Hampton Roads Regional Jail in Portsmouth houses hundreds of mentally ill from the peninsula. The special units sometimes hold mentally ill in solitary. There are anywhere from 6 to 12 inmates on suicide watch at any given time at the jail.

One barrier to successful reintegration is the up to two-month delay those leaving jail encounter in restoring their SSDI benefits that are cut off during incarceration. At Hampton's Center for Child and Family Services, Ellen Williams, director of behavioral health services, oversees 22 programs that include Fresh Start for re-entry and free counseling and job readiness coaching. "We need to stop being punitive and ask not 'what's wrong with them' but 'what happened to them'" she urged. "I think we're getting more open with juveniles. I want it to take hold in the adult system." She believes it's important for localities to pitch in for mental health care as an investment in the health and safety of the community.

For veterans, the Hampton VA Medical Center has been operating a Veterans Justice Outreach Program since 2009. One of its goals is to assist the transition from jail to residential treatment at the VA with no downtime in the community for those who require that level of treatment, said Kimberly Cheney-James, its coordinator. The VA provides both acute care stabilization services as well as intermediate residential care, along with assistance in connecting veterans with counseling and community resources. The increased number of returning troops exhibiting symptoms of PTSD has the center reaching out proactively to veterans and their families for treatment before a crisis occurs. Outreach workers also scour local jails for veterans in order to connect them with services.

Jail diversion programs

In order for the multiple community resources to be effective, they need to be instituted in a coordinated manner, emphasized NAMI's Signer. Currently, she said, many localities are practicing these efforts, but in a piecemeal fashion.

She pointed to the Sequential Intercept Model as a comprehensive approach that plans for mental health and criminal justice crossover at every juncture: pre-booking, post-booking, jail and re-entry. "At each point, there's a step that can be taken to intercept and alter the outcome," she said. For example, dispatchers can be trained to recognize calls involving mental illness; officers can be trained in crisis intervention, CIT; a defense attorney would have the full health history; there would be a specialty docket or a mental health court; and the need for housing and support groups would be recognized.

Hampton/Newport News has one of the state's 10 drop-off centers and has been a leader in CIT training. A drop-off center is a secure place staffed by medical and mental health professionals and security used as an alternative to arrest and jail. The cities' CIT program, led by Dean Parker, has trained hundreds of officers, and Jay Sexton, coordinator of the new Colonial area CIT program has used it as a model to train 62 officers, as well as crisis workers, dispatchers and nurses. "We try to instill in them a lot of good communication skills and patience," Sexton said.

Nearby, Norfolk General District Court has the only specialty mental health docket in the region; it has met twice a month since September 2011 without extra funding. "It creates a more appropriate atmosphere for family members and more consistency. It allows us to assemble all the services that the court may want to appoint in the disposition of cases," said Judge Joseph Migliozzi, the sole presiding judge. "We're not a therapeutic court, but a docket that facilitates discharge planning for those with mental illness charged with misdemeanors. It requires a great deal of cooperation from city services and the jail." In its first year the court heard cases for 320 individuals and reduced the average wait for admission to a state hospital for evaluation from 160 days to 95.

No solution yet

Thousands of Virginians diagnosed with a serious mental illness continue to cycle in and out of the criminal justice system. With limited access to hospital beds, the appropriate level of community care remains elusive.

"What we don't have is a way for people who used to be served by state hospitals to be served in the community safely for them and for the community," said Associate Inspector General for Behavioral Health Doug Bevelacqua.

To that end, earlier intervention and expanding access to care before a crisis develops are gaining traction as priorities with the state.

"The earlier we intervene, the more successful we can be. There's a wide range of gaps," said Commissioner Stewart, who endorses more psychiatric services for children. "We need more ongoing outpatient support and adequate coordination in the community. It does require more resources."

Day One: "Jail is not the environment for treating the mentally ill'

Day Two: Hampton Roads Regional Jail and Eastern State Hospital: Same population, different treatment

Day Three: Meet some mentally ill inmates in Hampton Roads Regional Jail

Day Four: A Navy veteran with PTSD deals with jail after a vandalism change

Day Five: A better way to look after those diagnosed with a mental illness