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Crisis Center project to answer mental health needs

Austin Daily Herald - 10/9/2019

Oct. 9--Addressing the need for more mental health care providers and resources, Mower County will be able to have access to a new crisis center that's being built in the region within the next two years.

The Mower County Board was updated by Tim Hunt of Olmsted County and Lisa Kocer, Mower County Human Services director, on the regional crisis center that's being developed to serve 10 counties in southeast Minnesota during Tuesday morning's board meeting.

What will eventually be known as the Southeast Minnesota Crisis Center, the facility was proposed by a collaboration among Mayo Clinic, Olmsted Medical Center and the 10 counties in southeast Minnesota that are all part of the Collaborative Resource Education Services and Technology collaborative.

Olmsted County requested $5 million in state funding to build a mental health crisis center on its campus in southeast Rochester after donating land for the project. In March, Olmsted County commissioners learned that they received the maximum amount allowed under 2018 legislation that designated $28.1 million for mental health crisis centers statewide by the Minnesota Department of Human Services (DHS).

Because the DHS grant agreement was finalized at the end of September, much later than originally hoped for, a tentative timeline was created where construction can start in 2020, with a service provider being selected in January 2020. As of now, the facility aims to open by April 2021.

"There's some exciting things happening," Hunt said. "Having construction start in September was a bit aggressive, but the grant got finalized in September. The process was painless, but it took a lot of time."

State grant funding will cover the majority of the construction costs, but it does not fund the facility operations, which will be left up to Olmsted County, Mayo Clinic, OMC and National Alliance for Mental Illnesses Southeast Minnesota, according to the Med City Beat.

Through the project, there was hope that the behavioral health delivery system throughout the region could see enhancements through expanding access to timely services, as well as supporting partners across various systems to meet the needs of the communities. Those include: law enforcement, medical community, behavioral health providers and mobile crisis teams.

While it seemed the facility would be accessible to the 10-county region, Commissioner Polly Glynn asked Hunter if there were concerns about whether the limited number of beds provided at the crisis center would be a disadvantage to individuals needing assistance from a larger area, or if there would be a higher concentration of individuals coming from one county as opposed to another and take up beds.

"Is this more on a first come, first serve basis?" Glynn inquired. "16 beds for the 10 counties, is that unrealistic? It's such a big area."

Acknowledging those concerns, Hunt noted that on a given day, healthcare providers meet with 11 people per day for outpatient services, or services that don't require overnight stays, while the mobile crisis teams meet with one or two people per day. By those numbers, he doesn't believe that the space would be at capacity since many individuals would go through the hospital first to get medically cleared.

Stabilizing individuals or giving medication is not what the crisis center is going to be built for, Hunt emphasized, and that some might end up going to the emergency room. If they're in need of ongoing psychiatric treatment for the long-term, then the crisis center will not be the right place for them.

"We're looking to divert some of that flow," he said. "For people who may not need to be in the emergency room can go to the crisis center, and free up beds for those who need long-term treatment. They may not need to be in the emergency room first, and instead go to the crisis center for an assessment."

There was also an additional focus on helping children with behavioral and mental health problems who end up staying at a juvenile detention facility because there isn't a dedicated place for them to go and receive the treatment needed. Usually, the children are between the ages of 10-13.

"It's not the right setting for them, but that's all we have," Hunt said. "When we look at the need, keeping people at home safe is the end goal. Even with this, we still have people going to the hospitals and going to the emergency room when they don't need to do that."

Statewide, challenges to children's emotional well-being and development are common, which affect one in five young people. In Minnesota, 9 percent of school-age children and 5 percent of preschool children have a serious emotional disturbance, which is a mental health condition that could last longer and interfere significantly with the child's function at home and in school, according to DHS reports. Around 109,000 children and youth, birth to age 21 statewide need treatment for serious emotional disturbances.

County Administrator Trish Harren stated that Gerard Academy in Austin has placed 37 calls to county law enforcement during the last week, where staff had asked for assistance in de-escalating situations involving children who are emotionally disturbed and are there for long-term treatment.

"Is there an appropriate place for kids?" Harren asked. "Where do they go? It's almost counterproductive that Gerard has that many calls for law enforcement to come in and de-escalate the situation."

"It would depend on the kid," Hunt answered. "Probably here at the crisis center. It really depends on the situation."

However, Commissioner Tim Gabrielson felt that although the crisis center would be a good resource for many in the rural parts of Mower County and beyond, he stated that it was only a temporary fix to a larger ongoing problem that hasn't been addressed.

"This is bigger than any other things we're fighting for," Gabrielson said firmly. "We need to curb this at the beginning. I've talked to many people about this, and it's damn near impossible to address if we're putting band-aids on the problem. We need to start way earlier and intervening sooner. It's just my opinion."

Hunt noted that Gerard Academy provided a valuable resource for the community and for its children that need help overcoming trauma. He also acknowledged that preventative measures before individuals reaching the point of needing long-term residential programs would be beneficial.

"It's good to catch them before they're sent to Gerard for long-term juvenile treatment," Hunt said. "We're more focused on building skills-based coping methods and acute care."

Kocer shared that she agreed, but there was also a difference between what the crisis center would be used for, as opposed to the services that Gerard Academy provides.

"We would probably need to work with law enforcement and some groups for de-escalation training down the road," Kocer said. "It's a conversation we need to have, especially if they're wondering where they should be taking these individuals, either the emergency room or the crisis center? Feds have been looking at families first prevention to find the root causes of these issues, and what we can do for these families instead of putting them over at St. Marys in an intensive care unit bed when it's not appropriate."

Contributing to the shortages are a lack of healthcare providers in rural areas and the shortage of beds available at healthcare facilities. The state dictates where the individual gets placed by working with healthcare providers, but if there are no beds, then the individual could end up staying in jail for long durations of time and languish from not getting the needed assistance.

Under Medicaid, individuals who need mental health stays for treatment can only do it for short-term and must leave at the end of 10 days, either to go home or get transferred to another open facility for long-term care.

Often times, counties end up accruing additional expenses since they are responsible for the individual who needs to seek mental health assistance. With the shortage of beds, sometimes law enforcement ends up transporting patients to places as far as Fargo, North Dakota, or Sioux Falls, South Dakota, because there are no other closer options.

It was shared by Hunt that by addressing mental health needs, the crisis center would be focusing on different approaches to treatment that doesn't feel restrictive or clinical so that children and families could receive help.

"The design of the facility is very intentional," he said. "There are features so that people who come for treatment cannot actively hurt themselves. We're seeing a youth activity space for kids ages 7-10 that allows them to be active and move. We included two courtyards as an outdoor space, and a residential space. It's hard to get funding from the state to create safe environments and it's not a cheap solution. It's a big mess statewide. It's more about how do we answer the need within the parameters we're given."

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