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Home My WebLink AboutIC City Council Access Center PPTAccess Center Why do we need a Behavioral Health Access Center? What is the Business Plan? How Do We Pay for It? Iowa City Council Meeting March 7, 2017 1 Steering Committee Jessica Peckover, Jail Alternatives Janet Lyness, County Attorney Jan Shaw, MHDS Ron Berg, Prelude Diane Brecht, AbbeHealth Stephen Trefz, AbbeHealth Becci Reedus, Crisis Center Crissy Canganelli, Shelter House Steve Dolezal, Sheriff’s Office Dr. Rick Dobyns, University of Iowa/President’s Office Dr. Michael Flaum, University of Iowa Psychiatry Lance Clemsen, UIHC Emergency Department Levi Kannedy, UIHC Emergency Department 2 Crisis Emergency Room Psychiatric Hospitalization Crisis Center Homeless Shelter CMHC SA Tx Current ? ? Family / Natural Supports Law Enforcement 3 Currently – when someone is in a behavioral health crisis, they often wind up in an Emergency Room (or sometimes in Jail); ER’s are great places to go when you are having chest pain, or may be having a stroke,etc. but they are actually LOUSY places to go if you are in a behavioral health crisis. There are basically two outcomes: 1) go back to where you came from – which wasn’t working or you wouldn’t be in in the ER; or 2) get admitted to a psychiatric inpatient unit. The latter is often a very poor utilization of a scarce resource – and many times not in the best interest of the person Concern about lack of psychiatric beds statewide Lots of news about closure of Mental Health Institutes Does Iowa have enough psychiatric beds? Functionally – No! Structurally – Maybe Must look at the whole array of services 4 Who do we see in the ER and Psychiatric hospital? People in crisis – not necessarily people with serious mental illness People who have multiple, co-occurring problems including: Substance abuse Trauma (often complex and multigenerational) Homeless ness Joblessness / underemployment Criminal justice issues 5 5 5 Hitting the wall When people “hit the wall”, they go to the ER (we’ve taught them to) From there, the majority wind up in acute inpatient units …go to Midas, get a muffler If a hammer is the only tool you have, you tend to see most problems as nails 6 6 6 Crisis Law Enforcement Psychiatric Hospitalization Homeless Shelter Outpatient Mental Health Services Urgent Care Appts Substance Use Treatment Vision ~ 2010 ? Family / Natural Supports Primary Care Comprehensive Behavioral Health Access Center 7 This was the vision of the Johnson County System of Care group, circa 2010; It involved a substantially enhanced role in urgent care for the CMHC, the Crisis Center, the homeless shelter, and Prelude (then Mecca). Aspects include: 1) the development of mobile crisis capacity within the crisis center – (likely tied directly to law enforcement); 2) the development of protected urgent care appointments at the CMHC; 3) the development of respite beds and or crisis stabilization beds located at the homeless shelter; 4) a dedicated, protected detox bed at MECCA. General Emergency Room Behavioral Health Access Center Psychiatry (tele?) Dedicated 24/7 Staff A Vision for a Comprehensive Behavioral Health Access Center (~ 2011) Crisis Stabilization Beds (< 1 week) Peer Support Sub Abuse Treatment (Inc. detox) 23 Hour Beds (sobering up) Crisis Case Management Shelter Jail Diversion Rapid Rehousing Hospital Family & Natural Supports Primary Medical Care 8 This evolved to considering a behavioral health access center within UIHC – but does this really need to be hospital based? Is that the best use of hospitals? Looking at other Models San Antonio’s Restoration Center Kansas Model Miami Dade Model 9 Current BH Access Center ModelKey Elements Low Barrier Shelter (~ 40-60 “bed” capacity) Sobering Unit ~ 10 beds 23-46 hr. obs. beds ~ 10 beds Evaluation Capacity Psych PA, BSN/MSW Medical Security Food Shelter House Other Housing Longer SA Treatment ER / Psych Hospital Case Management (Short term) Law Enforcement Drop Off ER / Hospital Walk-in Community Agencies INFLOW i Natural Supports OUTFLOW Mobile Crisis Detox Unit 5- 10 beds Urgent care Primary Care Crisis Stabilization Beds (~5) < 1 week 10 Diverting unnecessary hospitalizations, and actually helping people Crisis stabilization Non-hospital based Short-term crisis case management Connect patients to ongoing supportive services Housing supports Vocational supports Substance abuse services General medical services 11 We need to start doing what works Common sense approaches Approaches that are working elsewhere Stop medicalizing everything Medicalize what makes sense to medicalize Use hospital-based resources appropriately Housing First People helping people 12 Situation Emergency Services (law enforcement, fire, EMS) in Johnson County and surrounding areas have seen an increase in behavioral health calls. These calls can be time intense, taking first responders away from other calls/duties There are two (costly) options for law enforcement: Jail Emergency Department *Both are overwhelmed by behavioral health needs National estimates indicate that 50-75% of behavioral health patients who present at local emergency departments could be better served at an alternative location in the community Other communities have developed “access centers” or campuses to provide a more appropriate solution for individuals either in behavioral health crisis or experiencing other psychosocial issues You’ve heard about this information and there is support. We would like to come speak to your individual councils and discuss these slides in depth. 13 Background Johnson County jail is over-capacity and the county is spending significant amounts to house inmates out of county Emergency Departments have seen an increase in the average Length of Stay (LOS) for behavioral health patients, as options are often limited Many residents in behavioral health crisis end up with mental health and substance use-related criminal charges Neither jail or the emergency department are the best environment to provide behavioral health intervention or resources for these individuals 14 Proposal-Options Our long-term vision for the Access Center includes the following elements: Sobering Unit Detoxification Crisis Observation (~23 hours) Crisis Stabilization (~5 days) Low-barrier Shelter (year-round) Expanded Mobile Crisis Outreach Coverage Medical Urgent Care from nearby Community Health Care Center and 24 hr telemedicine Due to funding, we could start with the following: 10-bed Sobering Unit 10-bed Detoxification 10-bed Crisis Observation (~23 hours) 5-bed Crisis Stabilization (~5 days) Low-barrier shelter (winter only, 5pm-8am) Mobile Crisis Outreach at current capacity 24 hr Medical assessment (telemedicine) and first aid 15 Assessment Excluding the Low-Barrier Shelter and Mobile Crisis Outreach, this staffing model would be used 24/7/365 but could be modified based on volume: 16 Assessment - Initial Financials *Municipality and Philanthropy revenue is current support of Winter Shelter **Mobile Crisis revenue is current support of program at current capacity 17 Initial Financials Capital Cost Projected capital costs: Up to $7 M 15,000-16,000 Square Feet Footprint remains the same for Phase 1 and Vision Proforma Phase 1 Projected annual operating budget: $2.46 M Personnel salaries: $2.1 M Projected revenue (current contributions + projected healthcare reimbursement) : $2.1 M Proforma Vision Projected annual operating budget (include salaries): $3.7 M Personnel salaries: $2.8 M Projected revenue from health care reimbursement: $2.1 M 18 Capital Costs Estimates Renovation ~ $5.2M New Construction ~$6M Pros and Cons 19 Background - Our Community Population Coralville – 20,608: 13.9% Iowa City – 74,220: 49.9% Johnson County – 34,492: 23.2% North Liberty – 18,225: 12.3% University Heights – 1,125: .76% University of Iowa – 31,387**: (21.1%) Arrest by Agency* CVPD - 11.7% ICPD - 56.8% JCSO - 10.4% NLPD - 6% UHPD - 1.1% UIPD - 11.2% Other - 2.8% Ambulance Transport* Coralville – 17.4% Iowa City – 58.9% Johnson County – 11.8% North Liberty – 7.4% University Heights - .3% University – 1.4% Other – 2.8% *5-Year Average **2014 Total Enrollment 20 Capital Cost Request by Jurisdiction Johnson County $2.5 M City of Iowa City $2.5 M Cities of Coralville & North Liberty $1.0 M Other JC Cities $0.5 M Total $6.5 M --------------- 21 Questions? 22 San Antonio CIT & Restoration Center Video https://www.youtube.com/watch?v=zSbFbv2Bs_0 23