In January 2022, Children’s Hospital of The King’s Daughters (CHKD) opened a seven-bed, medical-psychiatric unit. Along with other services, the staff can stabilize a patient’s physical symptoms related to an eating disorder and start mental health counseling while doing so. It’s the care Trinity Gallagher needed six years earlier—but couldn’t find locally.
At the time, Gallagher was a five-foot, two-inch 9th grader at Princess Anne High School and The Governor’s School for the Arts. She weighed 68 pounds—a weight more common for a fourth grader. At her parents’ urging, she had been seeing a therapist and a nutritionist.
“But Trinity got worse,” Traci Winslow, Gallagher’s mother, says. “She described it as her brain being taken over by eating-disorder thoughts.”
An out-of-state residential treatment program agreed to accept Gallagher as a patient. First, though, she had to be physically stable. That meant gaining weight.
“CHKD wasn’t equipped [to help],” Winslow says, “so Trinity was sent to VCU (Virginia Commonwealth University Medical Center) in Richmond.”
Gallagher stayed for two weeks. With supervised eating, including a required feeding tube, she gained 10 pounds. Her parents then drove her 200 miles from home to Veritas Collaborative Eating Disorder Treatment Center in Durham, North Carolina.
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Coastal Virginia doesn’t have many specialized resources for children with eating disorders, notes Carolyn Hersh, a licensed professional counselor. When she moved to Norfolk in 1996, she remembers Eastern Virginia Medical Center having recently shuttered its inpatient treatment facility. If patients needed a high level of care, Hersh was forced to send them out of state.
Up until 2019, Hersh was the only certified eating disorder specialist working with locals. The next closest was in Richmond. By her count, the number is still low now, with only four certified eating disorder specialists in the area.
Availability of youth mental health resources for all types of mental illnesses in Virginia is equally bleak: In its 2023 State of Youth Mental Health in America report, national nonprofit Mental Health America ranked Virginia 48th out of 51, with Washington, D.C. included. Those ranked between 39 and 51 have the highest occurrence of youth mental illness and the lowest rates of access to mental health care.
A close look at Coastal Virginia magnifies concerns for children: The American Academy of Child and Adolescent Psychiatry (AACAP) tracks the number and the age of child and adolescent psychiatrists by city—quantifying how difficult it is to find specialists and suggesting the challenge will grow as they retire:
• In Chesapeake, for every 100,000 children under 18, seven child and adolescent psychiatrists (CAPs) are available. Their average age is 68.
• In Hampton: seven CAPS with an average age of 54
• In Newport News: two CAPS with an average age of 46
• In Norfolk: four CAPs at age 57
• In Virginia Beach: seven CAPS at age 54
• In Williamsburg: zero
According to the AACAP, a sufficient supply of child and adolescent psychiatrists is at least 47 per 100,000 children.
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Mary Margaret Gleason, a pediatrician and child psychiatrist, wasn’t looking for a new job four years ago when she worked at Tulane University School of Medicine researching methods for pediatricians to identify mentally ill patients. Yet she listened when CHKD called. The hospital envisioned a new high-rise dedicated to treating mental illness exclusively, in addition to a medical-psychiatric unit.
“The more I heard about the community’s involvement and the health center’s commitment to doing something big and right,” Gleason, now CHKD’s vice chief of mental health services, says, “the more excited I got.”
Despite the lingering COVID-19 pandemic, CHKD opened a new 14-story building named the Children’s Pavilion in October 2022. More than 600 people attended the celebration.
Two months later, Governor Glenn Youngkin introduced the Right Help, Right Now plan. In June 2023, he signed 24 bills supporting it. The plan stipulates same-day care for people experiencing a behavioral health crisis; expanding capacity to serve people; strengthening the behavioral health workforce; and identifying innovations to close care gaps.
Also this year, the Virginia legislature approved $6,800,000 for the Virginia Mental Health Access Program (VMAP), which gives primary care providers education and phone support to assist children with mental illnesses. CHKD is part of the program.
An August 2021 survey of primary care providers by the Virginia chapter of the American Academy of Pediatrics found a growing need for VMAP: Ninety percent of respondents saw an increase in mental and behavioral health issues in children since June 2020. Sixty-two percent said they could not meet the need. The primary care providers reported significant increases in conditions their young patients experienced since the start of the COVID-19 pandemic:
• Anxiety – 95% increase
• Depression – 93% increase
• Suicide ideation – 54% increase
• Behavioral issues – 52% increase
• Attention Deficit Hyperactivity Disorder – 49% increase
• Eating disorders – 40% increase
• Substance abuse – 20% increase
• Acute traumatic stress – 19% increase
Ninety-eight percent of providers said their young patients had inadequate access to psychiatry services.
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Mixed signs of hope are springing up: At CHKD’s Children’s Pavilion, the number of inpatient beds has grown from 16 to 36 since last October. The rest of the planned 60 beds are scheduled to open this year.
They have 21 psychiatrists, 22 psychologists and 14 psychiatric nurse practitioners—growing from one psychiatrist, one psychologist and two psychiatric nurse practitioners five years ago.
However, the waitlist for outpatient therapy stood at 5,600 children at the end of July.
“The need is simply staggering,” CHKD Director of Marketing Ridgely Ingersoll notes. “We’re hiring as fast as we can, but demand continues to grow, too.”
Ideally, the Pavilion will add another planned 92 full-time equivalent employees and bring the staff to capacity. Even then, a care gap will persist.
“We will not hire our way out of this mental health crisis,” CHKD’s Gleason warns. “The opportunity to be innovative is critical.”
Gleason recently completed research on an app that children with mild mental health symptoms could use. She’ll publish her study results in a few months. She also shared in a Hampton Roads Biomedical Research Consortium $1.5 million grant funded by Sentara Health. With the funds, she teams with interdisciplinary professionals in pediatrician offices to identify children with mental illnesses early.
“We know that pediatricians see children multiple times in the first years of life,” Gleason says. “In fact, 15 visits by age 6. Pediatricians really know the children, but don’t always have training in mental health or access to mental health clinicians. Our project expands the capacity of the ‘medical home’ to support young children’s mental health.”
Dr. Elizabeth Delores Dungee-Anderson, a professor and a former interim dean in Norfolk State University’s Ethelyn R. Strong School of Social Work, shares the grant with Dr. Gleason and Old Dominion University researchers. She’s surveying churches and other organizations serving African American communities to determine barriers to strong mental health and explore local resources to lower them.
“We’re concerned with young children having their attachment needs met,” Dungee-Anderson says.
Their parents are understandably sometimes more focused on paying rent. She is also considering young adults ages 15 to 22 in under-resourced communities. If parents can’t satisfy their need for connection, they might struggle mentally and be tempted to join a gang for a sense of belonging.
André Allen shares this concern.
Having been certified as a Qualified Mental Health Professional–Children for five years and working toward being a licensed clinical social worker, Allen is a social worker with Chesapeake Public Schools. He’d love to counsel students at work, but he’s restricted to interviewing them and their families to determine eligibility for individual education plans.
It’s too bad he can’t offer therapy: In the 2022 community health needs assessment conducted by area hospitals, the service most requested by families was access to more mental health providers in schools.
After school, Allen runs groups for boys at Indian River Middle School and Indian River High School. He coaches basketball, too. And he started Even You Coaching to improve teens’ mental health.
“I get parents asking me to counsel their African American teenage sons,” he says.
Allen wants more Black therapists, hoping their presence will ease the stigma of therapy.
“Our community frowns upon mental health treatment,” he says. “We’re taught ‘what happens in our home stays in our home.’ We’re taught that the stuff we go through mentally is associated with demonic powers; we’re told to pray about those things. But we’re never really encouraged to go seek mental health treatment.”
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Representation matters, says 21-year-old rising Virginia Commonwealth University senior Kayla Bravo, a Hispanic with immigrant parents. She spoke about the lack of minority therapists at the June 2023 Virginia Behavioral Health Summit in Richmond.
“When you find someone who looks like you, who is culturally competent, they’re more likely to understand your lived experiences,” Bravo shares. “When I had a white therapist, they didn’t understand [things], like the relationship between me and my parents. The relationship in a Hispanic household versus an Asian household versus a white household is going to be different.”
Over the course of five years, Bravo met with three psychiatrists and finally clicked with one. She was diagnosed with ADHD and depression. Therapy and medication made a world of difference.
“My life has completely changed forever,” Bravo says. “I go to college and want my master’s, and before that I didn’t even know if I wanted to go
to college.”
Trinity Gallagher spent several months in an in-patient treatment program for eating disorders in Durham, North Carolina. As a part of her recovery, she explored those experiences in her artwork, which was displayed as part of her senior showcase for the Governor’s School for the Arts, based in Norfolk.
Trinity Gallagher, the now 22-year-old woman diagnosed with an eating disorder in 2016, reports she is doing well also. Her road to mental recovery has been long and winding.
This spring, she moved out of state to be with her partner – half a country away from her parents and sister. Throughout the years, she says, they’ve given her constant support. Before moving, she experienced an anxiety attack.
“I thought it came out of nowhere,” Gallagher says, “but I believe now that it all started when I developed a fear of flying. From that point, I spiraled, feeling such constant and debilitating anguish over the thought of dying from anything and everything.”
She was prescribed Xanax, which she describes as her panic attack kill switch, getting her through hard days. She’s working to face fears, such as being alone in public and driving long distances.
In the spring of 2021, as the pandemic kept her college classes online, Gallagher battled depression—a condition she suspects started in middle school. Her family, a professor, and her college’s mental health professionals rallied around her as she decided to leave school.
But she didn’t relapse into restricting food or binging and purging.
“It’s debated in our field if you can be cured of an eating disorder,” says Hersh, the certified eating disorder specialist, who treats Coastal Virginia patients virtually after moving to Northern Virginia in 2022. “You can definitely get rid of the symptoms. A big life event might send you back to old patterns. Part of it is learning to cope with life in different ways, not turning to food, not turning to their body as their definition of who they are.”
Gallagher spent four months living at Veritas Collaborative Eating Disorder Treatment Center back in 2016. Her divorced parents alternated stays with her afterwards at a nearby apartment for six weeks as she transitioned from residential therapy to day treatments.
“When I saw my daughter getting well,” Winslow says, “it didn’t matter to me how long it would take.”
Winslow learned how to support her, with no shaming or scolding, as Veritas provided family education and therapy. For them, it meant eating the same food at the same time in the same portions together, and not talking about it nor mentioning calories.
“Trinity tells me that if we had not done all the things we did, she would not be here now,” Winslow says, “because she could not stop herself before.”
For her senior project in 2019 at the Governor’s School, Gallagher created a series of paintings about her eating disorder. “It was a sign of an incredible amount of bravery, to have 100 people at your show and be so open,” Winslow says. “A couple people have reached out to Trinity because of her openness about it. She can say, ‘Hey, there’s freedom for you. There’s hope for you. There’s help for you.’”
