Opinion: Honoring 250 years of mental health care as Virginia readies for the future

On Oct. 12, 1773, the Public Hospital of Williamsburg, now known as Eastern State Hospital, opened its doors, becoming America’s first inpatient mental health hospital. This week, we commemorate Eastern State’s 250th anniversary serving Virginians with mental illness with several days of events hosted by the Colonial Williamsburg Foundation and the Virginia Department of Behavioral Health and Developmental Services.

This anniversary and Eastern State’s unique place in our country’s history offer us a chance to reflect on the past, present, and future of behavioral health care in Virginia. When we reflect on the past, we are confronted with some complicated history and hard truths. When the Public Hospital was founded, the primary concern was not providing care for people with mental illness, but rather protecting public safety.

People were warehoused in large institutional settings away from society with little hope for effective treatment and recovery. Under the leadership of Superintendent John Minson Galt II starting in 1842, the hospital was a trailblazer in changing the landscape of mental health care by implementing a moral approach to treating patients. Galt taught that people with mental illness are entitled to human dignity and introduced therapeutic activities and talk therapy.

In fact, the forward-thinking Galt was perhaps the first leader in the national mental health field to advocate for a shift from institutionalization to care in the community. He wrote, “a large number of insane, instead of rusting out their lives in the confines of some vast asylum, should be placed … in the neighboring community. ” Though unpopular at the time, this opinion on community-based care, along with his focus on dignity and therapy, remain guiding principles for mental health care.

Today, the hard-working staff at Eastern State Hospital, and all of Virginia’s state hospitals, are dedicated to providing therapeutic, person-centered care that is focused on recovery. Our core belief is that people with even the most serious mental illnesses can and do recover, and we do all that we can to help people find their paths to recovery and live a happy, successful life. In its 250 years, Eastern State has had to adapt to changes in policy and mental health care, not to mention a changing world, natural disasters and wars.

Most recently, hospital staff worked tirelessly to protect the health and well-being of their patients and coworkers during the COVID-19 pandemic and adjusted to accommodate a significantly increased number of patient admissions. Eastern State also works closely with state and local partners, especially community services boards (CSBs), to make sure treatment is effective upon admission, and people are safely discharged to their own communities. With a staff of more than 800, Eastern State is constantly striving to be an employer of choice for the surrounding areas.

While state mental health hospitals are part of our legacy, our future is ensuring people get the mental health care they need in their own communities, near their families and support networks. Gov. Glenn Youngkin’s transformational “Right Help, Right Now” behavioral health plan offers us a road map for achieving our goal: getting every Virginian experiencing crisis, mental health issues, or substance use disorders, the help they need, right when they need it.

“Right Help, Right Now” is a six-pillared approach, which makes historic investments in crisis services, growing our workforce, expanding community capacity, and innovating service delivery. While there will likely always be a place and role for hospitalization, our aim with “Right Help, Right Now” is to help people access the services they need before symptoms become unmanageable, and to ensure there are exit ramps during a mental health crisis so not all emergencies lead to inpatient care. When I look at Eastern State and our entire behavioral health system and reflect on where we have been, where we are and where we are going, I am filled with hope and gratitude.

While we face real challenges, the work being done through “Right Help, Right Now” to transform our system and provide needed support for Virginians in crisis is changing lives for the better. And as I travel Virginia and meet the people doing the work, like those at Eastern State, I am humbled by their passion for service and the expert care they go above and beyond to provide. Together, we can ensure the future is a better one for Virginians with behavioral health disorders and their families in Tidewater and throughout the commonwealth.

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