Work in progress.

Late last year, I began to pay particular attention to efforts in Virginia to reform its mental healthcare system and laws/policies related to people with mental illness. In October 2006, the state Supreme Court organized the Commission on Mental Health Law Reform to study mental health laws in Virginia and make recommendations to the General Assembly. It's a fascinating multidisciplinary effort (not appreciated by some legislators, by the way), and I commented on it in my December editorial.

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To gain more perspective on the state's progress with mental health system transformation, I asked Mary Ann Bergeron, executive director of the Virginia Association of Community Services Boards, to contribute to this past April's issue. That same month, Virginia Tech was the scene of the deadliest shooting spree in American history, and the state and local mental health systems have been scrutinized in the ensuing investigations.

So in this issue of Behavioral Healthcare, we again look at mental healthcare in Old Dominion. This month's contributors focus especially on outpatient commitment, which has received much attention following the Virginia Tech shootings. With the Commission's work already underway when the Virginia Tech tragedy occurred, perhaps the state can make some real progress on reforming its laws and policies related to people with mental illness.

But there's no doubt about it: Virginia has a lot of work ahead. As Ron Allison explains in this month's cover story, Virginia's transition from a state-funded to a Medicaid-driven mental health system has dramatically impacted Virginians with mental illness. In its 2006 Grading the States report, the National Alliance on Mental Illness had this to say of Virginia, which received an overall grade of "D": "[T]he reality [is] that Virginia's public system has suffered from years of deep cuts that fell disproportionately on the community system. Traditionally, Virginia has bucked national trends by putting more emphasis on state inpatient psychiatric facilities than on community services--and the neglect is beginning to show."

To be fair, many of the problems Virginia faces are not unique to the state. Yet perhaps in the aftermath of the Virginia Tech tragedy the state can move toward being a national leader in real system change.

Douglas J. Edwards

Editor-in-Chief

dedwards@vendomegrp.com