I do not support only being able to provide Mental Health Skills Building Services for two units a day.  I believe there can be a compromise made in regards to the unit structure.  The necessity of greater than 5 hours of service is very likely in rural areas of the state in which it takes longer periods of time to reach service providers.  For example, when a client is having difficulty with heightened mental health symptoms, the Clinician is able to talk the client into going to a local hospital for evaluation with them.  The waiting times in rural areas for evaluation can be very long and often ends up being at least 5 hours in duration or longer. 

I believe seeing clients more frequently for shorter periods of time will create a dependence on services.  A Clinician may be unable to assist a client through heightened symptoms due to time restraints.  Many clients often come into services without any supports.  There may be certain situations that require a client to be linked to several different community agencies and may need assistance in accessing all of these resources.  These appointments often take an extended amount of time due to filling out applications, etc.

A client may finally agree to see a specialist and have very heightened anxiety surrounding this appointment.  The Clinician will utilize role play to assist client in interacting with the specialist in an appropriate manner prior to the appointment.  Often clients become very overwhelmed with new service providers and may not remember to address all areas of concern without assistance from the Clinician.  Following appointments, Clients may  need to visit local pharmacy to obtain needed medications and the Clinician may need to provide skills training regarding understanding new medication and how to properly take medication.  Appointments such as these may take more than 5 hours. 

Clinician providing services in rural areas may need 5 or more hours to properly help clients meet their needs.  In rural areas in Virginia, resources are often very spread out and require more time.  I fear  that adopting this regulation as it is currently written will likely dissolve the presence of Rural providers in the outlying areas of the Commonwealth leading to no access to care.