern State Hospital. Courtesy Virginia Department of Behavioral Health and Development

by James C. Sherlock

Nov. 29 updates in blue.

Supply cannot begin to keep up with demand.

In this case, the consequences involve personal welfare and public safety. And they can be terrible in both cases.

Governor Youngkin will propose to the 2023 General Assembly additional funding and policy prescriptions for the state’s mental health system.

The state offers inpatient services, community-based government services, and Medicaid-funded services.  Medicare offers payments to participating hospitals. Private insurances offer coverage.

I say “offer,” because much of what policy prescribes has proven difficult to fill in practice.

Virginia’s mental health system is in deep trouble because of shortages of personnel and facilities to absorb the very steep rates of increases in persons needing assistance.

The personnel problems are twofold and affect both government and private services.

  1. Key personnel positions require trained specialists, the shortages of whom are manifest across the country; and
  2. Working conditions in mental health care are very stressful, physically demanding and dangerous, driving away badly needed low skilled workers who can easily find jobs elsewhere.

Medicaid programs offer services that private facilities and practitioners, facing the same labor shortages, have proven in some combination unable or unwilling to provide at Medicaid reimbursement rates. State-contracted Medicaid Managed Care Organizations (MMCOs) have not solved those problems.

So part of the answer is money, but we really don’t know how much. And in this case, money alone may not provide sufficient services to satisfy demand. Continue reading

Homelessness in Petersburg – Part 2

Travel Inn was shut down by the ACE team in June. Courtesy Joyce Chu, Progress Index.

by James C. Sherlock

I wrote yesterday about the excellent investigative reporting by the Progress-Index about the knock-on effects of the renewal of fire and building code enforcement in Petersburg.

My position is that Petersburg must enforce its codes for public safety and the livability of the city.

But I also recognize the need to provide better solutions to homelessness in that city. I am pursuing a story on that subject.

But in the meanwhile, the Progress-Index’s Joyce Chu has posted her second article in that series.  I refer to

‘A fresh can of nowhere to go’: Health and stability stumble with fewer motel rooms for those on the edge”

It consists almost exclusively of the stories of those displaced with the closure of those motels.

It is powerful stuff.

Virginia Should Enforce Threat Assessment Laws. Noting Lack of Compliance Not Enough.


by James C. Sherlock

I have written about the Threat Assessment Teams (TAT’s) of two state universities, the University of Virginia and Virginia Tech.

I assessed Tech to be compliant with state law. I reported that UVa is not. That of course raises the issue of the rest of Virginia’s colleges and universities.

The Virginia Department of Criminal Justice Services (DCJS) in 2014, with far more resources and access than I, found the state of the TAT’s serving the commonwealth’s fifteen four-year state institutions of higher learning (IHL), its community colleges and private IHLs to be as a group a hot mess (my term).

I will follow this article with an assessment of the compliance of the current policies of Virginia’s fifteen public IHLs.

The 2014 report did not have the intended effect of standardization and professionalization of threat assessment and intervention in Virginia. Preliminary reviews of the policies of each IHL show them still to be all over the map in terms of compliance.

I am reasonably sure that if DCJS redid its survey tomorrow, it would result in similar findings and recommendations. Perhaps at this point the government should actually enforce the law rather than just reporting on the lack of compliance.

One wishes that had occurred years earlier. Continue reading

Petersburg Resumes Important Actions Against City Code Violators — Homeless Needs Increase

Travel Inn was shut down by the ACE team in June. Courtesy Joyce Chu, Progress Index.

by James C. Sherlock

Sometimes absolutely necessary actions have more than one outcome.

Such is the case in Petersburg.

Joyce Chu of Petersburg’s indispensable Progress- Index last evening initiated a multi-part series on the impacts of the city’s closure due to safety violations of two motels used by otherwise homeless people.

Her first article makes a case for more government and charitable services for the people affected by the closures. Good for her. No one wants people living on the streets and everyone wants the kids in school.

She explains that the California Inn, OYO and Travel Inn motels, among a group of low cost motels right off of I-95, were

also hotbeds of crime, drug overdoses and prostitution mixed in with families with children, according to former residents and homeless advocates.

She points out that Petersburg has resumed (after a lengthy period when it did not) enforcing its zoning codes. A team called the ACE team — Abatement, Compliance, and Enforcement — is on task, run by the Fire Chief.

Code enforcement is an absolutely necessary step to revitalize the city.

So is helping those adversely affected.  -Hotel owners should be forced within the limits of the law to assist. Continue reading