At LewisGale Montgomery Hospital, tucked in the back, are three small rooms operated by New River Valley Community Services. It's called a crisis assessment center, a quiet place for the ECO process to take place.

“There is a lot of pressure when we are in that emergency custody order process in trying to find folks treatment and getting them the appropriate level of care,” says Melanie Adkins, the emergency services coordinator for NRVCS. “Considering we have to go through a medical process and beds may not be available locally.”

But what really helps officers and deputies is the ability for an officer to come drop off an individual and have a legitimate transfer of custody.

“If we were not using this facility and we were not able to transfer custody of somebody, that certainly becomes a manpower issue at that point,” says Blacksburg Police Lt. Kit Cummings.

But there's not a “drop-off center” in every CSB coverage area. Around a dozen exist in the state; just three in the WDBJ7 viewing area (Blacksburg, Martinsville and Staunton.) There is money allocated in the still yet-to-be adopted state budget to create more in the next two years. Sen. Carrico worries his area won't get one.

“In Richmond, the more affluent, largely represented areas are usually the ones that get them,” he says.

And here's another problem to consider. Let's say a bed is found and you are getting treatment even after your TDO expires because you need long-term consistent care.

The goal is still to get individuals back into a community setting and out of institutions. But it's not always that simple. Some patients inside are deemed ready to be released but can't because there's no suitable place for them in the community. The same goes for private psychiatric bed facilities. It creates a turnstile where those who are not in extreme distress are admitted, stay a few days, and then get released.

But just because they're released, doesn't mean their mental health needs are being met. Stakeholders say the problem is funding. The House, Senate, and Governor's budget all put in millions of dollars to create more community-based options for those with a mental illness that cannot take care of themselves.

“There are other options needed. We need more resources to reach out to more people within the community,” says Adkins. “Crisis care admissions are up more than 100% since the Virginia Tech shootings [our CSB.]”

But if we as a community are going to provide better access to not only crisis care but also early intervention services, then we also need to build our sense of tolerance, advocates say.

First responders to mental health emergencies all across Southwest Virginia are learning and becoming certified in how to effectively resolve situations where someone needs help.

“Either people can appreciate it or not,” says Mimi Baskin in describing her son Billy’s mental illness.

Billy is impacted by behavioral disorders that have forced him to change schools. His mom gets more frustrated each time Billy has problems in the classroom because she says he's seen more as a troublemaker than a child with an illness. She hopes for acceptance and empathy.

“The teachers and the professionals have to [have empathy,]” she says. “They have to. Because as children, they don't understand, and a lot of times can recognize or understand there is something wrong.”

“I don't think it's the issue of not caring,” says Diane Kelly, executive director at Mental Health America of Roanoke Valley. “I think a lot of people don't know how to respond.”

For decades, Kelly has been in the front lines on the battle for awareness. Part of her day is spent helping those with a mental illness get lasting help, but she also is teaching mental health first aid.

The training is also happening for other first responders. Most community services boards team up with their local law enforcement for a week-long course for officers called Crisis Intervention Team or CIT.

If you ever come across an officer, look out for a little pin that will tell you if they've had advanced instruction on how to resolve situations while still showing a person with mental illness respect. The Blacksburg Police Department is striving for a CIT officer on every shift.

“Our initial goal was to have at least twenty percent trained in Crisis Intervention Team skills,” says Cummings. “We surpassed that very early on and right now our percentage is maintained somewhere (around) fifty to sixty percent.”

But Kelly says early intervention is key to prevent officers from getting involved in the first place. She says if a mental health issue comes after it noticeably affects your work, your learning in school, or your relationships nearly every day for more than two weeks, you should seek treatment options.

“I think we get on the right track by paying attention to early warning signs,” she says. “To know what to look for and to know that it is important provide care for people before we reach the standpoint of crisis.”

According to MHARV*, some signs to look out for include:

In adults:
• Confused thinking
• Prolonged depression (sadness or irritability)
• Feelings of extreme highs and lows
• Excessive fears, worries and anxieties
• Social withdrawal
• Dramatic changes in eating or sleeping habits
• Strong feelings of anger
• Delusions or hallucinations
• Growing inability to cope with daily problems and activities
• Suicidal thoughts
• Denial of obvious problems
• Numerous unexplained physical ailments
• Substance abuse

In older children and pre-adolescents:
• Substance abuse
• Inability to cope with problems and daily activities
• Changes in sleeping and/or eating habits
• Excessive complaints of physical ailments
• Defiance of authority, truancy, theft, and/or vandalism
• Intense fear of weight gain
• Prolonged negative mood, often accompanied by poor appetite or thoughts of death
• Frequent outbursts of anger