It is unconscionable that Virginia has now made accessing basic mental health services more difficult for our most severely and chronically mentally ill patients.   There are numerous details that have not been acknowledged from these new regulations that will make receiving basic outpatient treatment without mental health support interventions extremely difficult if not impossible to obtain.  Mental health support is the only form of “direct service” available to those who are not capable of accessing outpatient treatment services on their own.  From our 18-21 year olds living with parents who escalate (or neglect) their symptoms without mental health support interventions, to our mentally ill adults who are afraid of medications and present themselves well to the psychiatrist without any mental health support interventions, the outcome of this will be catastrophic.  In addition, many patients have been in the mental health system their entire lives due to the chronic and persistent nature of their illness.  Withdrawing mental health support services due to their lack of progress, or for any other reasons of the new regulations, will result in these patients quickly decompensating and result in increased hospitalizations and/or incarcerations.  This is not cost effective nor is it reasonable humane and ethical treatment.  Our state should be ashamed.