Foremost among the Charlottesville-Albemarle advocates were two persons who founded the Charlottesville-Albemarle Community Mental Health and Mental Retardation Services Board in February 1969, Ms. Isabel Amorous Palmer and Mr. William T. Stevens. This was the first multi-jurisdictional Community Services Board chartered. There are now 40 Community Services Boards serving every city and county in Virginia.

The original vision for what eventually was renamed the Region Ten Community Services Board (to give appropriate recognition to the four participating rural counties--Fluvanna, Greene, Louisa and Nelson) called for a partnership between the University of Virginia Board of Visitors and this new citizens' board. The University would provide space for 24-hour psychiatric emergency services and inpatient psychiatric beds, and the new community board would provide psychiatric outpatient services for children and adults, a day hospital program as an alternative to long-term state hospitalization, and consultation and education services to the schools, other community agencies, and the public at large. The Perry foundation served as an important third partner in this developing system of community-based mental health services by acquiring one property for the new community board to house its psychiatric day hospital program (409 Third Street), and two other properties--1602 Gordon Avenue, and 400 Ackley Lane--for psychiatric outpatient services and case management, and for the program's administrative support. This was a temporary measure so that the new board would be able to begin to build its programs until a permanent site could be secured for the construction of a comprehensive community mental health center. (Quoting from the August 3, 1970, minutes of the Charlottesville-Albemarle Community Mental Health Services Board meeting, "PERRY FOUNDATION: The current status of the Perry Foundation's interest in making available philanthropic funds to the Board for the construction of a building to house the center program was reviewed. It was noted that Dr. Garnett and Mr. Hedrick had met with members of the Perry Foundation and they had expressed interest and that this interest was contingent upon the actual award of the Federal grant. Due to the current uncertainty of the center funding it was felt advisable for a member of the Board to contact the Perry Foundation and to reaffirm their interest. Mrs. Palmer volunteered to do so."). The plan was for the Perry Foundation to participate to the extent necessary to enable the construction of the new facility, and at that time the Community Services Board would surrender the Gordon Avenue and Ackley Lane properties back to the Perry Foundation for whatever purpose the Foundation saw fit.

In 1971 the Perry Foundation conveyed the property located at 409 3rd Street to Region Ten for the use as a day hospital (one of the five required mental health services for boards receiving federal Comprehensive Community Mental Health Centers grants).

During those first years in the early 1970's, the board and staff of Region Ten directed their exclusive attention to the development of needed services. The search for a suitable site on which to construct a permanent facility was placed on the back burner as these dedicated advocates for mental health and mental retardation services sought to capture federal funds and other emerging resources to meet the demand for services. The board was successful in being one of only three communities in all of Virginia to be awarded a grant from the National Institute of Mental Health to establish a comprehensive community mental health center, designated at that time by both local and federal officials as the Blue Ridge Comprehensive Community Mental Health Center.

The positive result of this federal funding was that Charlottesville-Albemarle, Alexandria and Roanoke, were all able to immediately recruit an array of highly qualified professional mental health staff, and thus to launch full blown comprehensive community-based mental health services. The attending long-term downside of this otherwise enabling opportunity was that the federal grant funding was provided on a scheduled eight year declining basis. What that meant for the board from day one was that the threat of the loss of essential program support was ever present, and the attention and the energy of the board was continually siphoned off in a never ending struggle to preserve those very services that the original board members had worked so hard to establish.

Yet, due to the support of the local governments and the state administrations and General Assembly, the total program continued to grow. During that first decade the board established full time mental health clinic offices in the four surrounding counties, developed residential group homes and apartments, was designated as the first agency in Central Virginia to administer Section 8 leased housing certificates to subsidize affordable housing for disabled persons, provided case management services to persons with mental retardation, funded activity and employment programs through the Association of Retarded Citizens (now the ARC of the Piedmont) and Workshop V (now WorkSource Enterprises), assumed the operation of the formerly state-operated Alcohol Treatment Center, and founded the Alcohol Safety Action Program (ASAP). By 1985, the day hospital program had evolved into the Blue Ridge House clubhouse program (a day program for persons with severe and persistent mental illness based on a rehabilitative and mutual support model rather than a clinical model), and the program had expanded to the extent that a larger facility was needed (Region Ten was the first mental health program in Virginia to convert from the traditional day hospital model to the clubhouse model based on the Fountain House program in New York; there are now fifty clubhouse programs in Virginia patterned after Region Ten=s model).

Demands for office space to house Region Ten=s outpatient and related services meant that by the time the Worrell family donated the former Daily Progress building (located at 4th Street NE and East Market Street in downtown Charlottesville) to the United Way in the early eighties, Region Ten had come to occupy some twelve separate converted houses and office sites for its outpatient and administrative support staff. With the board's total dedication to preserving essential services, and responding to the needs of hundreds of disabled persons remaining on the waiting lists, the efforts to secure a permanent home for the board's services remained in the background. Region Ten was invited to participate as a tenant in the Worrell facility. This was received as a welcome interim step that would at least consolidate Region Ten's programs into one site and contribute to efficiencies and economies of operation. As it turned out, by the time the Worrell renovations were completed and the new tenants moved into the facility in July 1985, Region Ten's programs had expanded to the extent that the allocated space was insufficient to accommodate the staff even given the doubling up of many staff and crowding of staff into several open areas. The first of what eventually became six office suites was leased across Market Street in the Maclin Building. Even though the Maclin landlords were extraordinarily helpful and responsive, the constant flow of staff and clients with disabilities back and forth across Market Street between the two facilities created an inefficient and genuinely dangerous situation. Further, the noise created by WorkSource Enterprise's manufacturing processes on the main floor of the Worrell Building was transmitted down through the concrete floor to Region Ten's clinical offices below. The sound was magnified in the same way that a drum amplifies sound with the result that clients and staff in Region Ten's basement offices experienced the noise as if they were trying to conduct their treatment beneath the lanes of a bowling alley.

The daily census at Region Ten's Blue Ridge House continued to increase to the extent that the fire marshal urged the program to relocate to a larger facility. Region Ten was unable to locate a property that would be suitable and feasible to purchase for Blue Ridge House, and so Region Ten rented space in the old Better Living building on Avon Street. Region Ten sought and received approval in November 1986 from the Perry Foundation to use the Third Street property as a residential duplex to provide transitional, supervised, residences for persons who have successfully completed inpatient mental health or substance abuse treatment, but who required more intensive assistance as part of their reintegration into the general community. A loan for renovations through the Virginia Housing and Development Authority (VHDA) was also secured to bring the facility into code compliance and to renovate the interior to double the capacity to accommodate eight residents. The facility was converted to an AOxford House@ model to maximize the degree of responsibility which the residents take for their recovery process.

In response to the recommendation of the City Task Force on Illegal Drugs, Region Ten rented space on the first floor at 300 West Main Street to operate a neighborhood substance abuse outreach center and an intensive outpatient substance abuse treatment for adolescents and adults. Space pressures resulting from the growth of substance abuse prevention services contracted through the Charlottesville and Albemarle schools soon necessitated leasing additional space in the West Main Street facility.

During this development period, the revenue sources increasingly diversified just as the scope of the programs and services broadened. Yet, even given this history of success, the waiting lists for services continued to grow. In response to these demands, the Region Ten Board chartered a 501 (C) (3) nonprofit corporation in order to better position itself to develop permanent facilities and to raise funds.

Over the decades the Region Ten Board rededicated itself to securing an adequate home of its own, but always other emergent considerations took precedence. Also, the recognition that the facility must be conveniently located to public transportation, shopping and other services, and with adequate parking, meant that a quarter of a century elapsed before a singular opportunity was presented in March 1995--the availability of the NationsBank property at 800 Preston Avenue. An initial perusal of the facility suggested that it offered all the attributes recognized for the past 26 years as essential to providing an accessible, user-friendly site. The Board of Region Ten moved with remarkable dispatch to assess if this indeed offered a possible solution to the long standing dilemma. A no-cost, thirty-day option was secured on the property, and an initial feasibility study was conducted to determine the suitability of the structure itself to serve as a community mental health and mental retardation center, and also to determine if the structure could readily accommodate the kind of expansion that would be needed to meet future needs.

The engineering studies revealed that the existing building was in superior condition, and the roof structure was constructed to sustain three times the building code requirements. The addition of a second floor was therefore possible without any additional structural modifications. The board concluded that the facility offered the potential to replace the 15,000 square feet occupied in the Worrell building, as well as the 8,000 square feet in the Maclin Building, and to provide space for substance abuse prevention staff housed on the second floor of the West Main Street center, and some space for the mobile staff who serve persons with mental retardation through Region Ten's Community Builder's program and the extensive system of supported residential services.

All in all, the Preston Avenue site met all of the considerations that had been held in abeyance ever since the newly formed board and the Perry Foundation trustees planned for this need some twenty-six years earlier. Then, after tentative contacts were reinitiated with the Perry Foundation trustees and with officials at Jefferson National Bank (now Wachovia Bank), further impetus was given with the announcement by United Way that the Worrell Building had been placed on the market for sale.

The furtherance of the vision to secure a permanent home for Region Ten had been delayed for all the reasons detailed above. Ever present, also, was the concern about what the future may hold, and particularly what the changes in technology, treatment philosophies, political ideologies, emerging managed care approaches, local, state and federal support, and numerous other considerations could mean to the viability of future needs of Region Ten. Region Ten originally began with a budget funded equally by state and local tax dollars. Federal support was then secured, and state support began to increase significantly. State statutes always required that Community Services Boards charge fees according to the individual's ability to pay, but more importantly, Region Ten staff realized that unless a person helped to pay for their services, engagement in effective treatment and rehabilitation would be compromised. This recognition, later coupled with changing and expanding patterns of third party reimbursement mechanisms, resulted in a revenue picture that is extraordinarily diversified, but with the greatest reliance on Medicaid reimbursements.

With regard to the continuing need for services, public schools provide superior services to students with mental disabilities, and upon reaching age 22, these graduates require the full range of services provided by Region Ten. At the other end of the age spectrum, persons who have been maintained at home for their entire lives by caring, dedicated family members, suddenly find themselves totally devoid of supports when their aging parents become infirmed or pass away. And due to the continuing progress of medical science, disabled persons are living longer and longer. Finally, the institutions of decades ago, such as Western State Hospital, now serve as active, short-term inpatient treatment and rehabilitation facilities, no longer warehouses for abandoned unfortunates. Indeed, the 3,000 bed asylum has become a 250 bed hospital. Even if political leaders sought to return to the conditions of the previous century, it simply could not be done due to court decisions on civil and human rights.

The specific mix of services and programs offered by Region Ten has continually evolved in response to changing needs and demands, improved technology, and the emphasis and priorities of various funding sources. This will surely continue in the future, but the one constant element is the caring, compassion, advocacy and resolute determination exhibited by those who worked so tirelessly to develop a system of community mental health services here in Charlottesville, Albemarle, Fluvanna, Greene, Louisa and Nelson, and to the thousands of citizens who have since remained vigilant to assure that those persons who are the most vulnerable in our society are never again forgotten or abandoned.

In November 1997, Region Ten sought permission from the Perry Foundation to sell the Third Street property and apply the proceeds to a new Blue Ridge House facility. In response to an inquiry by the Friends of Blue Ridge House, Dr. Charles Hurt presented a proposal to construct a facility on an excellent site fronting on Elliott Avenue.

Region Ten provides services to persons with mental retardation services varying from case management oversight to full, 24-hour per day, year round service. Increasingly, these individuals have other disabilities and challenges in addition to mental retardation, often requiring intensive--sometimes one-on-one--24-hour care. Region Ten operates and contracts for residential services to provide a safe and secure home, and day support programs to provide a productive activity during the daytime hours. Region Ten's day support programs were housed in various leased spaces, but by 1999 were primarily located in leased space at the east end of the downtown mall and a small amount of temporary space in the basement of 800 Preston Avenue.

Substance addiction services provide prevention services and intensive outpatient services and were housed in a leased facility located at the corner of Ridge and West Main Street (300 West Main). The program had expanded to provide over 40 treatment groups each week for adolescents, adult men, and adult women. Also, staff who provide community and school-based prevention services were officed in the facility along with Project LINK, a program for women of child-bearing age at risk of substance abuse. The original intent of leasing first-floor space in this facility was to respond to recommendations by the City's Task Force on Illegal Drugs to establish an accessible outreach program. As a complete continuum of substance addiction services was developed, more and more space was rented in the building to the extent that the space on the third floor did not even meet state program licensing standards, and therefore clients could not be seen there.

The leased facilities were inadequate to meet the needs, with rental costs of over $100,000 per year. There was no parking, and this was particularly problematic and dangerous for the mental retardation day support programs where JAUNT lined up its wheelchair lift-equipped vans on the busy street to load and unload clients with multiple disabilities.

Sites were sought that would be physically and geographically accessible, with adequate parking necessary for program safety and efficiency. Large program spaces to accommodate group treatment and training services, as contrasted to smaller office-based activities, represented the primary space needs for all of these services. Services located on one floor, rather than multiple stories, would be preferable, along with the availability of on-site open space outdoors to enable cost-effective programing alternatives varying from outdoor recreational activities to horticultural programming.

In earlier decades, treatment for the dependence on, and the addiction to, mind-altering chemicals received little attention until the individual was so debilitated that they were committed to state mental hospitals. Because this was not an appropriate treatment site given the nature of addictive brain disorders, substance addiction treatment wards were closed in the seventies with the intent that treatment programs would be established in the community.

Another trend occurring simultaneously was the increasing addiction to illegal substances, including such powerful and devastating drugs as crack cocaine and the meth- amphetamines, even though the most prevalent drug found in dependency and addiction remains alcohol, but in ever-growing combination with other substances.

Although the state mental health treatment facilities are no longer focused on substance addiction, a majority of the patients with mental illness also have co-occurring diagnoses of substance dependency or addiction. Similarly, the vast majority of persons in the criminal justice system are there as a direct result of substance use or addiction.

Prior to the eighties, Region Ten's substance addiction services were largely geared toward Aproblem drinkers@ and alcoholics. Advances in research pointed to the effectiveness of group treatment approaches, and the local public concern emerging over the epidemic use of illegal drugs led to an evolution of Region Ten's services to the comprehensive continuum of services now in place.

Region Ten's Charter House was started as a program to divert public inebriates from the criminal justice system and provide shelter from the elements, but it evolved to become the Mohr Center, which later added social detox and residential treatment services that are the portal of entry, the first steps in engaging a substance addicted person into a life saving course of treatment. Substantial funding cuts in 2002 necessitated the ellimination of the detox service but added community housing services. Community housing services combines housing and treatment so that residents have a supportive environment while in early recovery. In September 2005, the Mohr Center added a new 2-week residential treatmnmet program that provides primary addiction treatment.

Region Ten operates an extensive program of outreach and HIV testing to reach high risk users. Intensive outpatient programs meeting for hours every day bring adolescents, men and women through the stages of recovery. Region Ten is a key participant in the very successful drug court program where offenders can be enlisted in a course of treatment, and in a very carefully monitored process overseen on a continuing weekly basis by the judge, can achieve effective treatment outcomes in place of otherwise revolving door, dead-end legal sanctions. Women of child-bearing age receive special attention through Project LINK, an interagency program administered by Region Ten to deal with women involved with substance addiction.

Two properties were indentifed in April 1999 for possible purchase. A 4.8 acre site bounded by Michie Drive, Hydraulic Road, and Brandywine Drive would provide an ideal location for mental retardation services, allowing for expansive parking, greenhouses and gardens, and an extensive natural area. Meadow Creek and the Charlottesville-Albemarle walking trail traverse the natural area. The property was purchased in December 1999, and construction completed in October 2000.

The potential site for substance addictions services was located at the corner of Fourth Street Northwest and Preston Avenue. The existing building contained 10,000 square feet, all but 700 square feet on the same level. The property included ample parking, and the convenient downtown location was uniquely suited for this kind of program. The property was purchased in October 1999, and renovations were completed in April 2000.

Blue Ridge House was completed and the program opened in the new facility on July 16, 2001.

Region Ten secured permanent low interest, tax-exempt financing through the Albemarle County Industrial Development Authority and Wachovia Bank for Preston Avenue, Blue Ridge House, Meadowcreek Center, Fourth Street, and four residential facilities.