Fairfax's Ailing Poor Waiting

"The help is just not there," McKee said.

Agency officials say they are dealing increasingly with patients whose multiple medical problems and personal circumstances -- combinations of mental illness, substance addiction, poverty and homelessness, for example -- pose special challenges.

More than 83 percent of the 11,000 people who received mental health care last year have annual household incomes below $25,000. Most are either uninsured or underinsured.

Perhaps more vexing have been staffing problems. The agency's outpatient treatment centers in Reston, Alexandria and Annandale have a total of 11 vacancies for psychotherapists, case managers and nurses. Even before the vacancies emerged last year, therapists were oversubscribed, DeFee said, each carrying an average of 50 cases. That workload has expanded.

Although some agency staff members are among the county's highest paid employees (one psychiatrist made $286,886 with overtime in 2003, according to a Washington Post study of area government salaries), DeFee said recruitment and retention are increasingly difficult. Competition from the private sector and other government agencies, as well as the expense of living in Fairfax, are the main obstacles.

Other jurisdictions face similar problems, but to a lesser degree. Loudoun County, which serves about 2,000 mental health patients a year, had 45 adults seeking outpatient care as of March 7. The average wait is 33 days, although some patients have encountered delays of up to three months. Tom Maynard, Loudoun's director of Mental Health, Mental Retardation and Substance Abuse Services, said that the waits have been "a chronic difficulty" but that his agency tries to get everyone evaluated and into treatment within a month.

"It's been a mighty struggle," he said.

Montgomery County, which contracts nearly all of its mental health services to a network of nonprofit organizations, had no immediately available information on waits. However, a November 2004 county report said 140 people were on waiting lists.