Police Policy: Mental Health Crises

LINE PROCEDURE LP-28-24: MENTAL HEALTH CRISES: 

Find below complete policy content or download the official directive. 

PURPOSE

To establish procedures for calls involving a person experiencing a mental health crisis. 

DISCUSSION

Division members frequently encounter those experiencing a mental health crisis. Such calls for service are fluid and dynamic in nature and require officers to consider the totality of the situation and its effect on the individual and the community. Officers are to utilize de-escalation skills, CIT training, intelligence and other Division and County resources to find the best solution. The possible solutions are wide-ranging and often include non-traditional law enforcement skills and resolutions. 

Some individuals may be a harm to themselves or others or suffer serious harm due to a lack of capacity to protect themselves from harm or to provide for their basic needs. When officers have probable cause that this potential harm is due to mental illness and is likely to occur within the near future without intervention, officers have the authority to take this person into emergency custody and to have the individual evaluated for the need of further hospitalization and treatment.

Medical information disclosed to officers as a part of this process shall not be used for the basis of criminal enforcement action, nor discussed outside of the mental health evaluation process.

Nothing in this directive shall prohibit any officer from initiating lawful arrest procedures whenever appropriate.

DEFINITIONS

CIT – CIT is a general term used internationally to describe the training, partnerships, and programs created to meet the needs of those experiencing a mental health crisis. Henrico’s CIT program is a valued partnership that includes the following County agencies: Police Division, Division of Fire, Sheriff’s Office, Mental Health (HMH), and Department of Emergency Communications (DEC). CIT encompasses the basic 40-hour block of crisis intervention training that all Henrico Police Officers must complete. (When CIT training is mentioned within this policy, it is referring to this 40-hour block of instruction.)

Commitment (Involuntary Admission) – (§37.2-814 Adult/§16.1-340.4 Minor) – Inpatient treatment mandated by an order of a district court judge or special justice, subsequent to a temporary detention order (TDO).

Emergency Custody Order (ECO) – (§37.2-808 Adult/§16.1-340 Minor) – Order granting authority to take a person experiencing a mental health crisis into custody for evaluation by a mental health provider to determine the need of additional treatment and hospitalization. The period of custody shall not exceed eight hours from the time the law enforcement officer takes the person into custody. If the ECO is going to expire and a bed has not yet been found, the area state facility must be entered as the TDO facility, and the TDO shall be served prior to the expiration of the eight hours.

Mental Health Awareness Response and Community Understanding Services Alert System (Marcus Alert) – (Code of Virginia §37.2-311.1) – A set of protocols to (i) initiate a behavioral health response to a behavioral health crisis, including for individuals experiencing a behavioral health crisis secondary to mental illness, substance abuse, developmental disabilities, or any combination thereof; (ii) divert such individuals to the behavioral health or developmental services system whenever feasible; and (iii) facilitate a specialized response in accordance with §9.1-193 when diversion is not feasible.

       Code of Virginia §9.1-193, states that specialized response protocols and training by law enforcement shall consider the impact to care that the presence of an officer in uniform or a marked vehicle at a response has           and shall mitigate such impact when feasible through the use of alternative uniforms and unmarked vehicles. The specialized response protocols and training shall also set forth best practices, guidelines, and     
       procedures regarding the role of law enforcement during a mobile crisis response.

Mobile Response Team (MRT) – A co-response team model that includes a Crisis Clinician and a CIT trained police officer. The MRT responds to behavioral health calls for service to determine the appropriate level of need, to de-escalate behavioral health crises, and to reduce stigma.

Temporary Detention Order (TDO) – (§37.2-809 Adult/§16.1-340.1 Minor) – an order issued by a magistrate pursuant to §37.2-809 or §16.1-340.1-authorizing a person to be taken into custody and transported to a facility designated on the order. This can follow an emergency custody order but can also be conducted autonomously.

     Pursuant to §37.2-809 Adult: The period of custody under a TDO must not exceed 72 hours prior to a commitment hearing unless the 72 hours terminates on a Saturday, Sunday, legal holiday, or other day on which the court is lawfully closed.

     Pursuant to §16.1-340.1 Juvenile: The period of custody under a TDO must not exceed 96 hours prior to a commitment hearing unless the 96 hours terminates on a Saturday, Sunday, legal holiday, or other day on which the court is lawfully closed.

     Pursuant to §16.1-341 Juvenile: A Special Justice can continue a TDO for an additional 96 hours following a petition for a commitment.

PROCEDURES

I. INITIAL RESPONSE

A. Officers shall complete an ICR for all calls classified as a mental health problem.

B. Officers shall stabilize the incident and determine if the person in crisis is going to require further evaluation and/or treatment. If the responding officers have not completed the basic 40-hour CIT training, an additional officer that has completed the CIT basic course should be requested to respond.

1. If the incident remains stabilized and no other intervention is deemed necessary, officers should offer additional resources (i.e., green sheet). Officers may also FYI the ICR to the Prevention Services Unit (PSU) supervisors and CIT Coordinator if additional follow-up may be needed. 
2. If the person wishes to be evaluated voluntarily, family or friends should transport the person to the requested hospital. HPD can provide transport to an appropriate hospital if no other option exists. Rescue/EMS should only be used if there are extenuating circumstances or other medical needs.
3. If the officer determines that involuntary hospitalization may be necessary, they shall evaluate for an ECO.
   1. When evaluating a person in crisis for ECO criteria, officers should consider the subject’s previous history of mental illness, violence, and prior calls for service and consult with HMH staff.
   2. Consultation with HMH may be over the phone or consider utilizing WebEx for a video consultation with the subject in crisis. Further ECO procedures and criteria are listed in Procedure Sections II-III. 

C. Arrest vs. ECO

1. An ECO may be an alternative to arrest in low-level misdemeanor offenses, such as trespassing, larceny, etc. However, the arrest takes precedence in crimes of violence, especially crimes against persons,  including mandatory arrest for criminal offenses such as Domestic Assault. When in doubt, contact the on-call Prevention Services officer for additional guidance.
2. If the person being evaluated has active warrants that need to be served, the warrants shall be served prior to proceeding with mental health evaluation. In these cases, Henrico Sheriff’s Deputies and Jail nursing staff should be notified of any existing mental health concerns when transferring custody to the jail. The officer shall document these concerns in Arrest Builder.
3. An officer may be called to investigate when a person is hospitalized due to an ECO, TDO, or Civilly Committed to a medical or mental health treatment facility, and they commit a crime within that treatment facility. The primary officer shall consider the totality of the circumstances before executing an arrest:

a. The primary officer shall request that a Patrol supervisor respond to the treatment facility before an arrest is made.
b. The Patrol supervisor will evaluate the totality of the circumstances to determine the most appropriate course of action based on the risk of safety to the public if an arrest is not made.
c. HMH shall be notified of the situation and the potential course of action for the patient.
d. If a custodial arrest is deemed appropriate: 

1. 1. 1. The Watch Commander and/or the Commander of Prevention Services should be notified prior to transport.
      2. The Patrol supervisor should notify a Jail Supervisor of the circumstances, (refer to section I.C.2, Arrest vs. ECO).
      3. The primary officer shall obtain a copy of medical discharge paperwork to provide the jail nursing staff upon arrival.

e. If a custodial arrest is not deemed appropriate:

The primary officer may consider obtaining warrants on a later date or advising the reporting party to obtain warrants through the Magistrate’s Office. The primary officer shall complete an ICR detailing all parts of the investigation to include the notifications made as well as the final determination. 

4. Nothing in this policy precludes the officer from lawful detention while all factors are considered. 

II. CRITERIA FOR AN ECO

A. Under Code of Virginia §37.2-808, a law enforcement officer who, based upon their observation or the reliable reports of others, has probable cause to believe that a person meets the criteria for emergency custody  may take that person into custody and transport that person to an appropriate location to assess the need for hospitalization or treatment without prior authorization.

B. Per Code of Virginia §37.2-808, the criteria for emergency custody of an adult are met if the officer has probable cause to believe the person:

1. Has a mental illness and there exists a substantial likelihood that, as a result of that mental illness, the person will, in the near future:

a. Cause serious physical harm to himself or others as evidenced by recent behavior causing, attempting, or threatening harm and other relevant information, if any; or
b. Suffer serious harm due to his lack of capacity to protect himself from harm or to provide for his basic human needs;
2. Is in need of hospitalization or treatment; and
3. Is unwilling to volunteer or is incapable of volunteering for hospitalization or treatment. 

C. Per Code of Virginia §16.1-340, the criteria for emergency custody of a minor are met if:

1. Because of mental illness, the minor:
   1. Presents a serious danger to himself or others to the extent that severe or irremediable injury is likely to result, as evidenced by recent acts or threats; or
   2. Is experiencing a serious deterioration of his ability to care for himself in a developmentally age-appropriate manner, as evidenced by delusionary thinking or by a significant impairment of functioning in hydration, nutrition, self-protection, or self-control; and
2. The minor is in need of compulsory treatment for a mental illness and is reasonably likely to benefit from the proposed treatment.
   Under Code of Virginia §16.1-338 a minor younger than 14 years of age may be admitted to a willing mental health facility for inpatient treatment upon application and with the consent of a parent. A minor 14 years of age or older may be admitted to a willing mental health facility for inpatient treatment upon the joint application and consent of the minor and the minor’s parent.

III. EXECUTION OF AN ECO

A. Once an officer has probable cause for an ECO, based on above listed criteria, the officer should consider placing the individual under an ECO. 

B. Once a decision is made to place a person under an ECO, the officer shall notify HMH immediately by calling Mental Health Emergency Services Program at (804) 727-8484. The officer shall consult with HMH on an appropriate location for evaluation. Officers will be required to provide the subject’s name, date of birth, the ECO time and probable cause for the ECO.

C. The subject may be kept at their current location or transported to one of the following locations as decided by HMH: 

1. Crisis Intervention Team Assessment Center (CITAC) (Refer to Section IV, CITAC) currently collocated at Parham Doctor’s Hospital
   7700 East Parham Rd
   Henrico, VA 23294
   804-727-5780 
2. Henrico Mental Health
   10299 Woodman Rd
   Glen Allen, VA 23060
   Emergency Services Program (ESP) – (804)727-8484
3. Saint Mary’s Hospital 
   5801 Bremo Rd
   Richmond, VA 23226
   (804) 287-7112
4. Henrico Doctors Forest
   1602 Skipwith Road
   Henrico, VA 23229
   (804) 977- 5888
5. An emergency facility as dictated by the patient’s medical status. If the patient’s status requires transport to a facility outside of Henrico County, officers shall maintain custody of that subject and contact the local Community Services Board for that jurisdiction. The local community services board will perform the evaluation, not HMH.
6. Other locations may be agreed upon on a case-by-case basis.

D. The Explanation of Emergency Custody Procedures (Form DC-4050) shall be given to any person placed under an ECO regardless of the location chosen for the evaluation. 

E. An ECO Supplemental form, located within ICR Builder, shall be completed for all individuals taken into Emergency Custody, regardless of the location chosen for the evaluation. The custodial officer shall be  responsible for updating the supplemental form in ICR Builder throughout the process. PSU personnel shall review and analyze supplemental forms for quality assurance purposes.

IV. CRISIS INTERVENTION TEAM ASSESSMENT CENTER (CITAC)

A. When the CITAC is chosen by HMH to be the location for evaluation, the following procedures apply:

1. Prior to beginning transport, the primary officer shall call the CITAC, and notify the CITAC Officer that they are en route, and confirm that there is a room available.
2. Officers shall search the individual in custody prior to admission to the CITAC.
3. The primary officer will maintain custody of the subject until the mental health assessment determination is made. Officers shall ensure the subject is always in their sight while in their custody.
4. If HMH decides a TDO is appropriate, the primary officer will notify the CITAC officer and coordinate for transfer of custody.
5. The CITAC officer will conduct a search during the transfer of custody.
6. All transfers of custody should be documented in the ICR.
7. Officers shall secure the subject’s belongings, including medications, purses, wallets, etc., away from the subject in a secured location.

B. If a person escapes the CITAC while under an ECO/TDO, immediately put out a BOLO and request additional officers to respond to assist with searching the facility. Notify Patrol supervision and a Prevention Services Supervisor of the escape immediately.

V. ST. JOSEPH’S VILLA JUVENILE CRISIS RECEIVING CENTER (CRC)

A. The Juvenile CRC is an emergency room alternative for children and adolescents experiencing mental health crisis. The Juvenile CRC is a specialized alternative for rapid treatment, with the goal of diverting hospitalization and allowing youth to be served in their own community.

B. The Juvenile CRC will serve youth between 7 to 17 years of age. The Juvenile CRC is open 7 days a week for call and walk-in service. The Juvenile CRC does not accept ECO’s or TDO’s and is only a voluntary admission location.

C. Hours of admission are 8am to 8pm. Upon an individual’s arrival, they will receive an initial screening to determine appropriateness for Juvenile CRC services or other resources. Admissions to the Juvenile CRC will not extend beyond 23 hours, therefore it is not a bed-based program.

D. For voluntary admission, the primary officer may contact the Juvenile CRC at (804) 553-3201 to ensure space availability prior to the juvenile being transported by their parent/legal guardian. Officers can provide transport if no other option exists. If the Juvenile CRC is not available, refer to Sections I – III.

VI. EMERGENCY EVALUATION OUTCOMES

A. Temporary Detention is Recommended

1. The mental health evaluator will recommend to the Magistrate that a Temporary Detention Order (TDO) be issued.
2. The Magistrate will notify the DEC when the TDO is ready for pick up. In cases where HMH locates a psychiatric bed quickly, the Magistrate may notify the Henrico Sheriff’s Office to pick-up the TDO on the way to transport the patient to their destination.
3. The TDO shall be served prior to the expiration of the 8-hour time limit for the ECO.
4. The person shall remain in police custody until such time that: 
   1. A psychiatric bed is located, and custody is transferred to Henrico Sheriff’s deputies or other applicable law enforcement agencies for transport; or
   2. The individual has a hearing and is committed. If committed, the individual will be turned over to the hospital where the patient is located and will no longer remain in police custody; or 
      c. If the individual has a hearing but is not committed. The hospital will arrange for the discharge of the patient.
5. In situations where the Henrico Sheriff’s Office or other applicable law enforcement agency cannot make a timely response, an officer may serve the TDO and transport the person to the specified facility. A Patrol supervisor shall approve any transportation outside of Henrico County’s jurisdiction. Document in an ICR to include the transport agency and treatment location in the narrative.
6. Per state code §37.2-810 if the nearest boundary of the jurisdiction in which the person resides is within 50 miles from the nearest boundary of the jurisdiction in which the person is located (Henrico), the law-enforcement agency of the jurisdiction in which the person resides, or any other willing law-enforcement agency that has agreed to provide transportation, shall execute the order and provide transportation for that resident to the treating facility. See section XIII for a list of applicable jurisdictions. If the person under the TDO is a resident of one of these jurisdictions, the Custodial officer shall contact the jurisdiction of  residence and have them respond to maintain custody.

B. Voluntary Hospitalization is Recommended

1. If the individual is already present in the hospital or the CITAC, the custodial officer will transfer care to the facility’s staff and police custody terminates. The facility and HMH will arrange transportation for that individual.
2. If HMH evaluated the individual at any other location, family members or other means should be utilized for transportation. Officers can provide transportation if no other option exists.

C. Hospitalization is Not Recommended and Appeals

1. When the mental health evaluator determines not to petition for a TDO, the HMH evaluator will notify the officer who initiated the ECO of their recommendation.
   1. If the initiating officer is not present, the mental health evaluator will notify the officer who accepted custody of the individual.
   2. The officer who has custody will make reasonable efforts to contact the officer who originally initiated the ECO to communicate the evaluator’s recommendation within an hour. All efforts to contact the initiating officer should be documented in the ICR.
2. If an officer believes that a TDO should be obtained, after being informed by the mental health evaluator that a TDO will not be pursued, the officer will contact a member of the PSU to consult regarding the appeals process.
3. After consulting with a member of the PSU, the officer is responsible for notifying the mental health evaluator of their decision to concur or oppose the recommendation of the mental health evaluator.
4. If an officer opposes the evaluator’s recommendation, the evaluator will notify the Magistrate of their findings and facilitate communication between the officer and the Magistrate. The officer will communicate their probable cause to the Magistrate before the expiration of the period of emergency custody. 
5. The individual will remain in custody until the Magistrate has determined if a TDO will be issued.
6. In situations where the mental health evaluator does not recommend a TDO, and this decision is not contested, or the Magistrate declines to issue a TDO, the officer having custody of the individual shall return the individual to their original or other safe location.

VII. PAPER ECO’S AND OUTSTANDING TEMPORARY DETENTION ORDERS

A. A magistrate may be petitioned to obtain a paper ECO in accordance with Virginia Code. A paper ECO may be obtained for mental health calls, or when family members are requesting an ECO but the officer does not feel the required criteria have been met. 

B. If an officer is called to serve a paper ECO, the officer shall make all reasonable attempts to locate the subject, place them into custody, and take them to a location determined by HMH.

1. Officers shall follow all procedures listed in Sections I – III of this Directive.
2. The PSU may be called if further assistance or guidance is needed.
3. If the evaluation location listed on the paper ECO is outside Henrico County, contact HMH to determine the appropriate location for evaluation.

C. When an officer locates a subject for whom a Temporary Detention Order is outstanding, the officer shall detain the individual until a member of the Henrico Sheriff’s Office or applicable law enforcement agency responds to serve the order and provide transportation. 

VIII. TEMPORARY DETENTION ORDERS IN OTHER JURISDICTIONS 

A. Per §37.2-810, Henrico Police Division is responsible for maintaining custody of any Henrico resident under a TDO and located in a jurisdiction within 50 miles of the nearest boundary. (Refer to Section XIII for a list of these jurisdictions.)

1. The assigned officer should make contact with the affected jurisdiction for coordination.
2. Document in an ICR and utilize offense UCR Code 4302 – “TDO Outside Jurisdictions”. The date and time of the TDO service, the individual’s home address, and any other pertinent information should be included in the ICR. 
3. A Patrol supervisor shall approve any TDO assignment outside of Henrico County’s jurisdiction.

B. Police Division members shall contact Henrico Sheriff’s Office for transport. Document the time the individual’s custody was turned over to deputies for transport in the ICR.

C. In situations where the Henrico Sheriff’s Office cannot make a timely response, an officer may serve the TDO and transport that person to the specified facility. A Patrol supervisor shall approve any transport conducted by members of the Henrico Police Division while outside of Henrico. 

IX. MARCUS ALERT SYSTEM RESPONSE LEVELS (in accordance with VA Department of Behavioral Health & Developmental Services) 

A. Level 1 (Routine): The DEC will divert calls to 988 (Suicide and Crisis Lifeline).

B. Level 2 (Moderate): DEC team members will refer Level 2 calls to Henrico County CoResponder Teams, referred to as mobile response teams (hereinafter “MRT”) when marked on and available. When MRTs are not available, the DEC will refer Level 2 calls to the PSU. If that unit is not available, the DEC will refer calls to a CIT trained officer who will immediately collaborate with either the MRT or PSU.

C. Level 3 (Urgent): The DEC will dispatch Level 3 calls to officers, as well as Fire and EMS as needed, engaging behavioral health services when practical. An MRT will be dispatched and respond (see Section X); if available, officers that are CIT trained may be dispatched if MRT is not available. Officers shall utilize de-escalation and crisis intervention training to stabilize the situation.

D. Level 4 (Emergent): The DEC will dispatch officers without delay, as well as Fire and EMS as needed, engaging behavioral health services when practical. MRT will also be dispatched to respond if available. 

X. MOBILE RESPONSE TEAM (MRT) PROTOCOL 

A. Active Calls for Service

1. For a Level 3 call being dispatched, MRT will be dispatched by DEC if available. Appropriate Patrol units should also be dispatched.
2. For a Level 4 call being dispatched, the closest appropriate police units will be dispatched to respond. If available, MRT will also respond to assist with incident de-escalation and stabilization.
3. For other calls where further mental health assistance is needed, officers should contact a member of the PSU directly and the Mobile Response Team (MRT) will respond to the scene, if available. If no PSU member is marked on, the officer’s supervisor should use the on-call list established for PSU. 
4. If MRT determines an ECO is appropriate, refer to Sections I-III.

B. Prevention and Follow up MRT visits. Cases needing follow up will be scheduled for MRT follow up as needed. Officers may FYI ICRs to the PSU supervisors and CIT Administrator for MRT follow up. 

XI. SPECIAL SITUATIONS – MEDICAL ECO/TDO 

A. Code of Virginia §37.2-1103 states: upon the opinion of a licensed physician that an adult person is incapable of making an informed decision as a result of a physical injury or illness and the medical standard of care indicates that testing, observation, and treatment are necessary to prevent imminent and irreversible harm, a magistrate may issue, for good cause shown, an emergency custody order for the adult person to be taken into custody and transported to a hospital emergency room for testing, observation or treatment.

B. After the Magistrate has issued the Medical ECO, officers shall take custody of the person and assist in transporting them to the listed hospital.

1. Henrico Fire may facilitate the transport; however, officers shall maintain custody during the transport.
2. Officers shall maintain custody until either a medical TDO is issued, the patient is either admitted, or is treated and released, or the four-hour time limit expires, at which time the patient shall be released from police custody.

C. If during the medical evaluation, probable cause regarding the above is developed and given to the Magistrate, a medical TDO pursuant to §37.2-1104 will be issued. 

XII. FIREARMS AND F CODE

A. Seizure of weapons:

For weapons seized during mental health calls for service, officers shall follow Evidence and Logistics Procedures outlined in RP-02.

B. Prohibition on Purchase, Possession, or Transport of Firearms 

1. Code of Virginia §18.2-308.1:3 prohibits any person (i) involuntarily admitted to a facility or ordered to mandatory outpatient treatment pursuant to §19.2-169.2; (ii) involuntarily admitted to a facility or ordered to mandatory outpatient treatment as the result of a commitment hearing pursuant to Article 5 (§37.2-814 et seq.) of Chapter 8 of Title 37.2, notwithstanding the outcome of any appeal taken pursuant to §37.2-821; (iii) involuntarily admitted to a facility or ordered to mandatory outpatient treatment as a minor 14 years of age or older as the result of a commitment hearing pursuant to Article 16 (§16.1-335 et seq.) of Chapter 11 of Title 16.1, notwithstanding the outcome of any appeal taken pursuant to §16.1-345.6; (iv) who was the subject of a temporary detention order pursuant to §37.2-809 and subsequently agreed to voluntary admission pursuant to §37.2-805; (v) who, as a minor 14 years of age or older, was the subject of a temporary detention order pursuant to §16.1-340.1 and subsequently agreed to voluntary admission pursuant to §16.1-338; or (vi) who was found incompetent to stand trial and likely to remain so for the foreseeable future and whose case was disposed of in accordance with §19.2-169.3, to purchase, possess, or transport a firearm. A violation of this subsection shall be punishable as a Class 1 misdemeanor. The committed individual can appeal this decision in accordance with §37.2-821 or §16.1-345.6 for minors. 
2. Issuance of an ECO or TDO, without subsequent commitment, is insufficient to bar a person from purchasing, possessing, or transporting a firearm.

C. CCRE – “F Code”

Information concerning a person’s prior commitment history will appear as “involuntary (or voluntary) admission” on the person’s criminal record (CCRE) along with the date of admission. Officers may obtain this information by contacting the Records Management Section and specifically requesting an “F Code” CCRE be run on the subject, as a standard CCRE does not reveal this information.

D. Firearms Related Charges

State Code §18.2-308.1:3 makes it a Class 1 Misdemeanor for a person meeting the criteria outlined in section XII.B. to purchase, possess or transport a firearm. If an officer has reasonable articulable suspicion that a person meets these criteria and that person is in possession of a firearm, officers shall conduct an F Code CCRE check before placing charges. Officers placing charges pursuant to this code section shall maintain a copy of the CCRE report for court.

E. Weapons Release

1. The release of firearms seized based on commitment status or that were recovered in the Emergency Custody/Temporary Detention process shall be governed by Evidence and Logistics SOP EL-EVI-15 Firearm Release Procedures.
2. If the owner cannot provide documentation of eligibility to possess a firearm, the Division may hold the firearm for 30 days to ensure sufficient time has passed for the CCRE to accurately reflect the outcome of commitment proceedings. 
3. If the owner cannot provide documentation of eligibility to possess a firearm, they will be given the opportunity to transfer ownership of the firearm to another person not living in the same household in  conjunction with procedures set forth in Evidence and Logistics SOP EL-EVI-15.

XIII. JURISDICTIONS WITHIN 50 MILES BORDER TO BORDER 

A. Counties

1. Albemarle
2. Amelia
3. Buckingham
4. Brunswick
5. Caroline
6. Charles City
7. Chesterfield
8. Cumberland
9. Dinwiddie
10. Essex
11. Fluvanna
12. Gloucester
13. Goochland
14. Greensville
15. Hanover
16. Isle of Wight
17. James City County
18. King George
19. King William
20. King and Queen
21. Lancaster
22. Lunenburg
23. Matthews
24. Middlesex
25. New Kent
26. Northumberland
27. Nottoway
28. Orange
29. Prince Edward
30. Richmond County
31. Spotsylvania
32. Southampton
33. Stafford
34. Sussex
35. Westmoreland
36. York 

B. Cities

1. Charlottesville
2. Colonial Heights
3. Emporia
4. Franklin
5. Fredericksburg
6. Hampton
7. Hopewell
8. Newport News
9. Petersburg
10. Poquoson
11. Richmond
12. Williamsburg