Historically, state hospitals had provided the full continuum of treatment primarily during business hours, Monday through Friday, with a decrease to essential services in the evenings, on weekends, and holidays. The full continuum of treatment includes assessments and interventions from all treatment team members (nursing staff, social work staff, psychiatric providers, recreational therapy, and psychology), an assortment of group treatment options provided throughout the day, forensic evaluation and treatment, and discharge planning. Following the passage of SB260 in 2014 (known as the Bed of Last Resort law), the state hospitals began experiencing a significant increase in patient admissions during non-business hours. However, while admissions moved to a 24/7 model, full active treatment and discharge planning did not.

In 2022, the Virginia Department of Behavioral Health and Developmental Services (DBHDS) submitted a budget request to fund positions to pilot a program of enhanced treatment and discharge services seven days per week at two Virginia state hospitals – Southern Virginia Mental Health Institute (SVMHI) in Danville and Central State Hospital (CSH) in Petersburg.    Item 301.D included $5,062,489 in funding to add 17 new positions at SVMHI, and 23 new positions at CSH. This was an effort to transition to the full continuum of treatment and was a result of continuous efforts to address the state hospital bed census, which is consistently at or above 95 percent of beds. This extremely high census has led to dangerous consequences, including increased staff turnover and vacancy in key positions, safety concerns for patients and staff, individuals in crisis experiencing extended wait times for treatment, and an increased burden on law enforcement as they provide transportation and custody for individuals waiting for treatment. Both hospitals have seen significant changes for the better regarding the ability to provide active treatment, assessment, and evaluation during non-business hours, as well as length of stay of patients, specifically forensic patients and continue to make implementation adjustments to ensure efficiencies.