Virginia's Mental Health System
A Place of Firsts
The first recorded incident of someone who was believed to have an intellectual disability becoming a ward of the state.
The first recorded incident of someone believed to have had a mental illness being institutionalized by court order. Unfortunately it was in jail.
Eastern State Hospital becomes the first public funded mental health facility in the nation.
Eastern State is the first to use a standard assessment instrument to aid in the admission process. It was also one of the first institutions to use the "moral" approach to treatment.
What is now Central State Hospital becomes the first hospital in the nation to exclusively treat people of color.
CSBs are regulated by the Department of Behavioral Health and Developmental Services
DBHDS provides oversight for the forty CSBs in the state as well as provide licensing and support to select other providers such as those running group homes or in home treatment providers. Their involvement in crisis services and requirement for licensure ensures the long term success of the CSBs and that true solutions to our state's crisis are never addressed.
Virginia's has a public mental health system consisting of 40 Community Service Boards.
Since 1968 Virginia's public mental health system has served as the primary access point for many individuals in need of treatment. Today, these mostly politically motivated institutions are only required to offer crisis intervention services; the last service that the state has yet to privatize.
The Department of Justice began its investigation into Virginia's Public Mental Health system in 1990.
The US Department of Justice began their investigation of Virginia's state hospitals after numerous complaints and many patient deaths. This came to a head in 1996 when they filed suit against the state for inadequate medical care, treatment, and supervision. The state then, as it does now, obstructed the investigation and denied any wrongdoing, usering in an era of pacification rather than reformation. DOJ sued Virginia again in 2008 over the institutionalization of the intellectually disabled. To date Virginia is still only 55% compliant with the terms of the latter suit.
Our Statistics
In the United States in Access to Care for Mental Health Issues
In Prevalence of Mental Health issues among the state's population
Out of 133 of Virginia's Localities are Mental Health Provider Shortage Areas
Rank out of all the States for Number of Suicides per Capita
Noble Gestures
In response to the spree shooting incident at Virginia Polytechnic and State University, the general assembly passed bills implementing a plan for Mandatory Outpatient Treatment. This plan uses the same assessment criteria as involuntary commitment
and it was only in subsequent years that it clarified that the CSBs should provide this service. To date, MOT is still not a widely used alternative to hospitalization because CSBs find it easier to hospitalize and commit someone to a hospital so they do not have to supervise them.
In 2013, 24 year old Gus Deeds, son of state senator Creigh Deeds, suffered a psychotic break and was taken to a local hospital for evaluation. Upon evaluation he was found to meet criteria for hospitalization, but no bed could be located, so he had to be released from the civil detention. The next morning, Gus mortally wounded his father by stabbing him and then completed suicide. Part of a slew of reformative legislation in 2014 was what is now known as the "bed of last resort law" which says that should someone meet criteria for hospitalization, and no bed could be found, they would then be detained to the state hospital service their area.
Fast forward to 2022 where state hospital utilization is up over 400%, because the power shifted from the local hospitals needing referrals, to them being able to shirk their responsibilities because there was then a safety net. Given that state hospitals have no beds available, clients are now 'boarded' in hospital emergency departments for days without treatment or further evaluation. The bill also created what is called a psychiatric bed registry that mandated (without penalty if a hospital failed to do so) daily updates from local facilities.
The Mental Health Awareness Response and Community Understanding Services or MARCUS Alert was passed by the General Assembly in 2020. The purpose of the measure was to encourage mental health professionals to respond to people in
a crisis and reduce the reliance on law enforcement for this task. It also paved the way for public-private partnerships to achieve this mission. Amongst its few achievements so far has been the implementation of 9-8-8 crisis hotline.
The Behavioral Health Redesign for Access, Value, and Outcomes initiative was started by DBHDS in early 2021 to supposedly change the way persons needing assistance can access services across the state. Included in this was a program called "Same Day Access" which allows people in need to be able to walk into a CSB without an appointment and sign consent forms, so that they can then set an appointment to see a provider in about a month.
On December 1, 2021, the state implemented phase two which allows for private providers to bill for family therapy, mobile crisis, community stabilization, and assertive community treatment provided they completed the requirements correctly to be licensed. It also quadrupoled the needed workforce because of the new requirements for billing.
Donald J. Fletcher
Independent Reviewer for the Department of Justice
June 13, 2022
“Examples of chronically poor-performing CSBs continued...Individuals with complex medical and/or behavioral health needs continued to receive insufficient and inadequate services"
Create a Comprehensive Crisis Service System
A system where there is truly a single point of access with uniform dispatch, response, and treatment protocols.
Marcus Alert System
Change the phone number but otherwise keep everything status quo, hold no one accountable for system deficiencies, and have no protocols for response or treatment.
Centralized Bed Search
Create one portal for uploading bed searches and use that data to intelligently match clients with hospitals, as well as hold facilities accountable.
TBD
Options for a solution are currently being studied by a committee of politicians to determine the best course of action.
Change Workforce Expectations
Have a well trained, well compensated, and accurately classified workforce that are dedicated to their niche.
Increase Spending
DBHDS is continually lobbying for additional funding to recruit and retain a workforce, without any change in training or expectations.
A Call to Action
Let them know that there are competent and compassionate community providers that can get the job done.