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.

What follows is a summary of the issues.

Detention orders.  Code of Virginia § 37.2-809. Involuntary temporary detention; issuance and execution of order is constantly being modified.  Since 2004, it has been changed by 11 different General Assemblies.

The 2008 General Assembly re-wrote the statute almost entirely, substituting “shall” for “may’ issue and providing broad new sources of evidence that can be considered in the issuance of a temporary detention order (TDO).  

In 2014 it was overhauled again.

The changes worked.  TDOs have more than quadrupled since 2014.  Building places to detain and providing medical specialists to treat such subjects has proven more difficult than changing that law.

Psychiatric hospitals. Residential facilities are in the worst shape.

In addition to physicians, nurses and other specialists, they are short of the minimum-wage workers who make up the bulk of the work forces. Those are the same workers needed by every small business and most large ones, and inpatient mental health work is hard and dangerous. Supply does not meet demand.

During the height of the pandemic, Commissioner of the Department of Behavioral Health and Development Alison Land told the General Assembly that

“low pay, burnout and growing workloads are pushing employees out of the field. In many cases, the shortages leave available staff scrambling to respond to a high-need patient population. Assaults and injuries within facilities are common, Land said — a difficult cycle that leads to more turnover.”

She went on to say that inpatient facilities across the state were operating at roughly 65 to 70 percent of staffing, with occupancy at or exceeding limits.

In mid-2021, more than half of Virginia’s state mental hospitals were closed temporarily to new admissions because of overcrowding.

Private providers have the same problems, exposed by increases in Medicaid-funded services that in some areas of the state have found few takers among services providers.

The state asked general hospitals to accept more patients in mental health crisis. The response from the Virginia Hospital and Healthcare Association was that general hospitals would do everything they could, but they had the same space and staffing issues as psychiatric hospitals.

Children’s Hospital for the King’s Daughters (CHKD) in Norfolk reported huge waiting lists for child mental health services driven by COVID.

Hospital Quality. The best source for reliable quality information about the nine Virginia psychiatric hospitals listed in Medicare Compare is to click on the hospital name.

Using Dominion Hospital in Falls Church as an example, page down and click on “Psychiatric Services.”  You will see that Dominion get’s terrific grades for every quality measure; the nearby Northern Virginia Mental Health Institute, not nearly as good.

Petersburg’s Poplar Springs Hospital has a lot of work to do across the board. Western State has serious patient safety deficiencies.

For general hospitals with a psychiatric unit, you can do the same.  Use Augusta Health as an example.

So the Medicare Compare list is worth a look.

Staff shortages – the Eastern State example.  Eastern State Hospital in Williamsburg, the state’s largest, is seeking workers for 44 job descriptions, for most of which they seek multiple workers.  

It offers a benefit package to include various health care plans, paid life insurance, Virginia Retirement System retirement plan, 12 paid holidays, annual, family, personal and sick leave.

Of course there are multiple positions for Registered Nurses (U.S. and International), Licensed Practical Nurses, psychologists, psychology associates, crisis prevention response team members, a dietetic tech, clinical care techs, healthcare techs, environmental services techs, and clinical social workers. They also are seeking a psychiatrist and a primary care physician.  Signing bonuses are offered for nearly every full-time position.

Included among the jobs is one for a pharmacy courier, for whom the minimum qualifications are a high school diploma, a drivers license and a background check.  It is a full-time salaried position offering a $7,500 sign-on bonus to those new to state employment with a one-year written agreement.

Community-based government services. The state has attempted since 2017 to move mental health care into the communities with increased funding to the 40 community services boards (CSBs).

In 2017 then-Governor McAuliffe signed a bill requiring CSBs to provide Same Day Access (SDA) to persons in need of mental health support.

In 2019, Governor Northam announced that goal had been achieved.  The program provided triage. After initial assessment, the goal was to get those who needed it care by appointment within 10 days.

Crisis services at the CSB’s aspire to include a team of clinicians available to provide 24-hour crisis response to individuals experiencing a mental health or substance use crisis. They provide crisis intervention assessment, counseling, and referral. They are responsible for pre-admission screening for hospitalization and court liaison services for individuals subject to involuntary commitment procedures.

Crisis intervention teams include law enforcement, behavioral health and persons with experience with close family with mental illness. CIT training is a 40-hour curriculum taught by specialists from those communities.

Training addresses common signs and symptoms of mental illnesses and co-occurring disorders; recognizing when signs and symptoms represent a crisis situation; safely de-escalating a crisis; and using community resources to provide assistance.

CSBs typically also provide a Crisis Intervention Team Assessment Center (CITAC) that provides a secure location for those experiencing a behavioral health crisis. Critically, CITAC relieves the burden from law enforcement for maintaining custody of persons exhibiting mental illness of sufficient severity that they are under TDOs.

A Crisis Center provides a safe and less restrictive environment for those in crisis.

In practice, CSBs struggle with the same resource shortages as the rest of the system. In some, full services described above are policy, but remain aspirational in practice.

Medicaid. In July of 2021, Virginia Medicaid, by far the biggest insurer providing mental health services in the Commonwealth, began offering to fund:

  1. Assertive Community Treatment (ACT), a “coordinated set of services offered by a team of medical, behavioral health, and rehabilitation professionals in the community who work to meet the complex needs of individuals with severe and persistent mental illness.”
  2. Mental Health Partial Hospitalization Program (MH-PHP), a “combination of interventions and services which are similar to an inpatient program, but on a less than 24-hour basis.”
  3. Mental Health Intensive Outpatient Program (MH-IOP): “clinical programs designed to provide a combination of interventions that are less intensive than Partial Hospitalization Programs, though more intensive than traditional outpatient psychiatric services.”

In December of 2021, immediately before the Youngkin administration took office, six more Medicaid-funded services were offered.

Contractually, the MMCOs must provide those nine services to their patient populations, but sufficient supply is just not there in many parts of the state.  And, yes, they do what they can with telemedicine.

Bottom line

In short, the Commonwealth cannot provide the state services that are mandated by law, and offers to pay through Medicaid for more services than are available in the private sector.

Even the funding currently provided is boosted temporarily by federal COVID money.

The first thing that any government properly would do in this situation is triage its programs because of the overarching staffing shortages which money alone may not fix. Which are the most vital?  Where are the biggest needs?

Virginia is ranked 14th overall in 2023 in Mental Health America’s ranking of states for lower prevalence of mental illness and higher rates of access to care for adults.

It is, on the other hand, ranked 48th among states for the same measures for youth.

The whole data table is here.

So we hope Virginia’s government looks first at improving youth mental health.

The Department of Medical Assistance Services has floated the idea of having MMCO’s screen demand, but that is getting pushback as not sufficiently timely.

The political problem is that any reduction in services driven by qualified labor supply shortages, not just the price of those services, will be called “cuts” by the political opposition. Throwing-Granny-out-in-the-snow kinds of ads.

Even though many services officially “offered” are not available in practice now in many areas of the state.

Because, in the current market, skilled labor goes where it wants to go, not necessarily where it is needed, some services available in wealthier districts may not be in poorer ones regardless of funding.

But to govern is to choose.

Governor Youngkin will have his administration’s estimates of what can be done with the money available, and how much money that is. And how much cannot be done.

It is that problem set that the Governor has set out, along with the General Assembly, to help Virginians address.


Updated Nov. 29 at 8:37 adding a section on detention orders.

Updated Nov. 29 at 9:52 adding Mental Health America state ranking data.

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42 responses to “Virginia Mental Health Services in Deep Trouble – A Survey”

  1. LarrytheG Avatar

    Your usual thorough as well as even-handed. Thank You.

    I assume since Youngkin is also working to reform Workforce Development – this could be a win-win opportunity.

    I have never understood why Va has been so irresponsible on the mental health continuum – truly bipartisan – even after Creigh Deeds tragedy.

    1. James C. Sherlock Avatar
      James C. Sherlock

      People were promised way more than the system can deliver. The people who did the last couple of expansions did not do their homework. Retrenching government programs is always tough.

    2. James C. Sherlock Avatar
      James C. Sherlock

      People were promised way more than the system can deliver. The people who did the last couple of expansions did not do their homework. Retrenching government programs is always tough.

  2. Cassie Gentry Avatar
    Cassie Gentry

    Long ago I was a social worker, back in the 70s, and was a witness to and a participant in the movement to deinstitutionalize mental health care and shut down the network of state run psychiatric hospitals. Most of back then were supportive of that and though how much more humane it would be to offer patients an opportunity for a “normal life” where they could trot on down to their local clinic and get therapy and meds. The movement was a natural at the time, following on the heels of the 60s civil rights ferment. Little did we know then that the law of unanticipated consequences would result in a situation which was far worse both for public order and for the chronic mentally ill. Community based mental health care is costly, probably more so than the old system, and it simply doesn’t work except in isolated cases of people with anxiety disorders or mental retardation. But for the seriously mentally ill people, those with schizophrenia and related disorders, it is hopeless. While individuals suffering from schizophrenia of the paranoid delusional may be medicated into a remission of a sorts that may provide a tenuous stability, that all depends on rigorous adherence to the medication regime, but most lack the discipline to stay on their meds (which typically have unpleasant side effects) and, being mentally shaky in general, are unable to maintain compliance with treatment contracts. To borrow from Putin, they are not “agreement capable”‘
    And so we have the streets crawling with crazies, many of them violence prone or given to risky behaviors. Many of today’s homeless are that category of people who 50 years ago would have been confined to “lunatic asylums” where they could be kept under control.
    The road to hell is paved with good intentions, and so it is with the mental health field in this country. While I’m a supporter of Governor Younkin and applaud his desire to fix the problem, none of the measures under consideration are going to accomplish a damn thing other than swell the ranks of publicly paid mental health workers, but without a return to involuntary long term custodial care for psychotics there will be no solution to the current problems.

    1. James C. Sherlock Avatar
      James C. Sherlock

      Your analysis is much appreciated. And brilliant. I wish I had written it.

      Dr. Charles Krauthammer, who was both a liberal and Chief of Psychiatry at Mass General before he took to opinion writing, regretted publicly that it was no longer possible to do what he did when he was practicing. At that time, he could write a prescription for confinement and it was honored.

      I provided this background article to give the average reader a basis for judging the Governor’s proposals.

      I hope the administration takes an analytical look at current programs, rather than try to fund all of them partially, when at some level funding is not the issue.

      We’ll see what they come up with. But thank you sincerely for this contribution.

      1. “at some level funding is not the issue.”

        But at many levels the issue is, and has been for decades, precisely funding. Virginia has chronically ranked near the bottom of funding per capita for services for people with severe disabilities. Often 48th or 49th with only states like Mississippi and Alabama lower.

        Can Youngkin catch Virginia up in one fell swoop? No way, the problem is far too big, but he can get a start. Part of that start is acknowledging that something is profoundly wrong and reorienting Virginia’s priorities to begin catching up for decades of neglect.

        The numbers may have improved some since I last paid attention to them, but Virginia has so profoundly underfunded services it has a huge way to go.

        Here’s an example of how far Virginia has to go. It is not quite yet replacing an 80+ year old mental hospital.

        1. James C. Sherlock Avatar
          James C. Sherlock

          My point was that some number of highly educated and skilled professionals are needed in private practice and 40 CSBs across the state as well as in the psychiatric hospitals and the psych wards of many general hospitals to provide all of the services government has promised. Given the national shortages of those professionals, we are unlikely to get the right numbers, much less the right geographic distribution across the state. They can live, work and raise their families where they wish. Hard fact.

          1. Staffing issues have existed for a long, long time. They may well be incrementally worse today. The structural problem is that Virginia has never appropriated the money to do what is needed.

            Blaming “national shortages” is a superficial explanation that papers over the problem without dealing with it. Tsk, tsk, “national shortages” what can we do? Oh well, on to the next windmill.

          2. James C. Sherlock Avatar
            James C. Sherlock

            You are endlessly cynical on this subject.

            Describing for readers national shortages of professional mental health providers and the implications of that fact in Virginia is not “blaming”. It is journalism.

            For recent data from KFF, see https://www.cnn.com/2022/10/08/politics/cnn-kff-mental-health-survey-what-matters/index.html

            Mental health is a big problem and certainly one on the plate of our elected representatives, but not the only one. Schools, housing, homelessness, fentanyl, transportation, public safety, and every other issue requiring public money are on the table.

            Let’s see what the governor submits. Then, if necessary, we can be cynical together.

          3. Cynical my butt. No, just been in this field for a long time, and know staffing has always been an issue. It is high stress work with burnout and high turnover. Good programs figure out how to attract and retain staff better than mediocre programs that pay poorly.

            For example, around 15 years ago the Feds opened a new traumatic brain injury unit at McGuire military hospital in Richmond for troops coming back from Iraq. A local CSB exec whined that he could not keep counselors because the feds were paying more money. The truth was he was a jerk, with rotten programs, and staff bailed on him as quickly as they could find other jobs. Higher pay made it a twofer. He was short handed 24/7/365. For other programs in the area the issue was not acute.

            There has been a hierarchy of wages in mental health programs for a long long time. Feds pay the best, then State/Local government programs, then not for profits. It has ever been thus.

            Staffing shortages depend to a significant degree on the ratio of graduates entering the field to new jobs/attrition. These are high stress jobs with high turnover. That supply/demand ratio varies. I do not doubt that currently there is higher demand and a lower supply that tightens the market. Blaming that for an inability to staff can be ignorant, lazy, disingenuous or naive.

            NO, I will not choose to be cynical with you, anyone else or by myself. I will take 40+ years experience in this field that has chronic staffing issues and watching good programs deal with it successfully as my guide. YMMV.

            edit: removed gratuitous comment.

    2. James C. Sherlock Avatar
      James C. Sherlock

      Article was updated Nov. 29 at 8:37 adding a section on detention orders.

      You will read that the changes made detention far easier and indeed mandatory. I think those changes were necessary and good, but they have put unprecedented demands on the system.

    3. …without a return to involuntary long term custodial care for psychotics there will be no solution to the current problems.

      Sad but true.

  3. Eric the half a troll Avatar
    Eric the half a troll

    Gee, it might have something to do with these jobs being minimum wage…

  4. Interesting post, but…

    Virginia’s shortage of mental health services is not new. Virginia has been profoundly inadequate since deinstitutionalization was court ordered starting in the 1970s (and before with lobotomies and sterilizations, but that’s another subject). Virginia has chronically been right near the bottom of state investment in mental health services. Virginia has never been willing to come close to providing the services needed for its citizens. Reporting current shortages is likely accurate, but fundamentally misses that Virginia’s problems are chronic and have been acute for 50 years. Bleats of “Oh we just can’t find staff these days, there’s a shortage” have some validity but are primarily cheap attempts to provide cover for fundamental institutional failures spanning decades.

    Virginia’s Community Services Boards (CSB) are profoundly variable. The good ones are pretty good, but the bad ones make incompetence look good in comparison. The issue being that as in many things Virginia, the CSBs are local and vary radically with locality.

    For example really horrid CSBs include Radford that failed to provide court ordered services to Cho, Rockbridge that failed to identify a bed for Gus Deeds and sent him home to assault his Dad, and Hanover with multiple failures that resulted in death including discharging a woman from crisis services who that night committed suicide by jumping off an overpass into I-95 traffic.

    “The overcrowding was driven in part by the 2014 law sponsored by
    Creigh Deeds in honor of his son, who in a mental health crisis injured
    his father and killed himself. The law required Virginia’s psychiatric
    hospitals to admit patients in crisis and under temporary detention
    orders (TDOs) for whom a bed staffed by qualified providers could not be found elsewhere.

    Since that time, TDOs have increased 400%.”

    That paragraph is fundamentally inadequate and misstates what Senator Deeds did and why. It is a disservice to both him and his son, “Gus”.

    Background: Senator Deeds son, Gus, was in crisis. He and the senator spent the day at the Rockbridge CSB. There a moron of a staffer failed to find a bed in a psychiatric unit for Gus and sent him and his Dad home. There were several beds listed on the Virginia registry of available beds. the closest one was at UVa hospital. The next morning Gus assaulted Senator Deeds with a knife and subsequently committed suicide.

    Senator Deeds bill may have been named in honor of his son, but he drew the legislation to prevent other Virginians from suffering the same fate Gus and he were subjected to because mental health “professionals” were too dense to identify services were available. It made sure state mental hospitals were identified as available to people in crisis. He has worked in subsequent GA sessions to increase state funding and services for Virginians with severe mental illness.

    Senator Deeds did not cause TDOs to increase by 400%. Nor is there evidence the underlying need has increased. However, we can be pleased that more people who need psychiatric services are being identified and services ordered. The problem being services have been needed but not provided for decades. The need does not go away, and the bodies, both living and dead, pile up. If you have one person who needs, but does not get, services and another one is subsequently identified, the need is twice what it was, but not because the incidence of severe mental illness has doubled. Be aware too that “waiting lists” have long been one of the tools providers use to try to persuade the GA to provide more funding.

    That’s more than enough from me at the moment. You’ve got a good start, and it is understandably shallow because you are approaching a long standing, complicated problem that varies locality by locality across Virginia. It ain’t a simple subject.

    I encourage you to pursue it and expect it will lead you to greater insight into the VPC/TAT issues and deeper into what failed at UVa with Jones. If you are serious about the issue I also encourage you to spend time with Senator Deeds. He has probably forgotten more about Virginia’s mental health debacles than most people have known. My experience with him is that he is bright, gracious, generous and forthcoming. Those are unusual but very welcome qualities in a politician. Oh, and beware of Virginia’s mental health establishment, like most bureaucracies it is self protective and has a pretty good patter to deflect scrutiny.

    1. James C. Sherlock Avatar
      James C. Sherlock

      Excellent insight. I stopped myself at 1500 words in an endlessly complex subject.

      I disagree that I did Sen Deeds a disservice. You may be sensitive to the details of the case, but readers needed to be reminded of the bi-partisan origin of the promises that outran Virginia resources.

      My core observation is that government, in attempting to make up for decades of neglect, tried to “fix” mental healthcare all at once (a few years – all at once in Virginia terms).

      And those who did it wrote “checks” that the system could not cash.

      I don’t yet know the role of the bureaucracy in this mess.

      I don’t have enough information, and never will, to recommend how to make a new structure out of the rubble of the existing one, but we await the Governor’s program to see what his people have come up with.

      This article was a primer to support that announcement. I will assess it against the background provided here.

      1. I encourage you to pursue it. You can do Virginia a service, but it won’t be a quick hit or easy.

        What I specifically objected to was this:

        “The overcrowding was driven in part by the 2014 law sponsored by Creigh Deeds in honor of his son, who in a mental health crisis injured his father and killed himself.”

        Deeds did not cause overcrowding, not even in part. He was reacting to the failure of Virginia’s mental health programs to access available beds in psychiatric units across the state. The specific example of the deadly consequences of that failure was the death of his son. His legislation was a solution to institutional incompetence, not cause of shortages.

        You do Deeds a profound disservice by stating that he is the cause of overcrowding of Virginia’s mental health system, even in part. You have it backwards. I urge you to correct your post.

        Talk to Senator Deeds. He’s your subject matter expert. He will have a better view of where we are, what is needed and the prospects of getting there than anyone else in the state.

        1. James C. Sherlock Avatar
          James C. Sherlock

          That is the way you interpreted my remarks about Sen, Deeds, not the way they were meant. My statement was factual background, not an accusation.

          1. What you said was: “The overcrowding was driven in part by the 2014 law sponsored by Creigh Deeds”

            If that is not what you meant please correct it to say what you mean. If it is what you meant it is factually wrong.

            Look, I think you are working on worthwhile stuff here. I care that you get it right. It is like with some of the gun stuff several of us did for you the other day, helping you get things right so errors do not detract from what you are doing.

            Please fix it, say thank you and keep moving.

            You are poking at an important and complex area that as we saw at UVa periodically has deadly consequences. I hope you care enough about it to invest the time to actually help make things better, you have a platform here at BR to work from.

            It will be a missed opportunity if you just natter around with more superficial quick hits, pat yourself on the back then dance off after the next shiny object. Got my fingers crossed that you will be earnest about mental health and do a good deed for Virginia.

          2. James C. Sherlock Avatar
            James C. Sherlock

            The article was updated Nov. 29 at 8:37 adding a section on detention orders and removing the discussion of Sen. Deeds.

          3. Very nice!

            The link I provided above on the difficulties Virginia is having in replacing 80 year old Central State illustrates some of the problems Virginia is having in providing mandated services.

            You’re at the right time to have an impact on the upcoming GA session. Go for it!

    2. how_it_works Avatar

      “Virginia has chronically been right near the bottom of state investment in mental health services.”

      What spending categories is Virginia near the top or even the average?

      It seems like a low effort, low spend sort of state.

      Example: My elderly mother was in the hospital about 2 years ago. A social worker from, I suppose, Spotsylvania County left me a voicemail about the situation but I could not make out the phone number she left.

      I couldn’t call them back and they never bothered to follow up.

      This sort of crap seems typical. Don’t let your parents grow old in Virginia, apparently.

    3. James C. Sherlock Avatar
      James C. Sherlock

      “Virginia has chronically been right near the bottom of state investment in mental health services. Virginia has never been willing to come close to providing the services needed for its citizens.”

      Quite a statement. If it were true, it would be a devastating critique. It is not. Virginia’s major shortfalls are in the treatment of children.

      1st is best in all of the following rankings. Each is out of 51.

      Virginia is ranked 14th overall in 2023 in Mental Health America’s ranking of states for lower prevalence of mental illness and higher rates of access to care for adults.

      It is, on the other hand, ranked 48th among states for the same measures for youth.

      In the access to care measure, Virginia is ranked 34th. Prevalence, 29th. Adults insured for mental health treatment: 10th. Adults with advanced mental health receiving treatment: 11th. Adult Suicidal Ideation 14th. Adult Substance Use Disorder 9th.

      The whole list is at https://mhanational.org/issues/2023/mental-health-america-all-data

      1. Access to care at 34th sure ain’t great. As I noted in my comment Virginia may be getting better, and I am glad to see statistics showing significant improvement.

  5. Nancy Naive Avatar
    Nancy Naive

    We never seem to strike a happy medium. Maybe we could add something to the water suppy?

    Bedlam came by its name honestly. Institutional systems have never had a good name.

    1. James C. Sherlock Avatar
      James C. Sherlock

      I had a fraternity brother, a scholarship linebacker, who worked at Eastern State right after college. He has always said it was the hardest and most dangerous work he ever did.

      1. Nancy Naive Avatar
        Nancy Naive

        My 13-yo ex-sister-in-law was ordered confined to Bayberry because of drugs and she was just plain acting whacked out. After a week she was ‘cured’. Not by anything the doctors did, but she saw what real crazy was like.

        It took another week for my ex-wife to get her released in our custody. She was a dream child for the next two years by that time the wife and I were ex-. Saw her at my ex-brother-in-law’s wedding about 20 years ago. She now owns a horse ranch in Georgia, which is a totally different kind of crazy.

  6. LarrytheG Avatar

    This is something the private sector does not do for the average man who is not rich.

    The rich, as always, can afford and are willing to pay for the “help” their family needs.

    And this is the way it works in most 3rd world countries. If you are not rich and you or a family member has a mental disease, it’s your problem.

    And this was the way it worked in the US for a long time and that included kids with special needs beyond mental disease.

    So this has become a fundamental responsibility of govt in most developed countries and US states.

    Virginia is not alone in according it a kind of “black sheep” status.

    But why we won’t do the deed, all the while we’ll lavishly fund law & order, criminal justice and prisons is odd and weird.

    I support local/regional facilities just as I do for Regional Jails and Regional health services. Why this is still be argued to be treated in a centralized institutional way just seems to me to be backward thinking.

    Most of us are also willfully unaware of the breadth and depth of mental illness in general. It spans a wide range and demands better than the one-size “lock em all up” attitude IMO.

    1. James C. Sherlock Avatar
      James C. Sherlock

      No one that I know has offered a “one-size lock-em- all-up” proposal, Larry. That must have appeared to you in a dream.

      Virginia is endlessly tweaking and overhauling its system trying to get it right. See the new paragraph on detention orders that I added to the article.

      The system is hierarchical because it is designed to treat varying degrees of mental illness.

      Long-term residential confinement and treatment requires facilities dedicated to that task. The ones the state runs are scattered across the state and it has proven unable to staff them adequately.

      That, in turn, varies by location, as you would expect.

      As much as no one wants to hear it, highly educated mental health professionals are in shortage and have their picks of where to live and work. There are places in Virginia that few of them will choose.

      The state tries to bring in foreign professionals looking to emigrate or for temporary visas to fill those gaps.

      That program, in turn, has to strike a delicate balance between desires and qualifications.

      The problem is very difficult.

  7. DJRippert Avatar

    Here’s a start – tax all political contributions at 39.5% and use the money as a starting point to fund more mental health services in Virginia.

    1. James C. Sherlock Avatar
      James C. Sherlock

      Out-of-state contributions at 100%.

    2. LarrytheG Avatar

      well.. that’s “free speech” … and Bob McDonnell was exonerated from such stuff , right?

      How about this – ALL cash and property forfeitures associated with drug crime – goes to mental health?

      1. James C. Sherlock Avatar
        James C. Sherlock

        We are discussing mental health, and it is easy to conceptually throw the kitchen sink at the problem, but it is not nearly the only government service that needs to be funded by the Commonwealth.

        Inflation is real, and federal Covid money has an end date.

        I made a reference to retrenchment. Maybe we have put too many programs in place. That assessment needs to accompany any resources allocation request.

        1. LarrytheG Avatar

          well, I sorta thought when we transitioned from mental health to “money” in elections and politics, and such….

          Priorities is THE name of the game in any budget.

          We never will have enough money to do everything that “needs” to be done so we have to recognize and reconcile “needs” that might be “wants”.

          And of course, that differs by people, ergo , politics…

          oops… back around again..

        2. Retrenchment will reverse some of the statistical gains in Virginia’s national standings you have reported.

  8. LarrytheG Avatar

    I found this interesting:

    ” The law required Virginia’s psychiatric hospitals to admit patients in crisis and under temporary detention orders (TDOs) for whom a bed staffed by qualified providers could not be found elsewhere.

    Since that time, TDOs have increased 400%.

    In mid-2021, more than half of Virginia’s state mental hospitals were closed temporarily to new admissions because of overcrowding.”

    in the context of the ongoing discussions about murders by the mentally ill……and proposals to find them and help them before they do it….

    1. James C. Sherlock Avatar
      James C. Sherlock

      I re-wrote the section about detention orders to make it more complete.

    1. James C. Sherlock Avatar
      James C. Sherlock

      Environmental impact studies and zoning rules don’t just slow down and drive up the costs of pipelines.

      1. LarrytheG Avatar

        no? geeze…

  9. LarrytheG Avatar

    more mental health news:


    “Edwards was hired by the Virginia State Police and entered the police academy on July 6, 2021, Virginia State Police Public Relations Manager Corinne Geller told The Associated Press in an email. He graduated as a trooper on Jan. 21, 2022, and was assigned to Henrico County within the agency’s Richmond Division until his resignation on Oct. 28.

    Corinne Geller, a state police spokesperson, said that during Edwards’ 15-month tenure there, he “never exhibited any behaviors to trigger any internal administrative or criminal investigations.” During his background and psychological tests, there weren’t “any indicators of concern,” she told the Los Angeles Times.

    Edwards was hired as a deputy in Washington County, Virginia, on Nov. 16 and had begun orientation to be assigned to the patrol division, the sheriff’s office said in a statement. During the hiring process, “no employers disclosed any troubles, reprimands, or internal investigations pertaining to Edwards,” the statement said.


  10. Thomas Dixon Avatar
    Thomas Dixon

    The patients at ESH have been systemically abused for the last two years due to unscientific and illegal restrictions imposed on them by a frightened and ignorant administration. Imagine having a mother or daughter, wife, etc. who suffers from depression, loneliness, confusion, suspiciousness, or even auditory hallucinations being forced to stay in a small room with not much bigger than a jail cell for ten days…not because they are sick, not because they are aggressive or dangerous, no. Tthey are in that small room for ten days with no contact with anyone but a nurse or aid because the might have been in an area where another person might have had a virus, even if neither has symptoms. The depression anxiety, confusion, and maybe voices intensify because of some gutless and masochastic administrators. It isn’t their daughter or mother or wife, it’s just some names . Names on a unit they will not visit.

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