Virginia mental health advocate Mary Ann Bergeron retiring after 25 years

July 01--The 2007 Virginia Tech shootings and "the November tragedy," the death of state Sen. Creigh Deeds' son in November 2013, marked the low points in her 25 years working in Virginia's mental health system.

Both resulted in needed legislative changes and increased funding, facts that Mary Ann Bergeron, who retired as executive director of the Virginia Association of Community Services Boards Monday, emphasized without downplaying their horror.

"The only response could be to help avoid its happening again," she said. "What's not recognized as easily, and is often overlooked, is that there are thousands and thousands of people that are stable and being served by CSBs."

Bergeron became the first head of the CSB association, a nonprofit group representing the state's 40 community services boards, in April 1989. CSBs provide frontline mental health services across the state.

"She was the only person able to convey a statewide view of the CSBs to the General Assembly," said Chuck Hall, director of the Hampton-Newport News Community Services Board. "She brought a different level of accountability."

Bergeron's retirement coincides with many others in state leadership positions.

"There's a lot of change. Ten executive directors, a quarter of those involved with the state's behavioral health and mental health systems, have retired since October," Bergeron said. "I think we have a firm foundation, but we still have a long way to go in Virginia in every disabling condition."

In a phone interview from Richmond, Bergeron reflected on a quarter century of mental health care in Virginia.

Highlights of change

During her tenure, Virginia moved from an institution-centered, "patriarchal, tell people what to do system" to one based on person-centered treatment in the community, she said. "There are risks involved -- medications don't always work, people don't always take them -- but it has to be better."

One of the high points came early on, in 1989, when she worked with then-state Sen. Joe Gartlan on a fair housing bill. The following year, "use by right" took effect for group homes for up to eight people, allowing people to move more efficiently out of institutions, she said.

At that time, almost 4,500 people were living in the state's five "training centers" for the intellectually and developmentally delayed population. Now, all but a handful live in the community, able to participate in fuller, more meaningful lives that include employment and volunteering, she said.

The Southside Virginia Training Center officially closed on Monday after its last residents were relocated into group homes in May. Eventually, the Southeastern Virginia Training Center in Chesapeake will be the sole remaining state training center.

Patients as partners

Likewise, she pegged a dramatic change in the temporary detention order system in 1995 as a major consumer victory.

Prior to 1995, she said, "special justices" -- judicial officers appointed by the chief circuit court judges to hear mental commitment cases -- were paid based on the number of detention orders they issued. That resulted in detention orders being executed in large numbers for the wrong reasons.

The legislative change brought in consumer protections for involuntary detention and involved CSBs as disinterested third parties. The change cut temporary detention orders in half by the following year.

That presaged the person-centered movement, "a giant leap forward," of the early 2000s in which "recovery" rather than "cure" became the focus, Bergeron said. Increasingly, those with mental illness or substance abuse issues and the developmentally delayed were "not just the subject of a treatment plan, but part and parcel of the plan."

The shift led to peer support programs, crisis planning, advance psychiatric directives and overall consumer empowerment.

Bergeron said she hopes the Affordable Care Act will help lessen the stigma attached to mental health care as it is takes on parity with medical care. She also lauded the ACA for its emphasis on wellness and a move away from reactive, crisis care. Prevention programs addressing parenting and violence, suicide prevention and mental health first aid are all gaining currency as a result.

In the future

One thing has remained a constant in the past 25 years, Bergeron said -- inadequate funding.

She urged the General Assembly to take the long view and increase the amount of money the state spends on intensive community based services.

"The savings will be over time, not in the first couple of years," she said.

She commended the dozen or so localities around the state -- Virginia Beach and several in Northern Virginia -- for their investment in CSBs and the associated results.

"Our biggest challenge is to coordinate and integrate all of the care at the right locations," she said, noting that it's essential to have enough intensive services in each community.

As an example, she believes that those with mild mental illness should be treated through primary care physicians; while those with serious mental illness should follow models in Alexandria and Arlington where physicians are embedded with the CSBs, allowing for the effective treatment of both severe medical and psychiatric conditions.

Realistically, Bergeron said, no one is going to get access to everything. "There's not enough money in the universe," she said, so she advocates for the basics -- emergency services and case management -- for all who need them.

Salasky can be reached by phone at 757-247-4784.

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