Illustration by Victoria Borges
For years, mental health has taken a backseat to other medical issues, often because of unfair stigmas and perceptions attached to it. More than one in five adults in the United States lives with a mental illness, and getting necessary help when a mental health crisis occurs is crucial. In Virginia, however, those services aren’t always available.
For the past six years, the problems have been reflected in the headlines throughout the Richmond region. In 2018, Marcus-David Peters, a Black 24-year-old biology teacher, was killed by Richmond police amid a mental health crisis. In March 2023, Irvo Otieno, a 28-year-old Black man, died during a mental health crisis when Henrico County sheriff’s deputies and hospital employees at Central State Hospital pressed him to the floor for nearly 11 minutes.
Though these cases are two well-known examples of severe mental health crises in the region, Richmonders and Virginians at large face high instances of depression, anxiety, suicidal ideation and other known indicators of poor mental health. As of 2021, more than 1 million adults in Virginia had a mental health condition, according to the National Alliance on Mental Illness. In the same year, 97,000 Virginia residents aged 12-17 were diagnosed with depression.
Henrico Area Mental Health & Developmental Services saw 10,419 individuals (6,055 of those for mental health issues) during the 2023 fiscal year, according to its annual report. The Richmond Behavioral Health Authority reported serving 13,000 individuals in its 2022 annual report. The Chesterfield County Community Services Board received 12,775 calls to its crisis line in fiscal year 2022, a 64% increase from the year prior.
“We are so far behind in Virginia,” says Bruce Cruser, executive director of Mental Health America of Virginia, an affiliate of behavioral health nonprofit Mental Health America. “Community mental health services have been underfunded for decades. Services that were required didn’t follow patients into the community. There is a bipartisan understanding that this is a problem.”
With these widespread problems reaching new heights in the last few years, Virginia has been trying to tighten the gap, but the task has been exacerbated by the number of people “having mental health challenges,” Cruser says. “COVID made it worse. People were saying, ‘I need support, and I can’t find it.’”
According to NAMI’s commonwealth-wide data, more than half of Virginians with a mental health condition did not receive care of any type in 2021, with nearly half of the group citing cost as the primary factor. Others cite a lack of care options and availability in their regions.
But now, Cruser and other mental health advocates are cautiously optimistic that the landscape for mental health care is taking a positive turn across the state. Gov. Glenn Youngkin’s initiative Right Help, Right Now, a comprehensive three-year billion-dollar strategy announced in 2022 to tackle mental and behavioral health challenges, has provided increased funding. In his recently announced two-year budget, the governor proposed $500 million in additional funding to strengthen the plan’s second year, now totaling close to $1.4 billion in dedicated funds. Included in that figure is $300 million to help empty the Medicaid funds waiting list and pay for services to support people with developmental disabilities.
“We commend the governor and legislature for making mental health a priority,” Cruser says, adding, “There are too many people in crises who can’t get the care when they need it.”
Within its first year, Right Help, Right Now took steps to address the inadequate access to and high cost of mental health care. In 2023, the plan launched an extensive marketing campaign to advertise the nationwide 988 Suicide & Crisis Lifeline call line, which is staffed by personnel trained to identify the correct type of intervention needed in each situation. Callers receive advice on immediate or long-term care in their areas and can be treated by mobile crisis response teams — behavioral health professionals trained to minimize risk during a mental health crisis — in the commonwealth.
In November 2023, for example, Virginia handled 8,348 calls for people seeking behavioral health assistance, compared to fewer than 6,000 calls per month in 2022. The number of mobile crisis teams responding to 988 calls has increased to 96, with a goal of 140, slated for the system’s expansion this year.
In a move to address cost barriers to mental health access, last summer Youngkin signed House Bill 2216 and Senate Bill 1347 into law, which require commercial insurance coverage for mobile crisis response teams and residential crisis stabilization units.
“All of that is a great start, but many challenges remain, such as a workforce shortage,” Cruser says, noting Virginia has consistently ranked worst for access to trained medical professionals. “If we don’t have trained staff, we can’t get there.”
Though many of the examples that highlight the crisis have been among adults, children are also majorly affected. “People haven’t been acknowledging mental health concerns with youth,” says Cat Atkinson, policy analyst with Voices for Virginia’s Children. “Historically, there is not enough language in the legislative budget/bills to address the specific developmental needs of young people,” she says.
Since the pandemic, Richmond Public Schools has seen an increase in reports of suicidal ideation, self-harm and more. According to a report on mental health care partnerships in RPS from June 2023, references to cyberbullying, potential self-harm and violence on student’s school devices rose from 2,696 in the 2020-21 school year to 4,470 in the 2022-23 school year, while suicide risk assessments rose from 150 to 516 and Child Protective Services referrals rose from 250 to 369 in the same period.
These reports highlight the variety of social and mental health issues for youth revealed since the pandemic. “In 2021, 38% of Virginia high schoolers during the past 12 months felt sad or hopeless every day,” Atkinson says, noting figures from the Youth Risk Behavior Survey from the Centers for Disease Control and Prevention. “The data and stories of students highlight that the need goes beyond depression. They do not have the support they need. It’s just really come to light.”
In 2022, the General Assembly took steps to address youth care in the broader context of the commonwealth’s mental health strategy and appropriated $2.5 million to provide grants to school districts to expand school-based mental health services. The funds will go toward educating school divisions on how to work mental health services into school facilities.
The pilot program included grants for six school divisions — public schools in Bristol, Hanover County, Hopewell, Lunenburg County, Mecklenburg County and Richmond.
“We are continuing to have to push for more funding and support for school-based mental health,” Atkinson says, adding the pilot program has private and community-based providers going to schools to provide their services throughout the day to students. “Doing that type of pilot program ensures they will have mental health services. We want that to continue.”
The commonwealth has responded to the crisis in recent months. In December 2023, the governor announced a Youth Mental Health Strategy that he hopes will address the impact of social media on behavioral health. A focus of this strategy is to expand the reach of mental health care professionals in public schools and colleges.
This January, the Virginia Department of Education established the Office of Behavioral Health and Wellness to assist students who are struggling and help schools address the rise in mental health and behavioral challenges.
Aware of what could come from the all-sides approach to fixing the behavioral health system, Cruser and Atkinson are hoping for a brighter tomorrow. “We are positive about the future, but we have a long way to go,” Atkinson says.
If you or someone you know needs help, call or text the nationwide 988 Suicide & Crisis Lifeline at 988.
