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Butler County leaders delay mental health crisis center
Hamilton Journal News - 9/29/2022
Sep. 29—Butler County officials have tapped the brakes on an emergency mental health crisis stabilization center because more delineated plans and cost estimates are required before they can seek proposals.
Scott Rasmus, executive director of the Butler County Mental Health and Addiction Recovery Services Board, was hoping to issue a request for proposals this month for an emergency mental health crisis stabilization center but has postponed the RFP until January or February.
He told the Journal-News after having discussions with the three county commissioners — they have already committed $3 million in federal rescue funds and a portion of the vacant Care Facility — he has more work to do.
"You want to do it right and not to say we're moving too quickly on this, no I think we've been moving comfortably," Rasmus said. "But I think we need to look at metrics and make sure the unit itself and the timeframe of the levy are appropriate."
Officials countywide have talked about this for years, and Rasmus conducted two rounds of eight focus group meetings. Attendees were from a wide swath of the community including police, judges, clergy, doctors, elected officials, about 80 to100, all tolled.
He has also studied five models so far, two in North Carolina, two in Ohio and one in Oregon. Based on those models he is estimating a Butler County facility could cost $7 million to operate, which is up from the original price of $5 million to $6 million.
Commissioner Cindy Carpenter traveled with Rasmus to tour the two crisis units in North Carolina last month, one in Durham County that costs $7 to $8 million a year to run and another smaller one in the city of Henderson that costs $3 million to $3.5 million annually. The Durham County facility serves about 250 people a month and they are similar in size to Butler County.
Carpenter told the Journal-News they are taking the extra time because, "we will do everything possible to make sure that the crisis stabilization unit meets our needs and is as efficient and effective as possible, because it's being supported by taxpayer dollars."
"The commissioners have asked the mental health board to provide data from the entry points into the crisis stabilization unit," Carpenter said. "We want to make sure that we're building the right size facility to house it. We are continuing to look at a variety of solutions for homelessness and individuals with mental health and substance use issues who are in our county jail."
Commissioner T.C. Rogers told the Journal-News "there were no definite plans" and before they proceed they need to know "how you are going to run it and how much that costs."
Commissioner Don Dixon told the Journal-News recently "it's going to have to be a design build here."
"We're going to have to open it on a small scale, test it, see what the results are and then see where the savings are...," Dixon said. "My anticipation how it will start is small as a test prototype and see how it works and we'll build off of that."
Over the past several years there have been many conversations about what such a center would provide. Early on it was being called a "drop-off" center for the homeless people who experienced a psychotic incident or caused a drug-induced disturbance so police wouldn't have to take them to jail.
More recently the definition has been expanded to a place where police and family members can take people with mental illness who are having an episode. Rhonda Benson, director of the county's National Alliance on Mental Illness chapter, has said this type of facility has been needed for years.
"There's that gray area there where they're really too sick to be on their own at home but they're not sick enough to get them in anywhere," Benson said. "It would benefit not just the police but anybody can drop somebody off and they just help stabilize them and identify what type services they need."
The commissioners made the decision in May to shutter the county nursing home and use part of it for the crisis stabilization unit. Rasmus said his board has hired an architect to determine the design and cost of retrofitting the building. The $3 million the commissioners promised out of American Rescue Plan Act funding would likely go for those capital costs. The thought is to start with 10 observation chairs and 10 private rooms and potentially doubling the number of each down the road.
This model mirrors the two facilities they viewed in North Carolina, both facilities have communal space with 23-hour observation chairs as well as longer term treatment rooms. After patients are stabilized in the observation area they are either referred out for wraparound services or admitted for two to five days for further in-house treatment.
"It treats clients in an open area to address their crisis needs but also to allow them to socialize with one another without any walls and that helps because of the socialization piece, they get maybe some support, some suggestions from each other on resources," Rasmus said.
The MHARS board does not provide direct services to clients it provides funding to local providers like Sojourner Recovery Services who have their own facilities. Rasmus has said his board could provide services on a short-term basis but they must find an outside provider long-term, hence the RFP.
To pay for it, Rasmus said his board would have to ask voters to approve some form of a new tax levy to support the project. The board has two levies, a half-mill taxpayers approved in 1985 that generates $1 million annually and expires in 2024 and 1-mill approved in 2006 that generates $9.3 million and expires in 2025. Voters have strongly supported renewing these funding sources through the years, the last one by 73% in November 2020.
"We are slated for a levy next fall and that's still the thought process here, that levy would not only be for the crisis stabilization unit to support that but the community mental health system itself," Rasmus said. "We're just going over what that's going to look like, what type of levy, the size of the levy."
The commissioners must approve putting levies on election ballots for county agencies like the MHARS Board. Carpenter said she is not quite ready to ask voters for more money.
"We will see," she said. "I believe we can get the crisis stabilization center up and running before the commissioners have to decide whether or not to vote on a levy and at that time we'll have actual numbers in, the cost of operations."
The county has also discussed using some of the OneOhio opioid litigation settlement to fund the unit. The county has received the first installment of $232,669 from the settlement with some of the distributors and should receive a total of $3.8 million to $5.4 million over 18 years, depending on a host of still unsettled variables. Plus access to a share in $38.1 million$54.4 million more, as part of regional group of seven counties that will decide future funding distributions.
A settlement has also been reached with Johnson & Johnson but those details haven't been solidified. County Administrator Judi Boyko said early estimates are annual allocations of $97,243 to $138,919 over nine years for the county's share.
Rasmus said they have also applied to the state department for mental health and addiction for $750,000 -he said that looks "promising" — to put toward capital costs for the project and his board would be required to match that amount if they get the grant.
Rasmus said once they issue the RFP it will take three or four months to vet the proposals before they can award a contract for the program.
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