A Brief Overview of Behavioral Health Dockets in Virginia
By Judge Jacqueline Talevi
Prior to 2016, the General Assembly of Virginia and the Supreme Court of Virginia did not recognize specialty dockets including behavioral health dockets. However, due to the growing concern to address the mental health needs of defendants appearing before the courts in the Commonwealth, the Supreme Court of Virginia enacted Rule 1:25 which created behavioral health dockets. In 2020, the General Assembly enacted legislation creating the Behavioral Health Docket Act which authorized the Supreme Court of Virginia to implement and oversee behavioral health dockets within the existing framework of the court system. Behavioral health dockets seek to identify and provide treatment to individuals with serious mental illness who have become involved with the criminal justice system. Behavioral health dockets hold individuals accountable while offering evidence-based practices to identify and treat mental health illness and co-occurring disorders. Currently, 20 behavioral health dockets operate in the Commonwealth at all levels of court.
Each docket follows non-mandatory evidence-based standards and coordinates the resources available to docket participants in their communities. To participate, a defendant must meet legal and clinical criteria and voluntarily agree to participate in docket programming. A treatment plan is crafted by a collaboration of mental health and criminal justice professionals to meet the unique needs of each participant. Each docket utilizes a treatment team to monitor each participant’s compliance with the goals of treatment. The treatment team members receive mandatory specialized training offered by the Office of the Executive Secretary of the Supreme Court of Virginia prior to their participation. The treatment team typically includes a prosecutor, a defense attorney, a mental health case manager, a mental health coordinator, a mental health clinician, a probation officer and the judge. Treatment team discussions are non-adversarial and focus on strategies to assist the participant in achieving treatment goals. Typically, the participant completes program requirements in one year. During the year, the participant regularly appears in court to review and discuss her/his progress with the judge one on one in the courtroom. Successful completion of docket requirements is celebrated with a graduation ceremony and a reduction or dismissal of the criminal charge.
Behavioral health docket data is collected from each behavioral health court docket annually by the Office of the Executive Secretary of the Supreme Court and measures various data points including but not limited to mental health diagnosis, the crime charged, successful completion of the program and recidivism rates. The report is submitted to the General Assembly and is available to the public.
Metabolism and Mental Health
By Raja Mogallapu, MD
Metabolic health and mental health are closely interconnected through shared biological pathways that involve energy regulation, inflammation, hormones, and mitochondrial function. This presentation examines how disturbances in metabolism—such as insulin resistance, mitochondrial dysfunction, and chronic inflammation—contribute to mood disorders, cognitive decline, and increased psychiatric vulnerability. The Standard American Diet promotes oxidative stress and neuroinflammation, which can negatively impact mental health. In contrast, nutrient-rich dietary patterns like the Mediterranean and ketogenic diets can enhance metabolic resilience and improve neurotransmitter balance. Additionally, epigenetic mechanisms influenced by nutrition and stress play a significant role in shaping long-term mental health outcomes. Clinical evidence shows that metabolic syndrome is linked to higher rates of depression and bipolar disorder, highlighting the need for integrative treatment approaches. Emerging therapies, such as metformin, GLP-1 receptor agonists, and creatine, demonstrate promise in improving both metabolic and psychiatric outcomes. By addressing lifestyle factors, nutrient deficiencies, and metabolic dysfunction, we can take a comprehensive approach to enhance brain health and emotional well-being throughout life.
Reflections on Electroconvulsive Therapy and Stigma
By Rebecca E. Barchas, MD, DLFAPA
Through the lens of a retired psychiatrist who later became a patient, this presentation uses electroconvulsive therapy (ECT) as an example of a highly effective and safe, yet stigmatized procedure to examine how stigma generates obstacles to optimal care. Stigma is not only societal or patient-driven. It also originates from clinicians who omit or dismiss ECT as a treatment option for severe or treatment-resistant depression. Such omission, whether from a lack of knowledge or subconscious bias, results in inadequate patient care and denies patients access to what may be the most effective intervention for their condition.
Physicians can break this self-reinforcing cycle by proactively challenging oversimplification, accidental misinformation, deliberate disinformation, and fear, and by ensuring they are well informed about all evidence-based treatments. We must lead efforts to educate patients so their decisions are based on accurate understanding rather than unfounded prejudice or stereotypes. By directly confronting stigma and informing patients about all effective options, clinicians can reduce and dismantle stigma within society. My paper, “Electroconvulsive Therapy Highlights the Urgency of Addressing Medical Stigma,” published in The Lancet Regional Health-Americas (July 2025), further develops these ideas.
You’re Involved, Whether you Know it or Not: Psychiatrists’ Influence on Juvenile Justice
By Jeffrey Aaron, PhD
The youth justice system is intended to help and support young people who have violated the law, but the system has other goals and support of youths’ best interests is not always the outcome. Psychiatrists can meaningfully impact justice system responses to their current and past patients in ways that are often not apparent or intended. Diagnoses, terminology, and descriptions appearing in summaries, notes, and other documentation may be released to decision-makers within that system (probation officers, judges) directly or indirectly, during treatment or long after its conclusion, and they can be misunderstood, taken out of context, and reinforce inaccurate perceptions and judgments. Many, most, or even all of your child/adolescent patients are at non-negligible risk for justice system involvement at some point, suggesting the importance of vigilance regarding what you say and how you say it. You’re involved – whether you know it or not.”
