Supporting individuals by promoting recovery, self-determination, and wellness in all aspects of life

A life of possibilities for all Virginians

Focus First on Individuals Receiving Services

Our decisions and actions consider first the best interests of individuals who receive services and their families. We respect the potential and capacity of each individual who receives services. We value and support the healing and recovery process.

Accountability and Oversight

We take seriously our responsibility to provide oversight and accountability throughout Virginia’s public behavioral health and developmental system to ensure individuals receive timely access to quality, consistent services.

Responsiveness to External and Internal Customers

We seek input and involvement from our customers. We share ideas and remain open to different opinions. We listen to and respect what our customers say and respond promptly to their requests.

Partnership and Collaboration

We create opportunities for partnerships, encourage teamwork, and support each other to succeed. We accept shared ownership and seek win-win (mutually acceptable) solutions. We communicate openly and clearly. We are willing to take risks as we look for creative solutions and new ways of solving problems. We make decisions and resolve problems at the level closest to the issue.

Professionalism, Integrity, and Trust

We recognize and celebrate individual and team successes. We use valid data that reflect best practices and positive results and outcomes. We take responsibility for ourselves, for our actions, and for how these actions affect others. We develop a supportive and learning environment and work continuously to improve the quality of the services we provide. We keep our word and deliver what we promise. We incorporate our values into everyday decisions.

Stewardship

We protect the assets and interests of the entire services system. We value and take care of staff. We use the Commonwealth’s resources in the most effective and efficient manner.

State Hospitals and Medical Center

The Department of Behavioral Health and Developmental Services (DBHDS) operates nine state mental health facilities (state hospitals).  Eight state hospitals serve adults:

• Catawba Hospital (CH) near Salem,


• Central State Hospital (CSH) near Petersburg,


• Eastern State Hospital (ESH) in Williamsburg,


• Piedmont Geriatric Hospital (PGH) in Burkeville,


• Northern Virginia Mental Health Institute (NVMHI) in Falls Church,


• Southern Virginia Mental Health Institute (SVMHI) in Danville,


• Southwestern Virginia Mental Health Institute (SWVMHI) in Marion, and


• Western State Hospital (WSH) in Staunton.

The Commonwealth Center for Children and Adolescents (CCCA) in Staunton is the only state hospital for children and adolescents with serious emotional disturbances.

State hospitals have made significant progress in changing their cultures to support recovery, self-determination, and empowerment. Recovery- oriented, person-centered, and trauma-informed principles are now increasing the recovery experience for individuals receiving services through peer-to-peer supports, treatment planning partnerships, and educational and career development and job training opportunities.

State hospitals continue to focus on improving bed utilization through aggressive monitoring of service plans and discharge efforts that reduce hospital lengths of stay and enable individuals to be integrated more quickly into the community. In addition, Discharge Assistance Program (DAP) funds are supporting creation of individualized services and supports for individuals residing in state hospitals who are clinically ready for discharge but have significant barriers to their discharge. Local Inpatient Purchase of Service (LIPOS) private hospital bed purchase funds are being used by CSBs to ensure treatment is provided in the community rather than in more restrictive settings.

To offset the increasing demand for state hospital beds by individuals with a forensic status, ongoing efforts continue to improve forensic patient management, review, and oversight processes and to safely and appropriately divert forensic admissions when possible. Although the Code of Virginia expresses a preference for outpatient competency evaluations and restoration whenever possible, many persons who could be served on an outpatient basis are instead referred to state hospitals. DBHDS is working to develop community-focused forensic services, including jail evaluations and treatment and outpatient competency restoration services in either the community or jail, to safely and appropriately divert forensic admissions to community alternatives.

DBHDS has funded external expert consultation and mock Joint Commission readiness surveys for the state hospitals to provide feedback on facility operations and compliance with oversight and accreditation requirements and offer consultative suggestions to improve service delivery. These consultation and mock survey results are being used to facilitate adoption of best practices and operational efficiencies; standardize procedures, as appropriate; and reduce duplication.

Operational efficiencies also should result from the implementation of the electronic health record system (EHR) clinical treatment/medical record, pharmacy, ancillary, and accounts payable modules. DBHDS has also retained nationally recognized experts to conduct mock compliance and quality of care surveys and to provide technical assistance and consultation for areas of identified need in the state hospital system.

With increasingly complex caseloads, state hospitals must maintain sufficient numbers of staff trained in best practice guidelines and evidence-based approaches in the treatment and care of individuals receiving state hospital services. Hospitals are working to improve staff cultural and linguistic competence so they can better address the recovery and communication needs of individuals and families in a culturally relevant manner.

Mental health treatment centers maintain small teams of information technology (IT) staff to support locally developed application systems and their local information technology infrastructure environments. The DBHDS Central Office Information Services and Technology (IT) office provides coordination, guidance, oversight, and support to ensure that these local systems comport to Commonwealth of Virginia (COV) security requirements and to enable required data integration with Central Office provided systems. 

Although many of the central office (720) IT goals are intended to support the mental health treatment centers, two are of particular importance. First, the reduction of the Facility Application Inventory will have the most significant impact on mental health technology operations. A reduced facility application inventory and increased central office support for agency-wide applications will allow facility IT staff to focus on the specific needs of their facility’s clinical staff.  

The agency will implement upgrades to the EHR that provides DBHDS with the most current system code level and enhanced behavioral health content and functionality to improve workflows and processes. The focus will also remain on stabilizing and enhancing the Electronic Health Record for DBHDS. 

Continued modernization of facilities’ Automated Dispensing Cabinets (pharmaceutical dispensing, and inventory capabilities). This effort provides a reduction in pharmaceutical errors while also improving inventory management resulting in patient safety, improved care, and a reduction in costs. 

The agency is constantly evaluating and implementing new and updated functionality based on the requirements of the Center for Medicare and Medicaid Services (CMS) and the Joint Commission.  A primary initiative is to re-evaluate Cerner’s eQuality check solution to manage core measure reporting within the enterprise EHR. Cerner delivers regular core measures and regulatory updates but without this solution implemented, it does not add value. Evaluate sunsetting NRI, a third-party core measure tool, and transition to Cerner’s eQuality check tool. This will also follow the initiative to reduce the overall number of applications for DBHDS and adhere to industry standards and best practices. IT is working to incorporate additional opportunities to further integrate the EHR and other ancillary solutions and reduce the possible points of manual including vital sign machines, blood glucose machines, CBORD (the food and nutrition system) and, medication dispensing cabinets. There is an effort to standardize and implement a single medication dispensing cabinet across all of DBHDS and integrate that solution into our Millennium EHR. There is also a project underway to integrate forensic documentation, currently in FIMS, into the Millennium EHR application. FIMS is an MS Access database and needs to be retired as soon as possible for security concerns. Integrating this documentation will also allow for a more complete patient record in Millennium.

The focus will continue on Millennium, DBHDS’ enterprise Electronic Health Record, and further enhancements will assist in better adoption and enhanced clinical care and service delivery. Enhancement and adoption activities will likely help determine what additional EHR support resources are needed and tracking tools for these efforts will assist in that determination. There are several areas of focus for Millennium in 2022-2024, including: 

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  Evaluate the master Cerner contract for additional solutions to be included in the Enterprise EHR to meet the needs and requirements of the facilities and rule out Millennium as a solution before evaluating third-party solutions.

  
  


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  The Health Information Exchange platform, CommonWell by Cerner, allows specific patient data to be shared (sent and received) among all participating providers in the public behavioral health delivery of care network.

  
  


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  Implementing the Patient Portal to allow for quick and easy access to patient records, communication, and encouraging collaboration.

  
  


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  Cerner Direct is a secure messaging solution that provides the ability to send specific, regulatory-compliant portions of the patient’s chart, securely and directly to another provider. This solution also promotes interoperability and data sharing to improve the quality of patient care.

  
  

State hospitals operate 24 hours a day, seven days a week and depend on a cadre of skilled and dedicated employees in a wide variety of classifications. Most provide direct care or support facility infrastructure. Among the human resource challenges hospitals face are workforce aging; competition for psychiatrists, occupational and physical therapists, nurses, pharmacists, and direct care staff; and turnover due to the difficult nature of the work.

The pandemic resulted in a major strain on staffing throughout all nine state hospitals. Vacancy rates were so high for direct care staffing that in July 2021 five of the state hospitals had to temporarily close to civil temporary detention order (TDO) admissions because the inadequately staffed environment was too dangerous for patients and staff alike. DBHDS worked with the Administration and the General Assembly to provide contract staffing, bonuses and targeted pay raises to assist with recruitment and retention. The state hospitals have been able to reopen 132 beds by August 2022 and will continue to bolster staffing until all of the closed beds can safely reopen.

DBHDS is responsible for the operation of nine state-owned mental health facilities. The state hospitals have approximately 3,000,000 square feet of building with an average age of nearly 50 years. Lack of adequate maintenance reserve funding continues to present problems with reference to these older structures.

These facilities consist of over 200 individual buildings served by a variety of mechanical heating and cooling systems ranging from central plant distribution systems to individual package heating and cooling units and in some instances makeshift systems. Replacement of these systems based on age and physical condition has typically been deferred due to an uncertainty of the long-range need for continued use of the buildings. Many buildings are anticipated to remain in use for a defined duration and have reached the point of requiring an investment to maintain reliable systems for the remaining duration of their use. Buildings that may reach surplus status require conditioned environments to prevent deterioration, therefore enhancing possible future utilization. Although substantial critical system improvements have been achieved in recent years, a  substantial backlog of potential system failures and system inefficiencies remain.  DBHDS has develop a ten-year Capital Plan to right-size its hospital footprint, modernize its hospitals, and avoid the costs associated with maintaining aging facilities and systems which have exceeded reasonable life expectancies.

Note:  This is one of five DBHDS Executive Progress Reports. See Department of Behavioral Health and Developmental Services (720); Grants to Localities (790); Intellectual Disabilities Training Centers (793); and Virginia Center for Behavioral Rehabilitation (794).

State hospitals as facilities of “last resort:” The 2014 General Assembly amended the Code of Virginia to require state hospitals to accept civil temporary detention order (TDO) admissions if other alternatives have not been identified within the eight-hour emergency custody order period. CSBs must notify the primary state hospital serving the CSB’s area when an emergency custody evaluation is needed. State hospitals are required to admit any individual for temporary detention who is not admitted to an alternative treatment facility prior to the expiration of the emergency custody period.  As noted above, as a result of the change in the civil commitment laws, state hospitals have experienced a massive increase in civil TDO admissions since 2014.

Lack of community alternatives: Delayed discharges from state mental health hospitals increase pressure on local private hospital emergency departments, law enforcement, and individuals who would benefit from state hospital services. The state hospitals average about 200 individuals who are clinically ready for discharge but who experienced barriers to discharge that extended their hospitalization over 14 days because appropriate community supports and housing arrangements were not available.

Forensic pressures on state hospital bed capacity: With adult civil beds increasingly occupied by adults with a forensic status, fewer state hospital beds are available for civil patients. Even with a statutory preference for outpatient competency evaluations and competency restoration whenever possible, many persons who could be served on an outpatient basis are instead referred to state hospitals. Continued investment in community-focused forensic services such as outpatient and jail-based evaluations, restoration of competency, and treatment for persons found not guilty by reason of insanity (NGRI) and ongoing diligence and aggressive utilization management of hospital jail inmate admission waitlists are required to offset the increasing demand for state hospital beds by adults with a forensic status.

State hospital geriatric services: Virginia serves older adults with psychiatric needs in its state hospital geriatric centers rather than in the community. This rate is among the highest in the nation, in large part because the Commonwealth lacks adequate community alternatives that provide specialized programs and providers trained to address the specific needs of older individuals with mental health or substance use disorders. Specialized crisis response services for older individuals with behavioral health disorders are not widely or routinely available across Virginia. Demand is expected to increase as this population group increases. DBHDS is working closely with health and long-term care partners to strengthen the availability of community services and supports for these individuals, including emergency and crisis response services.

Facility capital requirements: With the completion of the new Western State Hospital, the average age of state hospital buildings is nearly 50 years old. Many of these older buildings have significant physical plant problems requiring major renovation. Central State Hospital is in the process of being rebuilt.

Inadequate technical support capacity: As the mental health treatment centers expand the use of electronic health records, implement health care reforms, improve performance through technology improvements, and replace aging, expensive technologies with more cost effective solutions, reliance on technical support will increase. An increasing number of mission critical clinical and financial processes rely on technology provided by a limited number of facility and central office information technology staff.

State mental health facilities operated by the Department of Behavioral Health and Developmental Services (DBHDS) are funded with general and nongeneral fund dollars. Nongeneral fund dollars are derived from the collection of fees from Medicaid, Medicare, private insurance, and private payments.

Revenue collections include fees from Medicaid, Medicare, private insurance, and private payments.

The following statistics provide a snapshot of state hospital operations during FY 2022:

No data

State hospitals provide highly structured intensive inpatient services, including a range of psychiatric, psychological, psychosocial rehabilitation, nursing, support, and ancillary services. Specialized programs are provided to older adults, children and adolescents, and individuals with a forensic status.

Hospital forensic services include inpatient pretrial evaluation, competency restoration, and a variety of clinical and inpatient interventions. At CSH, a maximum security forensic unit has perimeter and internal security and security staffing equivalent to a medium security correctional center and an intermediate security unit has a medium correctional center level of perimeter security. Three hospitals have medium security units or programs, ESH, SVMHI, and WSH, with specialized staff and a minimum of two levels of locked security to prevent escape. Adults with a forensic status also receive services on state hospital civil units.

Geriatric centers at SWVMHI, CH, and PGH provide a variety of specialized clinical and inpatient interventions in areas of behavioral management, cognition, interpersonal skills, self-care, and leisure time development that are specifically designed to address the unique and complex recovery, treatment, and support needs of older adults (65 years and older).

An important measure of state hospital performance is readmissions of individuals within 30 days of discharge. This measures the effectiveness of hospitals in addressing the treatment needs of admitted individuals completely, working with the individuals’ case managers at local community services boards (CSBs) on discharge planning, ensuring applications for any necessary benefits (e.g., Medicaid or SSDI) have been applied for, preparing the individuals for discharge, and maintaining effective working relationships with the CSBs they serve to avoid unnecessary readmissions soon after discharge. As a result of the dramatic increase in admissions for individuals in a behavioral health crisis under a TDO, the state hospitals are now serving a much more clinical, medically, and behaviorally acute population, with a shorter length of   stay and a higher readmission rate. A measure of productivity for state mental health facilities is hospital clinical costs per patient day. Clinical costs include medical and nursing staff, psychologists, social workers, therapists, and other staff and activities that are directly associated with the provision of care to individuals receiving hospital services  This measure tracks the overall productivity of its clinical service staff and its ability to identify and address staff capacity issues across hospitals..

Chapter 3 of Title 37.2 of the Code of Virginia establishes DBHDS and Chapter 7 of Title 37.2 authorizes DBHDS to perform certain functions related to the operation of state facilities. Additionally, the federal Centers for Medicare and Medicaid Services (CMS) establishes requirements for certified beds in state hospitals and the federal Individuals with Disabilities Education Act defines who receives special education services in state hospitals. DBHDS operates eight state hospitals for adults: Catawba Hospital (CH) in Catawba (near Salem), Central State Hospital (CSH) in Petersburg, Eastern State Hospital (ESH) in Williamsburg, Piedmont Geriatric Hospital (PGH) in Burkeville, Northern Virginia Mental Health Institute (NVMHI) in Falls Church, Southern Virginia Mental Health Institute (SVMHI) in Danville, Southwestern Virginia Mental Health Institute (SWVMHI) in Marion, and Western State Hospital (WSH) in Staunton. DBHDS also operates one behavioral facility for children with serious emotional disturbance: the Commonwealth Center for Children and Adolescents (CCCA) in Staunton. This goal incorporates core principles of recovery and resilience into state hospital services and supports to help individuals improve their health and wellness, learn to live self­directed lives, and live productive lives in their communities.

This objective supports the realization in state hospitals of a more person ­centered, trauma-informed, and strength ­based system of developmental services and supports that build on the individuals’ strengths, preferences, and goals. This includes implementation of state hospital initiatives to establish and sustain recovery support services and increase use of peers in direct service roles.

• Integrate recovery principles in state hospital operations and implement strategies that increase the recovery experience for individuals receiving services, including peer ­to ­peer supports, treatment planning partnerships, and provision of educational, career development and job training opportunities.

• Incorporate recovery ­oriented peer supports and active treatment focused on discharge that includes wellness recovery planning and educational, career development, and job training programs.

• Continue to expand peer­ provided recovery supports and use of peer mentors in state hospital programs.

• Train and support staff in the integration of recovery values, principles, concepts, and language into hospital processes and practices.

• Expand opportunities for individuals and their families to participate as partners in state hospital service planning, delivery, and evaluation.

• Implement wellness programs designed to lower obesity, hypertension, diabetes, and heart disease and facilitate exercise and other healthy lifestyle choices.

• Participate in the Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TCS) process to bring peers, advocates, families, providers, state agencies and other stakeholders together to monitor and report on progress in achieving a recovery­oriented system of care.

This goal envisions state hospital services and supports that are flexible, are appropriately tailored to the needs of individuals receiving services, and exemplify clinical and management best and promising practices.

This objective implements highly structured intensive inpatient services, including a range of psychiatric, psychological, psychosocial rehabilitation, nursing, support, and ancillary services, that prepare individuals to participate as fully as possible in all aspects of the most-integrated community life possible upon their discharge.

• Maintain sufficient numbers of trained staff and equipment at each state hospital to provide services that are appropriate to the populations served and sufficient to assure quality and safety of individuals receiving services.

• Serve as the “safety net” for TDO admissions when alternate facilities in the community are determined to be unavailable.

• Improve state hospital bed utilization through aggressive monitoring of service plans and discharge efforts such as targeted discharge assistance that reduce lengths of stay and enable individuals to be integrated more quickly into the community.

• Use the results of Annual Consultation Audits and other hospital surveys to improve state hospital service delivery through adoption of best practices and operational efficiencies, standardize hospital procedures, as appropriate, and reduce duplication.

• Provide training to enhance the use of best practice guidelines and evidence ­based approaches in the treatment and care of individuals receiving state hospital services.

• Offer or arrange for medical care appropriate to the particular needs of individuals receiving services in state hospitals.

• Provide inpatient pharmacy services to individuals receiving services and supports in state hospitals that comply with state requirements and federal programs.

• Coordinate with local school divisions to provide education services that address the educational needs of children and adolescents are met while they are receiving inpatient psychiatric services.

• Continue work with the regions to implement best practices for regional management of inpatient resources.

• Operate state geriatric treatment centers that provide treatment and rehabilitation services that promote self­determination, recovery, and community participation.

• Implement a career path for direct service associates to improve recruitment and retention efforts.

• Provide funds to assure medical care and special hospitalization needs are met for individuals receiving services in state hospitals.

This objective implements effective and efficient secure inpatient forensic services.

• Strengthen state and local behavioral health and criminal justice partnerships and collaborative programs to reduce or divert forensic admissions from state hospitals and increase conditional releases and discharges to the community.

• Continue to take affirmative efforts to reduce current waiting list of persons in jails referred for restoration of competency and ensure individuals ordered for inpatient restoration of competency to stand trial are admitted with 10 days from receipt of the court order.

• Implement changes in DBHDS policy regarding Not Guilty by Reason of Insanity (NGRI) acquittee management to allow temporary custody of new insanity acquittees to be implemented in state hospital civil beds whenever possible based on clinical and risk status.

• Improve the flow­t hrough of NGRI acquittees by placing acquittees into the least restrictive settings necessary as quickly as possible and providing enhanced access to expert consultation to assist services providers address treatment­recalcitrant and institutionalized patients.

• Improve oversight to reduce unnecessary admissions for pretrial evaluation, competency restoration, and treatment of NGRI acquittees.

• Focus provision of inpatient pretrial evaluation and treatment to persons who meet emergency treatment criteria

• Evaluate the size of the CSH maximum security unit and explore opportunities to improve its safe and secure management.

• Improve the DBHDS Forensic Information System (FIMS).

This goal envisions consistent implementation of state hospital administrative and support services that support and sustain service quality and appropriateness, protect individual human rights, ensure compliance with federal and state requirements, and promote efficiency and cost­ effectiveness. Affirmative actions are taken to identify and eliminate unnecessary variability in state hospital practices and procedures.

Efficient and effective administration and support services must be in place if state hospitals are to provide quality services in a safe, secure, and healthy environment. This objective implements general management, computer services, food services, housekeeping, linen and laundry services, and physical plant services that support the effective and efficient operation of state hospitals and the implementation of an electronic health record.

• Adhere to all safety regulations as prescribed by the Department of Environmental Quality pertaining to boiler inspections.

• Adhere to all safety regulations as prescribed by the local Fire Marshall pertaining to building safety.

• Adhere to Virginia Department of Health regulations pertaining to state hospital food services operations, overall sanitation, and cleanliness.

• Comply with the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rule requirements.

• Continue to adhere to Prompt Payment Act, small purchase charge card usage, Payline participation, direct deposit participation, and other regulatory compliance requirements.

• Continue to assess opportunities to improve the effectiveness and efficiency of facility administrative services.

• Implement an electronic health record system of clinical treatment/medical record, pharmacy, ancillary, and accounts payable modules at each state hospital.

Facility­ Based Education and Skills Training Services consist of educational services provided to individuals receiving state facility services who are 22 years of age or younger and covered by the federal Individuals with Disabilities Education Act (IDEA).

Facility Based Education and Skills Training Services enable individuals to continue to make academic progress during their hospitalization and to improve their person-centered work skills, thereby promoting choice, selfworth, and satisfaction.

Facility education and skills training include functional academics required to implement the Individual Education Plan (for individuals 22 years of age and under).

This service area is funded with general fund and nongeneral fund dollars. Nongeneral fund dollars are derived from the collection of fees from Medicaid, Medicare, private insurance, private payments.

State hospitals consist of inpatient pretrial evaluation, competency restoration, and a variety of clinical services and inpatient interventions to individuals who are involved with the criminal justice system in Virginia. The most secure forensic treatment location is the Maximum Security Forensic Unit at Central State Hospital (CSH) near Petersburg, which has levels of perimeter and internal security and security personnel that are equivalent to a medium security correctional center. An Intermediate Security Unit at CSH has a medium correctional security level of perimeter security, with less restricted internal milieu and security staffing. Four hospitals have medium security units or programs, Eastern State Hospital (ESH) in Williamsburg, Southern Virginia Mental Health Institute (SVMHI) in Danville, Western State Hospital (WSH) in Staunton and Northern Virginia Mental Health Institute (NVMHI) in Annandale Virginia.

DBHDS must, by statute, provide secure confinement of individuals under criminal charge who are admitted directly from law enforcement custody. Chapter 11 of Title 16.1 of the Code of Virginia sets out the provisions of juvenile and domestic relations court law. Section 16.1356 of the Code of Virginia authorizes DBHDS to conduct evaluations of the competency of juvenile defendants to stand trial; and Chapters 11 and 11.1 of Title 19.2 of the Code of Virginia authorize DBHDS to provide forensic services to individuals in the criminal justice system, including evaluations of competency, determinations of sanity, restoration to competency services, and treatment services for individuals adjudicated not guilty by reason of insanity.

Forensic Services include inpatient pretrial evaluation, competency restoration, and inpatient treatment to individuals who are involved with the criminal justice system.

This service area is funded with general fund and non general fund dollars. Non-general fund dollars are derived from the collection of fees from Medicaid, Medicare, private insurance, private payments, and federal entitlement programs related to patient care.

Inpatient Pharmacy Services consist of medication selection and procurement, storage, ordering and prescribing, preparation and dispensing, administration, and monitoring. Medication orders are prepared, packaged, compounded (if needed), labeled and then sent directly to the individual's unit for administration by nursing staff.

State hospitals provide medications that appropriately alleviate the symptoms of and distress associated with an individual’s illness or medical condition, or both.

Inpatient pharmacy services include medication selection, procurement, preparation, dispensing; management, and education, and pharmacy service oversight and cost containment.

This service area is funded with  general fund and nongeneral fund dollars. Nongeneral fund dollars are derived from the collection of fees from Medicaid, Medicare, private insurance, and private payments.

Geriatric Care Services consist of a variety of clinical services and inpatient interventions that promote optimal performance in areas of behavioral management, cognition, interpersonal skills, selfcare, and leisure time development and are specifically designed to address the unique and complex recovery, treatment, and support needs of older adults (65 years of age and older). Specialized inpatient geriatric care services are provided by Southwestern Virginia Mental Health Institute (SWVMHI) in Marion, Catawba Hospital (CAT) near Salem, and Piedmont Geriatric Hospital (PGH) in Burkeville.

Inpatient geriatric services are provided to older adults (65 years of age and older) who are in crisis or who present with acute or complex conditions,  or both, and who require the highly intense and structured environments of care that currently is available only in an inpatient setting. Inpatient geriatric services are person-centered, flexible, and sensitive to the cultural needs of individuals.

Inpatient geriatric care services include inpatient psychiatric and medical assessment; psychology, nursing, and social work services; recreational, physical and occupational therapies; and medication management and rehabilitation.

This service area is funded with general fund and  nongeneral fund dollars. Nongeneral fund dollars are derived from the collection of fees from Medicaid, Medicare, private insurance, and private payments.

Inpatient Medical Services consist of a broad range of medical, dental, laboratory, and nursing services, but most predominantly include skilled nursing, infirmary services, and acute medical or surgical care provided in state hospital medical/surgical units or by referral to local acute care hospitals through the DBHDS special hospitalization program.

Inpatient Medical Services consist of a broad range of medical, dental, laboratory, and nursing services, but most predominantly include skilled nursing, infirmary services, and acute medical or surgical care provided in state hospital medical/surgical units or by referral to local acute care hospitals through the DBHDS special hospitalization program.

Inpatient medical services include physician, nursing, and dental services; skilled nursing care; speech and audiology; physical, occupational, and recreational therapy; and special hospitalization (purchase of medical care from local hospitals).

This service area is funded with nongeneral fund dollars and general fund dollars. Nongeneral fund dollars are derived from the collection of fees from Medicaid, Medicare, private insurance, and private payments.

State Mental Health Facility Services consist of a variety of intensive inpatient clinical services and supports to adults with serious mental illnesses and children and adolescents with serious emotional disturbances who are in crisis, who present with acute or complex conditions, or both, and who require the highly intensive and structured environments of care provided in an inpatient setting. Services include psychiatric assessment and stabilization and a range of psychiatric, psychological, psychosocial rehabilitation, nursing, and ancillary services, and, in collaboration with the CSBs, discharge planning.

State hospitals include Catawba Hospital (CAT) near Salem, Central State Hospital (CSH) near Petersburg, Commonwealth Center for Children and Adolescents (CCCA) in Staunton, Eastern State Hospital (ESH) in Williamsburg, Northern Virginia Mental Health Institute (NVMHI) in Falls Church, Southern Virginia Mental Health Institute (SVMHI) in Danville, Southwestern Virginia Mental Health Institute (SWVMHI) in Marion, and Western State Hospital (WSH) in Staunton.

State hospital services are person-centered and individualized to meet each individual’s goals for recovery. They focus on stabilizing acute psychiatric symptoms, developing skills needed for successful community living, and enhancing other fundamental life skills, such as identifying and developing positive community supports, increasing hope, motivation, and confidence, and making informed choices.

State hospital services include psychiatric assessment, stabilization, and medication management; psychosocial rehabilitation programming; psychology, nursing, and social work services; and recreational, physical, and occupational therapies. State hospital services are further specialized by the age groups and legal status served at a facility.

This service area is funded with general fund and nongeneral fund dollars. Nongeneral fund dollars are derived from the collection of fees from Medicaid, Medicare, private insurance, and private payments.

Facility Administrative and Support Services consist of general management and direction, computer services, food and dietary services, housekeeping services, linen and laundry services, physical plant services, power plant operations, and training and education services. These functions are essential for state hospital provision of services and supports.

Facility Administrative and Support Services provides the administrative framework so state hospitals can provide quality care in a safe and clean environment and comply with administrative and financial requirements.

Facility administrative and support services include administrative leadership and regulatory compliance; information technology support; food, housekeeping, linen and laundry, and physical plant services; and employee training and education services.

This service area is funded with general fund and nongeneral fund dollars. Nongeneral fund dollars are derived from the collection of fees from Medicaid, Medicare, private insurance, and private payments. Less than one-half percent of total nongeneral fund dollars are federal grant funds for the National School Lunch, National School Breakfast, and the Virginia Department of Agriculture and Consumer Services' Federal Food Distribution programs.

Efforts to provide administrative management and direction.

Efforts to provide information technology services including VITA costs, software, hardware and IT support personnel.

Efforts to provide food and dietary services to patients, costs include personnel, food products and food preparation equipment and supplies.

Efforts to provide housekeeping services for patients. Costs include personnel, and cleaning supplies.

Efforts to provide laundry services and linen services for patients.

Efforts to operate and maintain physical plant facilities including buildings and grounds.

Efforts to provide, operate, and maintain power plants (for institutions and university hospitals which accrue specific costs outside of physical plant services, excluding institutions of higher education).

Efforts to provide training and education to state employees. Facilities have high numbers of direct care turnover. As a result training departments are needed to ensure proper training of staff.