Episode 16: A Lifespan Approach to Mental Health: Why DBHDS Matters

Melina Davis 

Hello, welcome to JoyMed. I'm Melina Davis, I'm your host, and today I am so excited to have with me the commissioner for the Department of Behavioral Health for the state of Virginia, also known as DBHDS, Commissioner Darryl Washington is here. We're so glad you're here. 

Daryl Washington 

Oh, thank you for having me. 

Melina Davis 

I'm looking forward to this conversation. As you know, behavioral health to me is super important and a lot of work we've been doing around that is so instrumental and it's really helped physicians A lot. So I know they're going to be interested too. I ask that you indulge me because I want to read your bio. 

Okay, so I'm just going to brag about you a little. Daryl Washington, Commissioner of the Virginia Department of Behavioral Health and Developmental Services, he started in January of 2026 and was appointed by Governor Abigail Spamberger, our first female governor. So excited about that. And you are the commissioner of DBHDS. It's a state agency that operates 12 state hospitals. I don't think people really know that. And centers with over 6,500 employees and oversee about $2 billion. 

Annually, you serve 200,000 Virginians and families with behavioral health disorders and developmental disabilities. Prior to joining DBHDS, Darryl served as executive director of the Fairfax Falls Church Community Services Board, or a CSB, if people know that term, a role he was appointed to in 2018. In this role, he was responsible for overall operations at the CSB, which is the Public Behavioral Health Care and Developmental Disability Service Agency in the county of Fairfax and cities of Fairfax and Falls Church. That's a big county and area with a big, another big important job. I see why the governor appointed you, by the way, and prior to serving as executive director, you also served as deputy director of clinical operations for the CSB. I could go on because you're also a clinical licensed social worker, and you've done that for 30 years. You bring a lot of experience to this job. 

Daryl Washington 

I try to bring a few years worth of experience to this. 

Melina Davis 

We don't always get that, by the way, and we're thrilled. Tell me about working with the CSB. I'm really curious about what it is that drew you there and what you think is so important about community service points. 

Daryl Washington 

I think I just have a passion for the public behavioral health care system. I started my career working in the school system as a social worker. I very quickly went back to working in behavioral health care agency because that's kind of where my love and my passion lies. 

Melina Davis 

I love that so much. And when you were growing up, is this what you thought you were going to do? 

Daryl Washington 

No, actually. It's not even what I originally went to college for. I was good at math and science and like a lot of people need to go be an engineer. So, I didn't work out that way, so. 

Melina Davis 

Well, lucky for us. 

Daryl Washington 

Yes. 

Melina Davis 

Tell us what you're most passionate about now that you have this job as commissioner and what you're hoping that you can do in the role. 

Daryl Washington 

I guess, you know, the cookie cutter answer would be I'm passionate about everything because every day I get to wake up and work with a great team and really try to problem solve ways to have our public behavioral health care system and system that supports individuals with developmental disabilities work better for all of Virginians. 

And to me, if that doesn't get you excited, what does? 

Melina Davis 

I love that. I love the service part of your work and that you've dedicated your whole career to it. Tell us about DBHDS, some people don't know what the department does, haven't heard about it, and it's certainly a lot of letters. 

Daryl Washington 

Yeah, I think the Department of Behavioral Health and Developmental Services has a number of critical roles that it plays in the Commonwealth. 

One is, as you mentioned in my bio, we operate 12 facilities across the state. So, I think that is one huge role, where that is sort of the sort of safety net, if you will, where folks that can't be served anywhere else in the private behavioral health care system, they come to us and to be served by the department. 

The other role is to partner with and to license private providers throughout the Commonwealth. So, you know, one big role is we license behavioral health care providers and providers of developmental disability services. And I think we're responsible for, you know, ensuring that those providers are meeting a certain standard in quality care and that they're able to provide those services to Virginians across the Commonwealth. And I think, you know, we talk a lot about behavioral healthcare, but another critical role is working with individuals with developmental disabilities, making sure they're getting the care and the needs they need in the community as well. 

Melina Davis 

Yeah, I love that. It's such a time in our country where I think what you work in, and these needs are greater, I think, than any time in recorded human history. Is that your perception too? 

Daryl Washington 

I know the challenges that we're facing here in the Commonwealth are challenges as I meet my colleagues that do this across the country. Many other states are faced with these same challenges of the state hospital systems bursting at the seams. How do you find creative ways to provide community care to those individuals? Because, you know, we don't want to be serving individuals in institutions. There are going to be always individuals that need hospital stays, but like primary healthcare hospitalizations, that should be time limited. 

Melina Davis 

Right. 

Daryl Washington 

And should be focused and you should go there to get the care you need. And then as quickly as possible, transition back to the community, because you may get care in the hospital, but I truly feel like you recover and get better over the long term in the community. 

Melina Davis 

Yeah, especially with people you know around you, your family nearby. I do think Virginia isn't special in this way. The whole country is sort of dealing; most of the world is dealing with some of these stressors. Do you and your team feel like you've got enough resources to handle all the demand? 

Daryl Washington 

I've learned a long time ago from working in local government and now in state government, it's you could always use more resources. I do feel like I have the support of executive leadership in the state, and I also feel like I have a huge just well-working team at the Department of Behavioral Health and a number of community providers that are very passionate about the service they provide and providing care to Virginians. And to me, that's a great first start. 

Melina Davis 

That's huge. 

Daryl Washington 

But we could always use more resources. Yeah, absolutely. 

Melina Davis 

What do you think is really working in the state? And then the next question I'm going to ask you just as a preview is, what do you want to work on and improve and do work on next? 

Daryl Washington 

Yeah. So, you know, I think over the last few years, there's been a significant investment in our behavioral health crisis services continuum. So, I've made, I think we've made tremendous strides with that, with the federal government sort of standing up 988. 

But now we have, you know, across the state crisis call centers and the ability to dispatch mobile units for individuals in the community that are having a behavioral health care crisis. We're in the process of standing up crisis receiving centers, which is a 24-7 model, but it's a lower-level care than a hospital across the state. 

And I think one of the challenges is we are in transition. That system isn't fully built yet. And how do we continue to provide the care that Virginians need during this transitional time where we are still building out our crisis continuum and moving from a system of care that might have relied too much on hospitalization now to a system of care that's able to serve more individuals out in the community. 

Melina Davis 

That's really good. My guess is that the police force appreciates the development of this too, because they need partnership in this area, right? 

Daryl Washington 

You know, law enforcement are often the first responders for individuals experiencing a psychiatric crisis, you know, here in Virginia as well as nationwide. And I think we've been able to train a number of loss enforcement individuals in CIT training, which is a national model that was started in Memphis. And that's based basically on how to interact with individuals that might be experiencing some type of mental health crisis. At the same time, that's not why they went to the academy. 

Melina Davis 

Sure. 

Daryl Washington 

And our goal is to try as quickly as possible, when safe and appropriate, for there to be a handoff from law enforcement into some type of behavioral health care, mental health care professional, and have us be able to step into that space and be working with individuals in a crisis and then helping to navigate to the correct level of care that individual needs. 

Melina Davis 

Yeah, that's so important. We're finding that physicians in the emergency department also need more training in this regard. And sometimes people just get stuck waiting because the services aren't available as well, right? So, they're almost sandwiched between these two. 

Daryl Washington 

Yeah, so one of the things that I've done, and I'm guessing a little bit past 100 days into my role, is really visiting those parts of the state that are most unlike Fairfax. So, visiting rural Virginia and meeting with the community services boards there, meeting with my staff that work in the facilities, but also meeting with private hospital systems because they are a critical part of system of care. And each one is unique. 

They have their own challenges. But some of the common things we're seeing is that in emergency rooms, they are staffed with very qualified primary health care docs. But there's not necessarily that psychiatry specialty in the emergency rooms, even in our hospitals.  

And I see that as an area where we could collaborate with our private hospital system to find a way to start intervening with individuals as quickly as possible in the emergency room to see is how can we develop those partnerships and get those individuals that do show up in the emergency room that are in crisis, to some type of place where maybe they can get on medications quicker or maybe they can get some type of intervention there where we can still steer them away from a hospitalization. 

Melina Davis 

Right. 

Daryl Washington 

Because just because you go to the emergency room doesn't mean you have to automatically go to a hospital as the next step. 

Melina Davis 

Right, some interventions we've done this with some children's behavioral health, same thing, where we've had to train and provide those bridge resources and that bridge knowledge so they feel comfortable, but they can extend that care because of that knowledge and brain. 

Daryl Washington 

Yes. 

Melina Davis 

I love this work. This is exciting. What other gaps do you see that that you wish you had resources for that want to work on next? 

Daryl Washington 

As I traveled around the state and, I had heard about it, but it wasn't a huge surprise, but it's sort of like there's some parts of the state where there are just huge sort of basic behavioral health care gaps in our systems, where if the CSBs are not providing a service in those communities, the service doesn't get provided and things as basic as outpatient therapy. 

And then trying to find individuals that have the skill set and the competence to be able to prescribe psychiatric medications. And then how do we fill in those gaps even for immediate access to care or within a reasonable amount of time so that somebody doesn't have to drive an hour to get access to quality behavioral health care services. 

Melina Davis 

Because that could be a real barrier for families. But particularly if you have one car and it's through a mountain with no cell phone coverage, all of that, right? 

Daryl Washington 

And telehealth, I mean that, with the pandemic, telehealth really exploded in our country and the same thing happened in Virginia. But there, it's appropriate, and it's a great way as sort of a treatment extender, if you will. But there are just sometimes where it's not appropriate because you just need to be able to lay eyes on that person. And then to your point, there's some parts of Virginia where there's not the service. Right. 

Melina Davis 

They don't have broadband and those kinds of things. That's tough. Yeah. Remote areas in Virginia, I mean, they really have a provider shortage, right? And resource shortage, like broadband. 

Daryl Washington 

Definitely. 

Melina Davis 

Help me understand how are CSBs funded and how do they interact with your organization? 

Daryl Washington 

Yeah, so there's 40 CSBs in the state. And what I would say is each one of their funding level is different. They're funded by a blend of both federal pass-through dollars, dollars that come from the state, and dollars that come from their localities. Some of them can have fundraisers and fund it through sometimes local and federal grants, as well as billing healthcare companies for the services provided and by collecting co-pays from the individuals that provide services. So, they really do have a real blended sort of weave of ways that they pay for the care. 

Melina Davis 

It can be complicated. 

Daryl Washington 

It definitely is. 

Melina Davis 

And they're run by the communities, or they're non-profits. How does that work? 

Daryl Washington 

So, there are different types of community services. services board depending on where you're at in the state. So, there are 40. Nine of them are part of the local government. They're called administrative policy boards. Richmond has the one behavioral health care authority. 

And the remainder are what's called operating boards, which operate a lot like private nonprofit agencies. And they are multi-jurisdictional often, not just serving one county, but serving multiple counties and cities in the Commonwealth. 

Melina Davis 

Yeah, so it's so interesting. I think people just think that there are hospitals and communities, but there are state hospitals that you run, and there are these community service boards, and they all have to learn how to interact with one another. And then we all have to interact with law enforcement, right? And we all need to find more resources for all of them. 

Daryl Washington 

Yeah. 

Melina Davis 

Right. 

Daryl Washington 

Yeah. And I think the critical thing to remember is the private provider network are extremely important provider, you know, partners because they actually provide the bulk of the services. 

If you look sort of statewide that are provided in the Commonwealth, it's done by the private provider network. CSBs serve a significant number of individuals, but we have to have every component of that system of care, partnering and working together, if we're willing to take meaningful steps towards strengthening that and have it work better to serve Virginians. 

Melina Davis 

And that really is a big part of your focus, right? Is coordinating the resources efficiently so that there's no duplication, but coordination, right? So important. These are things that I don't think people understand how this all works and how important your role is. 

Daryl Washington 

Sure. 

Melina Davis 

When you're out there, I love that you said, by the way, that you're trying to visit places that are the least like Fairfax. I love that in concept, but what are you learning as you're listening to families? You know, any "aha"s or anything that you think others should be paying attention to or can help you with? 

Daryl Washington 

So I think, you know, some of the things that I am learning is this: the interaction between public and private partnerships is significantly different depending on what part of the Commonwealth you're in. And the private healthcare systems, depending on what part of the Commonwealth and the resources that are available, not just in the public healthcare system, but also in the private, just is very significantly. 

And I really sort of think it really is going to take some type of regionalization of collaboration because what's going to work in the Tidewater area and the health care systems that both public and private there may not necessarily work in the New River Valley area or in the North Virginia area. So, I think we have to kind of work with these different systems, but then also allow enough flexibility because we can't just take a cookie cutter approach to how we're going to be able to improve both public and private behavioral health care in the Commonwealth. 

Melina Davis 

I think that's so smart. And it's also respectful, respectful to talk to that community and listen to what they think about what would work best where they live, right? I think sometimes we forget to do that when we think we've got it all figured out. 

Daryl Washington 

Sure. Yeah. 

Melina Davis 

I love that that's your approach. Do you feel like we have enough people in the behavioral health workforce? 

Daryl Washington 

No, it's a short answer. So, there's a national shortage of behavioral health care professionals. And what we're struggling with at the Department of Behavioral Health, the private providers, the CSBs, and even the private hospital systems, there's a shortage of everything from psychiatric nurses to, you know, case managers to name your prescriber, whether it's a psychiatrist, psychiatric nurse practitioners, physician assistants, there's,  

There's shortages at every level of care and every professional level in the behavioral healthcare system. 

Melina Davis 

Which is exciting in a way for young people who are looking for a path, right? 

Daryl Washington 

Yes. 

Melina Davis 

We care a lot about working in local communities with children in middle school, high school, and so forth to encourage them and put in front of them healthcare professionals where they could see themselves doing that. Yes. We should all talk about that more, because I do think we need to encourage young people to go into this space, but if they don't see it, it's not in their community, it's hard to imagine doing it, I think. 

Daryl Washington 

It is, and that's actually, to me, even a larger challenge in the behavioral healthcare field, because when you think about people shadowing other professionals or seeing things like that, people might think about the doctor's office in their community, or they might think about the hospital in their community. 

They're not necessarily thinking about the behavioral health care clinic in their community or the psychiatric hospital in the community. So, we are doing active outreach to the schools and even trying to find a way to do that in high schools to introduce them to behavioral health care as a profession and letting them know this is an option. You can make this not just a job, but a career. 

Melina Davis 

Yeah. And so many different kinds of roles, like you named so many. And I think, we think of a doctor and nurse, but there are so many different professions here that are needed and can extend care. 

Daryl Washington 

Agreed. Agreed. Yeah. 

Melina Davis 

I like it. So, if you had a magic wand and you could change one policy or one thing, what would you? 

Daryl Washington 

Just one. 

Melina Davis 

Okay. I'll give you 3 wishes. 

Daryl Washington 

Okay. All right. You know, I think that It's not necessarily always about policy change. I think it's about finding new ways to collaborate with each other. 

Melina Davis 

Yeah. 

Daryl Washington 

You know, we talked earlier about law enforcement. And I think if we could find a way to get the public and private behavioral health care providers in the room with law enforcement and hospital administrators, both in the public and private field. And I'm trying to recreate this right now and having kind of what I call problem solving sessions where I'm bringing the people from all these specific areas and having just sort of laying it on the table on what's working with our system, what's not. 

And then if we could do a legislative change, what would that look like? If we do need additional resources, what that looks like? And then the other question I'm asking them is, if it's not something that the law says we have to do it this way or the General Assembly says we have to do it this way or something, and we've just always done it that way, asking why, and then can we change it so it works better for the people we serve? 

So, I like that question, but I'm really having those discussions. We just had one yesterday. I plan on having some more over the next couple of weeks, sort of really looking at different parts of our crisis system to try to find ways to problem solve. Some of them are going to take some additional resources and some of them are going to be things that, maybe it's a legislative change. And then also some of it is we just need to change what we've done and do it differently. 

Melina Davis 

Yes. You know, you and I have had other conversations before today. And, you know, we believe strongly at the Medical Society of Virginia that some things just need to be fixed. And sometimes that means just starting to do something new, just starting and trying. It doesn't have to like the world on fire, but let's just try. People who are in the trenches typically know what would work better. 

Daryl Washington 

Yeah. 

Melina Davis 

And I think it's so smart of you that you're listening. Because I really think that's where solutions are found. People who depend on that system know why it doesn't work. 

Daryl Washington 

Yeah, I totally agree. I've learned that during my tenure of my career is, you know, I walk around, and I would talk with my frontline staff around what's working, what's not working. 

Melina Davis 

Right. 

Daryl Washington 

Sometimes didn't always like what I hear, but to me, that's what I needed to hear. And I think that's important with leaders that, as we take that time out to talk with the staff that are doing the work and listening to them, and then try to take that back and to see what can we change to have our system work better because We're here to serve individuals that, and I say that, nobody walks into an emergency room in a psychiatric crisis because they're feeling good. Or CSB, I mean, often it's one of the worst days of their life. And then how can we have that experience go as good as it possibly can, given the challenging situation that they're in? 

Melina Davis 

Yeah, I think that's smart. It's interesting. I'll just give some commentary here. I'm getting to know you. and I have just met each other over the last few months. 

What I observe about you is that you are so open to people and you want to listen and you want to learn and you want to fix things, but you want to do it in a way that serves who you're serving versus you have something in mind where you're going to change their lives so you feel good about it. 

I think it's a form of humble leadership that I admire, frankly. And in this space in today's age is so important and I think it'll be really effective. That's just Melina's personal commentary on meeting you. I think where you are right now is the right place. 

Daryl Washington 

I appreciate it. 

Melina Davis 

Thank you. No, it's true. I think If people want to interact with DBHDS and want a partner, what's the best way to start that? 

Daryl Washington 

Send us an e-mail, give us a call, just talk with us. Daily, I get emails around what's working and then what's not working in our system. And some of those I answer directly and some of them I triage onto my content experts because I don't know all the answers, and I have to rely on my team that know more about some of these services because they are so unique and special. specialize. 

Melina Davis 

Yeah, I think it's really, I think that's really important. I admire who you are as a leader. I think it's an interesting thing. You're a quiet leader. And I think that's going to serve you really well. 

Daryl Washington 

Oh, thank you. 

Melina Davis 

Yeah, it's true. I think it'll serve the Commonwealth well. What's the one thing giving you a lot of hope right now that we can improve things and we can make it better. 

Daryl Washington 

I think the fact that people are coming to the table. So, when I had my problem solving session yesterday, I kind of said this to the group. I was like, you can always tell the interest in the issue by the number of name tags that are left on the table after people have signed in. 

Melina Davis 

Yeah. 

Daryl Washington 

And there were hardly no name tags left on that table. So, I mean, and I think people were engaged and having conversations and really trying to talk about what's, what are issues in our system, but also then having those conversations on if we could change things, well, why can't we change this or can we do this? 

And then even during breaks, people were coming up to me and saying, you know what, I'm going to go talk to this hospital, and we're going to try to do a pilot. We're not going to wait on this. 

Melina Davis 

I love a pilot. 

Daryl Washington 

And to me, those are the things that bring hope because it tells me that, you know, people are energized about trying to do something different, trying to make the system work better because they see the challenges that are going on. And behind each of those challenges are people that are having some type of psychiatric crisis that's going on, that are in a tremendous amount of pain. And, you know, having those individuals not getting access to care as quickly as they need to is a challenge that I think all of us are face here in this system. 

Melina Davis 

You know, I think sometimes people just need to hear that we can fix things, that you believe it's possible, and that you're willing to be their champion when you find the right solution. It's so powerful, so empowering. It gives me hope. 

Daryl Washington 

Yeah, I have that. And you know, one of the things I've talked with my staff about and in multiple other settings is that, you know, it would be great if we could just sort of have one big swing for the fences type of wind and things like that. But I'm also a realist. I think that if you can have 20 small and medium-sized winds, that can make just as much change, if not more change, than one huge thing. 

And to me, that's kind of how I'm looking at, I'm like, I'm fine with the big swing for the fences change if we can make that happen. But I'm also trying to approach it as in, okay, what are some other things where we could maybe do a pilot quickly or make a change quickly or do things like that, that maybe you don't notice it right away, but then after a year, you look back and you've got 10 of those things going on. And those 10 things added together are really making a significant difference in our system. 

Melina Davis 

And I think it creates momentum, right? Momentum and momentum. Some breeds bigger wins and more support, which gets you up that hill to the big, big things too, I think. 

Daryl Washington 

Agreed, agreed. 

Melina Davis 

Yeah. I love it. Anything else you want to share with anybody before we're in? 

Daryl Washington 

Those open-ended questions. I should know about that as a therapist, but sometimes they get me when they ask so many things. You know, I just think that stepping in this role has been a tremendous learning experience for me, even though I have worked 30 years in the public behavioral health care system. 

And I'm just grateful that I've got a great team that has been really partnering and welcoming me in. And that as I go out and talk with CSBs and hospitals, people want the system to work better. 

Melina Davis 

They do. 

Daryl Washington 

They're frustrated with how it is working and I'm really optimistic that by sort of energizing that wish to kind of want our system to work better, that we'll be able to truly have some things after some chunks of time that are working better within our public and private behavioral health care system. 

Melina Davis 

I think you're going to get a lot of support, especially the more people here you meet with you and your team. So, thanks for all you're doing. 

Daryl Washington 

Thank you. 

Melina Davis 

And thanks for spending the day with JoyMed. 

Daryl Washington 

Happy to be here.