State hospitals in Virginia have historically delivered full treatment services primarily during weekday business hours, creating service gaps during evenings, weekends, and holidays. After the 2014 implementation of the Bed of Last Resort law, admissions shifted to a 24/7 model without a corresponding expansion of resources for treatment and discharge services. This contributed to persistently high hospital census levels, which—in turn—contributed to increased staff vacancy and turnover rates, patient and staff safety concerns, prolonged wait times for individuals in crisis, and an increased burden on law enforcement.

Pursuant to a new budget authority, the Virginia Department of Behavioral Health and Developmental Services (DBHDS) launched a pilot program in 2022 at Central State Hospital (CSH) and Southern Virginia Mental Health Institute (SVMHI) to establish seven-day-a-week treatment, evaluation, and discharge planning services. The pilot was supported by annual funding of $5,062,489 and authorization for 40 new positions.

Under the pilot program, both hospitals achieved significant improvements. CSH expanded competency restoration services, increased psychology involvement on admissions units, added forensic evaluation capacity, strengthened rehabilitation programming, and created a dedicated discharge planning team. These enhancements reduced delays, expanded weekend and evening treatment access, and improved patient flow, particularly for the forensic population. SVMHI increased weekend treatment offerings, introduced a psychiatric nurse practitioner working Tuesday–Saturday, and developed regional partnerships to support forensic diversion and community-based stabilization. Weekend patient engagement also increased by 35 percent following these enhancements. Data from July 2025 through May 2026 (referenced as FY 2026 YTD data) further demonstrate the pilot’s impact. CSH discharged 545 individuals with an average length of stay (LOS) of 165.8 days, and SVMHI discharged 312 individuals with an average LOS of 64.6 days, reflective of different patient populations and treatment needs. Despite these differences, both hospitals showed similar timelines for individuals ready for discharge, averaging 12 to 15 days between clinical readiness and community placement. Taken together, the results from both pilot hospitals demonstrate sustained improvement since the implementation of the pilot. Between FY 2024 and FY 2026 YTD, the pilot hospitals increased the number of individuals discharged from 777 to 857, reduced the overall average LOS from 148.9 days to 129.0 days, and reduced the average time from clinical readiness for discharge to actual discharge from 17.5 days to 14.2 days. These trends show the pilot has matured beyond implementation and is producing measurable improvements in treatment efficiency and patient flow. The data also indicates that while the pilot has strengthened hospital-based treatment and reduced internal delays, remaining LOS barriers are primarily linked to community housing, services, and supports.

Overall, the seven-day treatment model has improved access to assessments, competency restoration, active treatment, and discharge coordination outside traditional business hours. The pilot demonstrates clear value in strengthening patient flow and reducing treatment-related delays. Continued progress will depend on sustained investment not only in hospital-based services, but also in community capacity, which will be increasingly critical to reducing overall lengths of stay and ensuring timely transitions to the least restrictive settings.