County prepares pitch for crisis center

November 22, 2018


Courtney Lawson said she’s seen the benefits of being available

“In my time at NAMI, I’ve been awed at what a difference 20 minutes can make,” the executive director of NAMI Southeast Minnesota said. “Countless times I have de-escalated a crisis in that short period simply by being present, validating and listening.”

She credited the organization’s peer-support specialists of doing that every day but said more is needed, which is why she carries hope for a proposed regional mental health crisis center in Rochester.

“We need a door to a welcoming mental health services that’s always open,” she said. “That’s how I envision the crisis center.”

She said she’s also experienced what can happen when that door is not available.

“Earlier this year, I lost my husband to suicide,” she told Olmsted County commissioners Tuesday. “While I try not to dwell on unanswerable ‘what ifs,’ I wonder what the outcome would have been if there was somewhere for him to go in crisis.”

Today, that place is often an emergency room, which can be a deterrent for people who know their stays could be hours or days before stable help is found.

As an emergency room doctor, Casey Clements said the ER’s doors are always open, but it’s not always the best answer for patients who fall in a gap between treatment options.

“They need mental health programming, which I can’t do in an emergency department setting, and they need someplace that is safe to be when you are not sick enough that you need to be in a hospital, but you are also not well enough that I’m sure I can send you home safely,” he said.

The answer for Lawson, Clements and variety of other collaborators is the proposed crisis center, which would tap into a portion of the $28.1 million state lawmakers earmarked for creating such facilities.

Outlining the need, Clements said the St. Marys emergency room sees more than 3,000 patients a year who are seeking mental health care, and at least 50 percent of the patients do not need hospital care.

Tim Hunter, Olmsted County’s regional programs director helping coordinate the crisis center project, said estimates show the facility could expect to serve an average of 11 people daily or 4,015 in a year.

While operational costs are uncertain — estimates range from $3.4 million to $4.6 million a year — Hunter said approximately 65 percent will be billable to health insurance. Other costs could be covered by various partners who will likely see reduced costs elsewhere.

He said Olmsted County could commit up to $475,000 without increasing its budget, based on shifting services to the center. “Those dollars are already being spent in the system,” he said.

Serving a 10-county region, the facility could also address circumstances that today require people to seek treatment in other parts of the state or across state lines.

“This will provide a true option,” said Nina Arneson, director of Goodhue County Health and Human Services.

While Olmsted County commissioners told county staff to prepare an application for up to the project maximum of $5 million provided by the state, Board Chairwoman Sheila Kiscaden said she has some concerns, noting the facility would work with adults and youth.

“I just have trouble seeing how this will work when its 18 beds,” she said.

Clements noted the state’s request for proposals requires a concept that will help youth and adults. He said 15 percent to 20 percent of the patients seeking mental health care in the emergency room are under 18 years old.

Hunter said preliminary plans for a site near county facilities in Southeast Rochester are being developed, but adjustments can be made, if needed.

The county must submit its application for the state funds by Dec. 14.

Deputy County Administrator Paul Fleissner said it’s unclear how many applications the state will receive, but the number could be low due to the daunting nature of the projects requested.

Bruce Sutor said the cooperative spirit of the local proposal is what makes it work. “There’s no one else doing it this way,” the Mayo Clinic psychiatrist said.

Olmsted Medical Center doctors Kathryn Lombardo and Jeff Gursky joined their Mayo Clinic counterpart in citing the need for the proposed facility.

“There are no available services,” Lombardo said of crisis mental health care, citing a growing need in the last 15 years.

County commissioners are slated on making a final decision on Dec. 6 regarding the proposed application for funding, but they indicated Tuesday that the next stop for the plan had their support.

“We have to try something,” Commissioner Jim Bier said.

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