One unwanted issue is mental health care, which is important to the voters because it is a service regulated and largely provided by the state. One agency of state government is responsible for services for mental health, mental retardation, and substance abuse. People in need of these services frequently qualify for Medicaid because of their mental disabilities, thus they are major contributors to the ballooning state Medicaid budget. Medicaid is the second largest line item in the state budget (after public education), but the fastest growing. So it is noteworthy that no candidate had proposals for mental health care, which is a marked departure from other statewide elections.

California, which already has deinstitutionalized, is providing its own answer to this question. In a landmark piece of mental health and fiscal legislation, California placed a 1 percent tax on adjusted gross income over $1 million, affecting about 30,000 California taxpayers and raising $1.8 billion (a 31 percent increase) in new revenues over the first three years to support county-operated mental health systems. An important requirement for receiving new money at the local level is for integrated service planning and outcome measurement involving "local stakeholders including adults and seniors with severe mental illness, families of children, adults, and seniors with severe mental illness, providers of services, law-enforcement agencies, education, social service agencies, and other important interests." This is much like Virginia's restructuring initiatives in mental health, but we have no reward for participating.

Any funds saved by the closure or conversion of a state hospital should be locked up in the Mental Health, Mental Retardation, and Substance Abuse Services Trust Fund established in the Virginia Code. Any appropriate tax (old nor new) associated with mental health, mental retardation, or substance abuse should be deposited in the fund. The trust fund should be used to receive competitive proposals from CSBs to support new integrated-service plans and outcome-improvement efforts. A number of imaginative and dedicated leaders of CSBs would jump at the chance to compete for new money.