File: House majority leader, Del. Kirk Cox, R-Colonial Heights, back to camera, delivers a resolution to the Senate at the Capitol in Richmond, Va., Thursday, March 6, 2014. The resolution called for an extension of the current session by 30 days. (AP Photo/Steve Helber)

Lawmakers cleared out of Richmond Saturday after largely accomplishing their goals on mental health reform. But they also failed to come to a budget agreement, leaving some differences on mental health funding unresolved, including money for mental health services for children and adolescents.

 Awaiting lawmakers’ consideration are two proposals. One would add $1.5 million over two years to expand children’s crisis response services and child psychiatry, for a total allocation of $4.5 million. The other proposal still in play would devote $7.5 million over two years to fund outpatient mental health for older teens and young adults and telepsychiatry, among other services. Gov. Terry McAuliffe (D) also included a measure to help teens transition into the adult system.

The proposals seem modest when compared to the changes made to the adult system, which some advocates and experts already fear did not go far enough. They also seem modest given the demand and the cuts that children’s mental health services absorbed during the recession. In 2012, the state estimates about 341,773 adults in Virginia suffered from a serious mental illness, and 130,658 children and adolescents contended with a serious emotional disturbance.

But Margaret Nimmo Crowe, executive director of Voices for Virginia’s Children, said they would be a big improvement over what happened six years ago.  The Virginia Tech massacre was just as seminal an event for children’s mental health care as it was for the adult system, but for very different reasons.

“Cho was very recently a child and had mental health issues as a child and the focus was on colleges and the adult system,” said Crowe, who called the post-Virginia Tech reforms “disappointing.” “After a crisis, everyone is focused on the exact thing that happened,” she said. “It is hard after a tragedy like that for people to take a big view. The kids part didn’t get a whole lot of focus.”

Children’s mental health advocates chose a different strategy, and in 2009 began a separate campaign, called “1 in 5,” a reference to a federal report that estimated one in five children have a mental illness but only one in five get treatment. A major catalyst was a proposal to close the 48-bed Commonwealth Center for Children and Adolescents, the state’s only in-patient facility for children and an adolescent unit in Southwestern Virginia.

Those two facilities took in kids and teens that private hospitals refused to take  because they were too violent, lacked insurance, or were ordered there by a judge. The idea of closing one or both of them alarmed parents such as Jen Little, who at the time sat on the board of the department of behavioral health and developmental services.

“I said, ‘You can’t close Commonwealth. My daughter is there,'” she said.

She recalled that her daughter, who had a diagnosis of bipolar disorder, once spent the night at a sheriff’s office waiting for a bed to open up. Budget cutters said because few people stay there long, it often had empty beds, and many children and adolescents could be better served in their communities, closer to home.  Little said their plan might have worked if community health boards weren’t also grappling with budget cuts. “They wanted to move everyone to the community to force the community service boards to put services in place,” she said. “It sounded great. It sounded better than sending someone to a hospital clear across the state, but [the CSBs] didn’t have the money.”

(In fiscal year 2013, the 40 community services boards and state hospitals provided mental health services to 112,000 mentally ill Virginians, an increase of 5 percent, compared to 2011. Of that total, 32,000 of were younger than 18. )

Commonwealth ultimately survived the closure attempt. The adolescent unit in Marion did not.

Since then, the General Assembly has doled out small pots of money to fund promising programs such as mobile crisis units. And then there are the proposed increases for the next two years.

“It might seem surprising that we make such a big deal about it. But I think that in itself is very enlightening about the state of children’s mental health in Virginia,” Crowe said. “Children’s mental health needs are almost routinely overlooked in any conversation about ‘the mental health system’ unless there are very loud protests from advocates, families, and children’s providers.”