Accustomed to dealing with people in times of crisis, mental health workers in Virginia are feeling some anxiety themselves these days.

That’s because several weeks after the General Assembly made sweeping changes to the state’s mental health system — placing more demands on an already-understaffed network of treatment providers — it remains unclear just how the reforms will be implemented at the local level.

Before leaving Richmond, lawmakers appropriated $41.7 million to fill some of the gaps in the system that were exposed last April when a mentally ill student went on a shooting rampage at Virginia Tech.

The Department of Mental Health, Mental Retardation and Substance Abuse Services is working to divvy that money up among localities across the state. That could take weeks or even months, leaving some treatment providers to wonder if the new jobs created will be enough to handle their increased responsibilities when the legislation takes effect July 1.

“There’s a high level of anxiety,” said Mary Ann Bergeron, executive director of the Virginia Association of Community Services Boards.

A key part of public-funded mental health treatment in Virginia is provided by 40 community services boards, local agencies that also serve the mentally retarded and those addicted to drugs and alcohol.

The CSBs have been short-staffed for years, mental health advocates say. Among other things, the new legislation will require CSB workers to spend more time monitoring patients ordered to receive mandatory outpatient treatment, and to attend all commitment hearings held across the state.

Those hearings, which have numbered about 30,000 in recent years, are likely to increase as a result of the new legislation, which loosens the legal criteria under which the state can hold or treat the mentally ill against their will.

Under the current system, which some have blamed for failing to intervene in the case of Virginia Tech shooter Seung-Hui Cho, someone can be involuntarily committed only if a special justice finds the person to be an “imminent danger” to himself or others. Effective July 1, the new standard will replace the words “imminent danger” with “substantial likelihood” of causing serious physical harm.

No one seems to know just how many more people will be subjected to the commitment process under the new law.

“I can’t even speculate what the volume may be,” said Gail Burruss, director of adult clinical services for Blue Ridge Behavioral Healthcare, the CSB that serves the Roanoke Valley.

“But if it is a significant increase, then I’m not at all certain there will be adequate resources to provide the necessary services.”

One thing that worries Burruss is the large amount of time it takes to monitor someone ordered to receive outpatient treatment, a seldom-used practice that she expects will soon be applied more frequently to cope with growing caseloads.

“The worst-case scenario would be that we have to devote so many more resources to manage those who have been mandated under an out-patient treatment order, we would have to further diminish services for those who have not yet reached the point of crisis, and that would be a real disservice to our citizens,” Burruss said.

Meghan McGuire, a spokeswoman for the state Department of Mental Health, said it’s too soon to say how many new positions the $41.7 million will buy.

With about 12,000 employees statewide, CSBs served 194,431 people with mental health needs in 2004, according to the Association of Community Services Boards.

McGuire said the department hopes to inform local CSBs of how much money they will get “in the coming weeks or months.”

Whatever that amount is, department Commissioner James Reinhard said, it will be just the first step in a complicated process.

“True reform into a mental health services system that seeks to prevent before it must treat, and focuses on individuals and their path to recovery instead of on their illnesses, requires a thorough examination,” Reinhard said in a prepared statement.

“These issues cannot be fixed in one legislative session, but will take focused attention by lawmakers, mental health professionals, the courts and the media for years to come.”

To put the $41.7 million in context, Bergeron noted that in any given year, the state’s CSBs make funding requests of between $30 million and $50 million for what they define as high-priority needs.

“We are very grateful for the money, because it will fill some holes,” Bergeron said. “But it will not fill all the holes.”

Mira Signer, executive director of the Virginia chapter of the National Alliance on Mental Illness, agreed that $41.7 million is not that much, considering the “decades of neglect” that passed before the Tech shootings brought mental health concerns to the legislature’s attention.

“Virginia has to recognize it’s just a first step, and regular and substantial investments are needed,” Signer said. “There’s just a tremendous amount of work to be done.”

One challenge will be to find a way to carry the sense of urgency created by the shootings, now approaching their one-year anniversary, into future budget talks.

“We’re just going to have to continue pursuing it and reminding people of the needs and what disastrous consequences can result if we don’t fully fund the system,” said Sen. John Edwards, D-Roanoke, whose district includes Tech.

In the New River Valley, mental health officials hope the new money will increase the agency’s ability to provide crisis services and adult outpatient treatment.

“All in all we feel really good about things. … Increases are always a plus,” said Mike Wade, spokesman for the New River Valley CSB.

Wade said the requirement that CSB representatives be present at commitment hearings won’t affect his agency because it already staffs those hearings. The board had stopped sending representatives to every hearing but resumed the practice last year after it became known that no one from the agency was present at Cho’s hearing in December 2005.

Although a special justice found that Cho was a danger to himself, the Tech English major was ordered to receive outpatient treatment and soon slipped through the system’s cracks. Sixteen months later, Cho killed 32 people before committing suicide as law enforcement officials moved in.

Under the new practice, when hearings are held outside the New River Valley, an agency representative phones in. The New River Valley board has an agreement with the Mount Rogers CSB that a Mount Rogers representative will cover hearings at the state mental hospital in Marion, and New River staff cover those at the Carilion St. Albans facility outside Radford, Wade said.

While this year’s mental health reforms are the biggest in decades, concerns remain.

One is the lack of money for additional inpatient psychiatric beds. According to a study by the Treatment Advocacy Center, Virginia has a serious bed shortage, and the lack of mental hospital space in the Roanoke Valley has led to backlogs of patients in hospital emergency rooms.

Another concern, voiced by Signer and other mental health advocates, is that lowering the commitment threshold might infringe on the rights of people with mental illness.

Richard Bonnie, head of the Virginia Commission on Mental Health Law Reform, said the panel plans to evaluate the new laws, particularly those concerning commitment and mandatory outpatient treatment.

Implementing the new laws will require training, coordination, evaluation and oversight, Bonnie wrote in an e-mail.

“The last thing we should do,” he said, “is to add new challenges before the system has successfully absorbed the ones that have just been made.”