Greene County’s jail is set to become one of five in the state to offer mental health treatment to inmates who need to be restored to competency before standing trial, part of an attempt by the state to address the need for services quickly and efficiently.

When suspects arrive at jail and await trial, they may be ordered by the court to be evaluated for mental health competency. Those deemed to be incompetent to stand trial often are ordered to receive competency restoration treatment. Previously, the only option for this treatment was to go to a state hospital to receive inpatient mental health treatment. With a recent surge in people who were determined to need the services in order to proceed with their criminal cases, the limited number of available beds left many waiting in jail for months.

As of Sept. 28, there were 35 inmates at the Greene County Jail awaiting an inpatient bed to receive competency restoration services. Statewide, there were 253 individuals awaiting admission into state hospitals and 57 waiting to be added to that list as of Sept. 14. At the same time, there were 267 evaluations requested, with about 50% estimated to be found incompetent, according to a presentation to the state’s Mental Health Commission.

This summer, the Missouri legislature amended statute to allow mental health restoration services to be provided within county jails and out in the community. With the new law, the state allocated $2.5 million to establish jail-based restoration programs across five counties, including Greene.

Jeanette Simmons is the deputy director for the Missouri Division of Behavioral Health. She said the program was based on similar programs in other states that have faced the same problem.

“We have more individuals needing competency restoration services than we have inpatient hospital beds,” Simmons said. “This is not just a Missouri issue; this is a nationwide phenomenon.”

The program aims to solve this by easing the demand for inpatient beds while cutting down wait times for people to get treatment.

Sheriff’s office questions use of resources but state says moving ahead

Although state authorities said work to implement the program in Greene County is moving ahead, the sheriff’s office expressed doubts.

Deputy Paige Rippee, public information officer for the Greene County Sheriff’s Office and the jail, said that while many inmates have been waiting for treatment for several months, the program would not be the most efficient use of the jail’s resources.

Rippee said in order to create space for treatment, the jail would have to shut down one to two units. The inmates who would be housed there for treatment would not fill the units to full capacity, she said, which would mean the space is not used in the most cost-effective or efficient way.

“It is something we have looked into, but it’s just not in the cards for us,” she said of the jail-based model.

Debra Walker, spokesperson for the Missouri Department of Mental Health, reiterated however that the state is still moving forward with implementing the program in Greene County and currently working out the details of the contract.

Ironing out the details

The program will operate using the state’s Forensic Mobile Teams, which include nurses, nurse practitioners and social workers. Two staff members from a local community mental health center also will be hired to work at the jail.

The two existing Forensic Mobile Teams were expanded with state funding in the most recent budget. One of these teams was established a couple of years ago. Currently, the teams are serving those needing restoration services in jails across the state regardless of county while they await inpatient treatment.

The jail-based program will also be implemented in Clay County, the City of St. Louis, St. Louis County and Jackson County. Simmons said other counties have already requested to be included if the program expands, though currently the services are limited. She said the counties were selected based on the volume of referrals that come from each jail — no surprise considering that these are the most populated areas of the state.

While an option, the jail-based model will not become the default.

“We don’t anticipate that it will be the answer for every client, but I think individually we can look at it and make those types of assessments and ensure that people are receiving those treatment services while they’re there,” Simmons said. “That’s the intent they would receive the same types of treatment services they would receive in an inpatient setting.”

Stephanie Appleby, the executive director of NAMI Southwest Missouri, said she is grateful the department is putting time, energy and effort into providing more resources, which previously have been very limited.

“I think it’s fabulous and long overdue,” she said of the program. “I hope it works.”

Appleby said she hopes this program and any future efforts can establish a more continuous network of care providers. Creating a playbook on an individual’s care that both law enforcement agencies and mental health professionals can reference to determine best ways to support those needing care is a way to ensure a more sustainable approach to address mental health in the community, she said.

Other treatment options

Outpatient treatment will also be an option for some in need of competency restoration treatment. Simmons said this program would allow people to receive the needed services at their local community mental health centers. Providing this as an option would be a court decision for those demonstrating that they would be successful while free on bond, she said. Individuals held on dangerous felony charges are not eligible.

Rippee, with the sheriff’s office, said there are concerns about this model of service as well. In order for those out on bond to get to these services, they might have to rely on someone else for transportation, along with other potential obstacles.

“Homelessness often goes hand in hand with mental health issues,” she said.

Those who do not have the resources to actually get to their outpatient competency restoration treatment provider or keep on top of their medication may not fully benefit from the program, she said.

More: In the year since 988 went live, here’s what a Springfield mental health provider has seen

Appleby also has concerns about the outpatient portion of the effort. She said inpatient care is generally always a better option, since in order for patients to be successful in outpatient, they “have to really want to live a self-directed life.” Many who find themselves within the criminal justice system are not at that point in their recovery, she said.

But Simmons said the department hopes to work on more ways to connect individuals with treatment before they are within the criminal justice system. Increasing awareness and education of current resources like the 988 suicide and crisis hotline and local behavioral health programs is a large part of this.

“We’ve got to look at getting more upstream to try and help individuals engage in treatment services,” she said.

Marta Mieze covers local government at the News-Leader. Contact her with tips and story ideas at mmieze@news-leader.com.

This article originally appeared on Springfield News-Leader: Missouri plans new mental health restoration program at county jails

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To close Suicide Prevention and Awareness Month, the Veterans Assistance Commission of Will County is hosting a family friendly resource fair.

VetFest 2023 will be held from noon to 4 p.m. Saturday at the Veterans Assistance Commission of Will County, 2400 Glenwood Ave., Joliet.

Features of the day include a bearcat pull (sign up on site), axe throwing (must be 10 and older), bags tournament, raffle baskets, face painting, bounce house, Mission BBQ food truck, resources for veterans and live music by Ukulele Moonshiners.

Proceeds from the event benefits K9s for Veterans and the Joliet Police Department’s Battle Buddies.

K9s for Veterans use trained service dogs to help veterans with post traumatic stress disorder “transition back to civilian life once their military service ends, according to K9s for Veterans.

K9s for Veterans hosted a ribbon-cutting ceremony for the opening of its new training campus on Wednesday, Feb. 15, 2023, in Joliet. (Gary Middendorf – gmiddendorf@shawmedia/Gary Middendorf)

Officers with the Battle Buddies program connect with veterans to prevent crises and after they experience negative events, the Joliet Police Department said.

Jen Solum, superintendent of Will County Veterans Commission, said the goal is to “let the community know where available resources are.”

“We wanted to raise awareness in the community specifically about mental health and suicide prevention and awareness,” Solum said. “We’re more aware of it today and there are more resources available. As the wars are winding down and people are getting out of service – people who have been in combat and are coming back to the civilian sector – did not have resources when they were in the military.

“Mental health still has so much of a stigma; they [veterans] hesitate to reach out for help. We’re seeing issues with substance abuse as a coping skill if they’re not getting treatment. That has a snowball effect. We want to work more on the preventative aspect and not the reactive side of it.”

Sgt. Chris D’Arcy (left) and Officer Jeremiah Eaton (right) speak to the Joliet Herald-News about the departmentÕs Battle Buddies program on Thursday, May 27, 2021, at the Joliet Police Department in Joliet, Ill. (Geoff Stellfox – gstellfox@shawmedia.com/Geoff Stellfox – gstellfox@shawmedia.com)

Resources for Will County veterans

Solum said many people don’t realize all the community partners the Veterans Assistance Commission of Will County has, the varied services the commission offers and the counselors that provide one-on-one or group therapy.

Many people don’t know that the commission acquired a cane corso therapy dog named Charli about 18 months ago, Solum said.

“She is 100% of a slobbering mess, and she’s still growing,” Solum said. “She is a gentle giant.”

Solum said K9s for Veterans helped with Charli’s training.

But veterans need more than resources, Solum said. Veterans need to know the community supports them. That’s why an event built around veterans’ mental health has fun aspects to it.

“It takes the entire community to support a veteran,” Solum said. “We want people to come out with their kids, with their neighbors. So a bounce house is one way to encourage people to come out. Really, probably almost everyone knows a veteran or has a neighbor that’s a veteran or seen a veteran on the side of the road holding up a sign. I don’t think this [event] should be pigeon-hole to just veterans. I think this is a community issue.”

IF YOU GO

WHAT: VetFest 2023

WHEN: Noon to 4 p.m. Saturday

WHERE: Veterans Assistance Commission of Will County, 2400 Glenwood Ave., Joliet

ETC: Bearcat pull, axe throwing (must be 10 and older). bags tournament, raffle baskets, face painting, bounce house, Mission BBQ food truck, resources for veterans and live music by Ukulele Moonshiners. Benefits K9s for Veterans and the Joliet Police Department’s Battle Buddies

INFO: Call the Veterans Assistance Commission of Will County at 815-740-8389 or visit veteransassistancewillco.org.

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After years of work, Larimer County officials gathered in southwest Fort Collins Friday morning to officially cut the ribbon on the Larimer County Behavioral Health Services at Longview Campus building.

The multi-level building that sits on a 40-acre lot at the northwest corner of Trilby and Taft Hill Roads serves as the culmination of a mental health initiative led by the county and funded by a 2018 sales tax of 0.25%.

Larimer County Commissioner John Kefalas, left, participates in a Native American sweet grass blessing with Zach Rockwell, right, at the opening ceremony for the new Larimer County Behavioral Health at Longview Campus in south Fort Collins. (Jenny Sparks/Loveland Reporter-Herald)

Jody Shadduck-McNally, Larimer County commissioner, welcomed the large group of county and other local officials Friday morning, starting off by asking if anyone there had been themselves or had family impacted by mental health issues; many of those gathered raised their hands.

“It (is) important to know that this impacts our community more than people may know,” she said.

The facility, which will be operated by SummitStone Health Partners who will work in collaboration with area hospitals and outpatient behavioral health providers, is meant to serve as a single location for a variety of mental health crises, according to previous reporting. The building houses its own pharmacy, therapy rooms, a full withdrawal management — or detox — wing, a full-service kitchen and a docking bay for ambulances and law enforcement dropping patients off.

Patients are expected to be accepted into the center by early December.

Shadduck-McNally spent several minutes thanking the large group of individuals who helped make the building possible, from those who were with the county years ago to those who are still there today. She also thanked the SummitStone team, who she described as a “cornerstone” partner, as well as the county voters who “overwhelmingly” supported it, adding this creation of this facility may not have been possible in other communities but was in Larimer County because of how everyone worked together.

People walk through the lobby of the new Larimer County Behavioral Health Services at Longview Campus Friday. (Jenny Sparks/Loveland Reporter-Herald)

“This took a community,” she said. “This took a village. And this took an entire county.”

Michael Allen, CEO of SummitStone, also thanked the many people who made the project possible and who came to celebrate Friday. He said that as of now, the facility has hired 75% of the staff that will be needed to run it.

“We will be ready for you when we open in December,” he said.

Friday’s event also included a land acknowledgement, which featured a sweet grass blessing to a large portion of the crowd and several dances by the Iron Family, a third-generation group of Native American performers; each dance represented different stories and ideals such as love for the earth and relief from grief and mourning, among others.

Jan Iron, in speaking to the crowd, said that being able to come and be part of land acknowledgements and being able to perform like this helps continue the memory of those who came before them and and celebrate their lives.

She added she appreciates those who will work to save and help those in need no matter what.

An official ribbon-cutting on the building and self-guided tours followed, allowing those who came to go inside and see what there is to offer.

Allen said getting to see the building after the years it took to get it finished was surreal but important, saying that it is going to change the Larimer County community.

“This facility is one more tool in our arsenal to (lower) suicide rates,” he said. “Because one suicide is too many.”

Shadduck-McNally said the campus was named both for the literal view around the facility and its proximity to the Long View Trail, but also for its connection to how the building will approach mental and behavioral health care, focusing on the long view of helping those in need. She said the center will show compassion, equity and a belief that mental health is a “fundamental right for all.”

“This is only the beginning of our journey for mental health and behavioral health (services) in our county,” she  said.

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Ames Police officers are not ashamed to talk about their struggles with mental health. And they say you shouldn’t be ashamed either.

Several officers appear on camera in a promotional video for the Sept. 25 Story County Mental Health Expo to talk about their mental health diagnoses.

Ames Police Commander Jason Tuttle is among the personnel featured. As an early responder to the June 2, 2022, shooting at Ames’ Cornerstone Church, which left three people dead, Tuttle experienced physical and mental symptoms in the wake of the tragedy.

With his wife’s and fellow officers’ support, he sought professional help, which has made a difference.

“I’ve been in therapy for the last year,” Tuttle said in the video. “I feel much healthier, both physically and emotionally today.”

He shared his story so others wouldn’t feel alone in their struggles.

“It’s okay to not be okay,” he said.

More: Cornerstone Church first responder receives city’s highest honor with Award of Valor

Story County Mental Health Expo is free

The Story County Mental Health expo is entering its eighth year, which has grown annually. About 400 people attended in 2022, said Ames Police Department mental health advocate Julie Saxton.

“It’s free. It’s always free — admission, parking, food, everything,” she said. “We’ll have more than 35 vendors and keynote speaker Kai Roberts.”

The event runs from 6 p.m. to 8 p.m. Monday, Sept. 25 in the Great Room at the Iowa State Memorial Union.

Kai Roberts

Kai Roberts will perform “Mental Health Through Music” at 7 p.m. The Pennsylvania-based mental health advocate uses hip-hop to share how he has dealt with anxiety and panic attacks.

“We always have such amazing keynote speakers from different backgrounds, with different experience,” Saxton said. “I think Kai will really relate with college students, but also with all ages. I think we can all relate to having anxiety.”

Youth suicide numbers are ‘astronomical’

The annual Mental Health Expo is held in conjunction with suicide awareness month.

The number of people in mental health crises is overwhelming, Saxton said. Last year, she received 2,800 mental health calls for service and responded to 2,500.

“Twenty percent of those calls were people who were actively suicidal,” she said.

At least one person in her daily call log is suicidal, and it’s often more than one.

“The number of youth that have died by suicide in Story County is astronomical,” Saxton said. “And the numbers are higher than even reported, because sometimes the family members don’t want to admit that’s what it was.”

More: Iowa’s gender-affirming care ban is chasing transgender kids out of state for medical care

Saxton’s figures don’t include calls to Iowa State police, medical providers or social service organizations.

“There are many more people struggling that we don’t know about,” Saxton said. “Every therapist is full, the waiting lists are longer, especially if you’re a new patient.

“We’re also lacking medication providers, like psychiatrists — that’s countywide, statewide and nationwide.”

People on Medicaid take even longer to get treatment because “a lot of agencies and clinicians just don’t want to have to deal with it,” she said.

“It doesn’t make a lot of sense. It’s no different than being treated for a broken bone, going into the emergency room and being treated immediately,” Saxton said. “But it’s not at all the same for people who are struggling with mental health.”

Social media contributes to mental health issues

A combination of factors have contributed to the rise in mental illness, Saxton said.

The coronavirus pandemic forced many people to isolate, specifically having an effect on youth development.

“Our students don’t have coping skills and they are not resilient,” she said.

Social media can also play a role, which often is the root of anxiety and depression, Saxton said.

“We collectively are saying it’s okay to have a culture of hate. What I mean by that is: every community has a social media page, like Ames People,” Saxton said. “And if you are even looking at it, you are contributing to that.”

Although citizens have a right to free speech, she said, there are consequences. One of the consequences is a decline in mental health.

“It’s a cesspool of hate, misinformation, made up information, and that’s allowed,” Saxton said. “It’s a place for adults that are creating hate and anger, which we know as providers contributes to the decline of mental health.”

She said social media allows people to say whatever they want with no consequences, hiding behind their computer screens.

“My question to the community is, ‘Why is that okay?’” Saxton said.

The theme for the 2023 Story County Mental Health Expo is “Escape for overcoming anxiety and intrusive thoughts.”

A suicide prevention training is offered at 5:30 p.m. prior to next Monday’s expo. The hour-long class will give residents the skills to identify suicidal behavior and crisis.

As the Ames Police asks in their Mental Health Expo promo, “What’s preventing you from reaching out?”

If you or a loved one are having thoughts of suicide, call 988 or reach the 24-hour crisis line at 855-581-8111.

Ronna Faaborg is a reporter for the Ames Tribune. Reach her at rlawless@gannett.com.

This article originally appeared on Ames Tribune: Hip-hop artist is keynote for Story County Mental Health Expo

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For a little more than a decade, UNC Health Care has provided care at WakeBrook, the mental health hospital in east Raleigh. Wake County owns the facility, but UNC has been the care provider. Earlier this year, UNC Health announced it will transition away from WakeBrook, a move advocates say will leave a hole in care for some of the most vulnerable patient populations in the area.

“If their needs are such that they really need a qualified psychiatrist, [or] really good psychiatric hospital beds, those aren’t going to be available anymore,” said Ann Akland, a past president of the National Alliance on Mental Illness (NAMI) Wake County and a longtime advocate for mental health services in and around Wake County. “I’m terribly concerned for the welfare of patients who have no insurance in particular, because there has to be a place for those people to go.”

County health leaders say they are well prepared to absorb these patients, and say more new care options are just over the horizon.

The WakeBrook facility sees patients with substance use disorder and severe psychiatric diagnoses, including schizophrenia. It has crisis assessment services to treat people in active mental crisis, alcohol and substance use detox unit, and 28 licensed inpatient psychiatric beds where patients can sometimes stay for days while recovering from an episode.

Many WakeBrook patients rely on Medicaid or Medicare or do not have health insurance. Of the 485 patients who received service at WakeBrook in fiscal year 2022, just two had commercial insurance, according to UNC regulatory filings.

Because of this, their care is often filed as charity or uncompensated care from a business perspective. On Aug. 16, Wake County announced RI International would become the new provider of WakeBrook.

When UNC leaves WakeBrook, care for nearly all of these patients will fall to other providers. Much of that will fall to RI, but WakeMed Health and Hospitals will also absorb some of the patients. Despite the similar sounding names, WakeBrook, WakeMed, and Wake County are different entities and have no shared management or ownership.

“The needs around caring for those with mental health conditions will take all of the health providers in this community working together to develop and provide solutions,” according to a statement released by WakeMed. “WakeMed will continue to collaborate with the County and other organizations on collective solutions that better support a healthier community.”

From hospital-based to peer-led care

RI operates differently than UNC in a variety of ways, mainly that it is not an academic medical center and does not staff its facilities with as many medical doctors. It operates a more peer-led model with trained counselors, some of which have endured mental health episodes themselves, said Sean Schreiber, chief operating officer of Alliance Health, the managed care organization for publicly funded behavioral health care services in a six-county service area, including Wake.

“They’re actually kind of the founder of something called the Living Room model, which builds a lot of peer supports, and really makes sure that when people come to a crisis facility, it’s kind of a warm and welcoming experience to kind of help lessen the trauma,” said Schreiber. “I think UNC being a health system and academic medical center, operated that campus a little bit more like they might operate a large health system. It was staffed very much like an emergency department may be staffed.”

Schreiber said one noticeable difference to patients would be right at the front door, especially for an involuntary commitment.

“[Currently] you’re greeted by a law enforcement agency who’s taking custody of that individual,” Schreiber said. “RI uses peers. So someone who’s had lived experience; experienced mental health crisis themselves.”

Another difference is simply in language. RI refers to the people it serves as “guests” instead of “patients” or “clients.”

But some advocates worry that without hospital level care, it could leave certain patients without an option. Advocates like Akland say trained peer counselors can often provide good quality care, but some extreme cases require higher levels of care.

While RI does not staff its facilities with emergency room doctors who specialize in heart attacks or other physical injuries, it does staff with licensed psychiatrists as well as nurses with specialized psychiatry training, according to RI Chief Operating Officer Joy Brunson-Nsubuga. The RI model also seeks to work out partnerships with hospitals so they can bring patients in need of that kind of medical care to those emergency departments. In return, RI offers to take patients they can serve out of those EDs.

“RI prides itself in being that base and that diversion from jails, from EDs. Making sure that individuals get that level of care they need without going to a hospital level of care,” Brunson-Nsubuga said.

Brunson-Nsubuga estimated that about 3% to 6% of RI’s “guests” are taken to emergency rooms. She said it’s likely that more patients would actually be diverted away from an ED to an RI facility than the other way around.

Opioid overdoses soar during pandemic

As the opioid crisis ripped through the United States, governments – including in North Carolina – put in measures aimed at lowering deaths. These measures had limited success with 2018 and 2019 recording fewer opioid overdose deaths than in 2017, a year that was at that time a record high.

But the pandemic washed away all those gains. Opioid overdose deaths increased 72% from 2019 to 2021.

N.C. Department of Health and Human Services

Opioid overdose death rate in North Carolina by year.

Some advocates say licensed medical providers are needed now more than ever, as the animal tranquilizer xylazine makes its way into street drugs like heroin. Akland was also concerned about patients who cannot afford to pay. Holly Hill hospital sits just across the street from WakeBrook, but it is a for-profit hospital and more than 30% of its patients last fiscal year had commercial insurance, according to regulatory filings.

“When you have something that’s like a medical model based, the cost is always going to be higher than some of the community based services,” said Schreiber.

Wake County Chief Medical Officer Dr. Jose Cabanas said RI’s model more closely matches what the county needs and will allow the facility to treat more people. He based that off recommendations from a May report by Human Services Research Institute (HSRI) which assessed the county’s behavioral health crisis service system. He lamented that there would be a gap in service during the transition from UNC to RI, but said the timing gives the county an “opportunity to align some things based on those recommendations from that report, and definitely RI hits those points.”

Cabanas emphasized the move was not simply to save the county money, but to spend money in a better way. He said he hopes that offering care to more people will reduce the number of people who need high level crisis interventions.

Negotiations between UNC and Wake County soured

In February, Wake County Manager David Ellis and then UNC Health Chief Operating Officer Steve Burriss met to discuss the future of their relationship at WakeBrook. After that meeting, Burriss informed Ellis that UNC would no longer provide care, and would wind down services well into 2024. That set in motion months of negotiations that at one point seemed to near a resolution, but that ultimately ended contentiously and with UNC planning to wind down operations on Sept. 30, months earlier than initially proposed.

It is not entirely clear how talks between the county and UNC broke down. Through a Freedom of Information Act request, WUNC received emails from the county between Ellis and Burriss that seemed to show a 5-year extension had nearly been reached, only for it to fall apart days later. These emails paint only part of the picture, though, as the two leaders also held face to face meetings. Clearly, though, talks broke down quickly and irreconcilably.

“In all honesty, I am extremely disappointed not only in the outcome and I no longer believe UNC was negotiating with us in good faith,” Ellis wrote in an email to the board of county commissioners and county senior staff. “First, they publicly mischaracterized their initial meeting with us, blaming the County for not wanting to enter into a long-term funding and operating agreement when they informed us they were pulling the plug due to financial considerations and once the County met their request they moved the goalposts.”

WUNC filed a FOIA for emails from UNC Health on June 22, but had not received those emails by publication. In a written statement, UNC blamed the county for the breakdown.

“Our leaders were committed to negotiating a sustainable, long-term contract, but were unable to persuade Wake County officials, who were relying on inaccurate financial projections,” according to the statement.

Burriss left UNC Health Care to become chief operating officer of Orlando Health. His first day was July 24.

Separately from WakeBrook, UNC Health has said it wants to shift to focus to adolescent and family mental health and formed a new partnership with N.C. Department of Health and Human Services to operate a psychiatric hospital for children and adolescents in Butner.

“UNC is working toward a new emphasis on behavioral health that is broader than our current work at the WakeBrook campus,” Burriss wrote to Ellis in the February letter.

More care options

Even though UNC Health will leave WakeBrook, the county has more care options for marginalized patients, and more services are on the way, according to county health leaders.

For one, WakeMed in February received regulatory approval to build a 150-bed psychiatric hospital in Garner. That hospital’s planned opening date is not until 2026, but in June, The Hope Center for Youth and Family Crisis began treating people at its location in Fuquay-Varina. There’s also the Wake Behavioral Urgent Care in south Raleigh and other facilities like Triangle Springs, Healing Transitions, and Morse Clinic.

The county has also equipped emergency services personnel with Narcan kits, which can reverse an opioid overdose, and started a nurse navigator program to better triage 911 calls.

Wake is one of the few North Carolina counties to already allocate funds from the landmark opioid settlement. These funds are aimed at helping some of the same patient populations treated at WakeBrook.

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Fort Worth resident Christopher Blake never considered sharing the trauma from his military service when police profiled him two decades ago. 

Then, three years ago, he started therapy.

Blake, a 39-year-old Black man, had the “tough-it-out” mindset. For many communities of color, the sense is that such a mindset, not unusual in mental health discussions, has contributed to higher rates of suicides. The psyche is so deeply ingrained in some people of color that even among those who have embraced conversations about mental health, barriers to actually seeking care still exist. 

“It’s a pride thing — why you don’t want to admit that you may have some kind of mental health issues,” he said.  

Blake turned to therapy after developing suicidal thoughts, he said. He became aggressive and confrontational, and he would get triggered if someone raised their voice at him, or if he saw a weapon that wasn’t in his possession.

He calls himself a “short-ticking time bomb” — he always watches his surroundings, and he makes up negative scenarios in his mind even though nothing is wrong. 

“As I’ve gotten older, it has gotten worse,” he said.  

Lower reporting rate, higher suicide percentage

In 2020, people of color were generally less likely to report experiencing any mental illness or substance use disorders compared to their white peers. 

Just over 28% of Black adults and 27% of Hispanic adults reported having a mental illness or substance use disorder in 2020, compared to 36% of white adults, according to Kaiser Family Foundation, a health policy research nonprofit. 

However, the nonprofit found that a lack of culturally sensitive screening tools to detect mental illness along with structural barriers — including racism and socioeconomic disparities — may contribute to the underdiagnosis of mental illness among people of color. 

The death rate by suicide also rose faster among people of color between 2010 and 2020 compared to their white counterparts.

‘I feel like I should be OK to get through everything’

Chris and Martha Thomas understand the pain of losing someone to suicide. 

Their daughter, Ella, died by suicide in 2018. The Thomas family had heard about some microaggression toward their daughter, who was biracial, but they said they genuinely didn’t know the depth of their daughter’s pain. 

Chris and Martha Thomas, co-founders of The Defensive Health, pose for a portrait July 12, 2023, at TCU’s Debate Chambers inside Scharbauer Hall. The organization focuses on increasing mental health awareness for young people of color. (Dang Le | Fort Worth Report)

Following Ella’s death, the Thomases co-founded The Defensive Line along with their son, NFL player and Coppell High School graduate Solomon Thomas. The organization serves everybody but focuses on the needs of young people of color. This summer, the family spoke at TCU about raising awareness of mental health issues for minorities.

“A lot of times, people feel like, ‘Because our ancestors have been through so much, I feel like I am embarrassed about the fact that I’ve gotta talk about my mental health. I have people go through Jim Crow or slavery or discrimination, I feel like I should be OK to get through everything,’” Chris Thomas said. 

Challenges for minorities in addressing mental health

While research has shown that minority groups aren’t more likely to have mental health challenges than the population at large, they are less likely to seek or receive services from a mental health organization, said Brian Villegas, senior director of Adult Behavioral Health services at My Health My Resources of Tarrant County.

Mental health resources

MHMR of Tarrant County offers resources for people struggling with mental health

ICARE Call Center: Toll-free call/text at (800) 866-2465

If you are in a crisis, the Mobile Crisis Outreach Team provides a combination of face-to-face, 24-hour crisis services to children, adolescents and adults in Tarrant County, including:

• Emergency assessment for treatment at a clinic or a community location
• Urgent care
• Crisis follow-up
• Relapse prevention

Help Me Grow North Texas provides an information line that connects a family or provider to child development services and other community-based resources within your area. Children through age 5 are eligible. Contact 844-NTX-KIDS.

Help Me Thrive North Texas provides resources at no cost for families with children and teens ages 6 to 18. Contact 844-NTX-TEEN.

Many reasons are cited for this, from limited availability of services in local communities, mistrust of the health care system and language barriers that affect minority communities in getting help, Villegas said. 

“I’ve noticed in my encounters with patients that they feel discriminated (against) at times and that they don’t have the same right to access the resources that we all have available to us,” he said. 

The stigma around mental health discussions

As an Indian immigrant, TCU student Rini Cherian has witnessed many people in her community having a crisis, but that they wouldn’t go to counseling. They’d just brush the matter off because they don’t know of anyone to talk to, she said.

Cherian didn’t have access to mental health resources until college, despite a history of abuse and adverse childhood events she experienced as an immigrant, she said. 

Cherian is studying to become a psychiatric nurse practitioner. She left out the psychiatric part when she told her parents about her choice, she said. 

“We do have a lot of cultural barriers because a lot of our parents don’t believe in getting help,” she said. “It’s like, ‘Oh, that’s not real.’”

Vorice Perryman, director of Youth Intensive Services at MHMR of Tarrant County, said his job involves working with young people and educating their parents. Numerous times, his young patients told him that the people in their lives didn’t understand how they felt. 

The key component is “being able to provide,” Perryman said. His team works to educate and involve all of those in the family dynamic to help them better address mental health challenges common among their young people. 

Minority mental health care disparities

The Kaiser Family Foundation found that Black, Hispanic and Asian adults were less likely to receive mental health services than their white counterparts. 

“It’s important to talk about the topic because there’s so many barriers to mental health care. So yes, talking about suicide, talking about anything mental health related —  it’s so important,” Cherian said. 

Some people would believe that their mental health problems would eventually go away and that they would feel better once their lives stabilized, Villegas said. 

The opposite is true. 

“They keep getting into other challenges that keep compiling and compiling: anxiety, depression, post or post-traumatic stress disorder, so it augments,” he said. 

MHMR of Tarrant County welcomes those who believe they’re isolated or discriminated against and mistrust the system, Villegas said. The center has focused on building a diverse staff and professionals at the clinics while listening to the focus groups in the community. 

Chris Thomas of The Defensive Line has his own story as a Black man. He said he never talked about mental health, but he has realized that it doesn’t affect any specific demographic. 

“It impacts everybody — socio-economics, demographics, race, gender, so we’ve got to find a way to talk about it so people know that it’s an issue and that it can be addressed,” he said.

Dang Le is a reporting fellow for the Fort Worth Report. Contact him at dang.le@fortworthreport.org or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.

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The Mental Health Project is a Seattle Times initiative focused on covering mental and behavioral health issues. It is funded by Ballmer Group, a national organization focused on economic mobility for children and families. Additional support is provided by City University of Seattle. The Seattle Times maintains editorial control over work produced by this team.

People in a mental or behavioral health crisis were turned away from treatment at facilities in the Seattle region 1,173 times last year, according to a new report from King County’s Behavioral Health and Recovery Division. 

The reason people are denied treatment isn’t a lack of available beds, the report shows. It’s frequently a slew of other causes like being too acute or sick, having a history of aggression or use of restraints, or having autism or other cognitive or developmental disabilities. 

Ultimately, the data demonstrates how the most vulnerable patients in the system also struggle the most in accessing care — and few facilities and staff are equipped or willing to take on the most complicated and difficult-to-place patients.

The report found that facilities on average decline people 25% of the time, though the person could later be accepted at a second or third facility after an initial decline. This rate is similar to the decline rate for 2021.

“[Facilities are] just not staffed or oriented towards taking care of people with complex needs,” said Paul Getzel, the director with the local Seattle chapter of the National Alliance on Mental Illness, an advocacy nonprofit that supports family members and people living with mental illness and substance use.

Often he hears from parents of adult children who have a hard time finding the right facility for their loved one in crisis and are fighting to keep them from falling into the criminal-legal system. 

“What we’re concerned about is getting folks into care and not jail,” Getzel said. 

The county’s annual report analyzed how often people are turned away at nine local facilities, including residential treatment facilities like Telecare and Recovery Place; free-standing psychiatric hospitals like Navos, Fairfax and Cascade; and traditional hospitals that provide crisis care like Swedish Ballard, MultiCare, Harborview Medical Center and the Geropsychiatric Center at the UW Medical Center. 

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To get a bed at one of these facilities, a person must go through a lengthy process, starting with an evaluation from a designated crisis responder. If they find that a person in crisis meets the threshold for involuntary treatment because they are a danger to themselves or others, or are so sick they cannot care for themselves, they will be detained for up to five days. A judge will then order their civil commitment for an additional 14 days, with additional extensions if that person has not stabilized. 

Once they arrive at a facility, people typically receive medication for their mental illness and intensive group and individual therapy. 

However, those who don’t get accepted to a facility generally stay in a hospital emergency department or medical unit under what’s known as a single-bed certification, a temporary license that allows them to hold someone for up to 30 days while a proper bed is found. Critics of this practice argue it is a far cry from adequate treatment, and sometimes staff in those more generalized departments lack training or expertise in caring for psychiatric patients with severe illnesses or substance use disorders. If the patient in crisis doesn’t get a placement on time, they are ultimately released without treatment. 

While King County’s data doesn’t indicate whether a person who was declined at one facility was ultimately accepted by another, it’s clear that many people are having trouble finding a placement: According to a Seattle Times analysis of data from the Washington Health Care Authority, an average of 443 people a month in King County were held on a single-bed certificate last year. Statewide, an average of 80 reports were filed each month when beds were not available for people.

Facilities like Harborview are the most accepting of patients with complex backgrounds, declining just two people last year. Compare that to Cascade in Tukwila and MultiCare in Auburn, which declined people 44% and 40% of the time, respectively. 

Laurel Kelso, the director of hospital operations for Navos (which is owned by MultiCare) explained that as a free-standing psychiatric facility, they aren’t able to deal with certain needs like wounds, dialysis treatment or mobility issues.  

“If we can’t manage those individuals when they’re referred, then we have to decline,” Kelso said. “That is for the best interest of the patient.”

She also points out that the facility does not have single rooms — so anyone who needs private space if they’re being aggressive or volatile due to their untreated mental illness will not be accepted by Navos. 

Staffing likewise remains an issue. Currently the facility is at 50% staffing levels and relies on travel nurses and mental health techs to keep providing services.

Recovery Place, one of the facilities that improved their decline rate from 43% in 2021 to 30%, opened up their acceptance criteria to take more patients. For instance, they’ll now accept someone who is medically detoxing but using methadone, said Richard Geiger, chief of inpatient and residential services at Valley Cities Behavioral Health Care, which owns Recovery Place.  

He credited their new director, Teresa Hardy, who championed this change. 

“If she gets somebody that doesn’t fit in the specific box, she makes sure that we can adjust the box a little bit,” he said. 

Harborview, on the other hand, is able to accept a high percentage of patients because they’re specially equipped to handle people with more complex needs, a spokesperson explained. They have access to medical services to care for someone with a physical injury or illness, for example, and can consult with neurology or surgical specialists.  

Staff at the Swedish Ballard campus, which hosts 22 psychiatric beds, likewise pointed to their high staffing levels, which allow the facility to take patients who have higher acuity. Swedish Ballard also recently opened a new partial hospitalization program that helps people transition from inpatient to outpatient settings. 

Telecare declined to comment and Fairfax did not respond to multiple requests for comment.  

The 2022 King County report also cites a particular need for specialized units that can care for people with traumatic brain injuries and intellectual and developmental disabilities. 

Meanwhile, fewer psychiatric beds are available to begin with: The report notes the recent closure of Cascade Behavioral Health Hospital in Tukwila, which used to make up about 13% of beds for patients committed to involuntary treatment in King County. The hospital was recently bought by the Department of Social and Health Services, but the state currently plans to use it for a different population of patients.

“We are of course deeply concerned about the closure,” said Isabel Jones, the interim behavioral health director with King County. 

Officials will be tracking how this affects the decline rates at the remaining eight facilities to see whether more people are turned away next year. 

But the landscape of crisis care in King County is likely to shift in the coming years anyway. 

In April, voters overwhelmingly passed a property tax to build five new walk-in crisis facilities that would be capable of taking people in a mental or behavioral crisis, regardless of insurance.  

The centers represent a new opportunity to stabilize people in crisis before they need involuntary treatment — though it’s not yet clear whether that will help the most complex patients access the types of specialized treatment they’re denied today.

Construction for the centers wouldn’t start till 2026, but Michael Reading, chief of crisis systems and services for King County, said now is the time to start thinking about how that future system will interact with the current one. 

At the future walk-in crisis centers, both law enforcement and families can bring in a person for care. Though the facilities are voluntary, county officials have said that the walk-in crisis centers will operate under a “no wrong door” policy. 

The centers may also house designated crisis responders, who would be able to kick-start the involuntary care system if necessary. At that point, patients would be rerouted to another psychiatric locale like an evaluation and treatment facility. 

King County is not alone. Communities across the country have struggled to care for people with complex needs. 

“As a society, we have created such profound challenges and simply don’t have the resources to safely or appropriately place people with those histories,” said Robert Trestman, chair of psychiatry and behavioral medicine at the Virginia Tech Carilion School of Medicine. 

Patients with the most severe needs are often the ones most likely to be bounced through the system, he said. 

Besides having a hard time during a crisis, people with sex offenses, substance use disorders or criminal histories will then face an uphill battle to stabilize with appropriate housing or employment. 

“Our patients typically are at the back of the line,” Trestman said. “And there are very few advocates and very few legislators who are willing to take a broader social perspective.” 

Mental health resources from The Seattle Times

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Dane County will participate in a Harvard initiative to explore alternatives to a police response during mental health emergencies, with the aim of creating a program for rural communities that’s similar to CARES in Madison.

The CARES program, or Community Alternative Response Emergency Services, is a partnership between Madison Fire Department community paramedics and Journey Mental Health Center crisis workers that responds to behavioral health emergencies in the city. In less than two years, it has rapidly expanded from a pilot program operating only in Madison’s downtown to a citywide operation responding to hundreds of calls a year. 

Its success has opened up the question of whether the rest of Dane County could also have access to this behavioral health response in emergencies — a service intended to avoid police interactions that escalate into violence and to provide specialized care appropriate to a mental health crisis. Both Madison Mayor Satya Rhodes-Conway and Dane County Executive Joe Parisi have signaled their support for a partnership on CARES between the city and county. 

Those discussions are in early stages and haven’t yet led to a clear timeline or a solution to numerous obstacles. Local leaders hope the new Harvard initiative will help answer big questions on how a countywide system would work.

Harvard Kennedy School adds resources

The Harvard Kennedy School Government Performance Lab announced Thursday at the Dane County Community Justice Council meeting that Madison and Dane County will be included in its 2023-24 “Alternative 911 Emergency Response Implementation Cohort,” providing research support, testing new approaches and analyzing data.

“We were drawn to the program in Madison and Dane County for the success of the CARES program in its first two years of operation and the opportunity to support CARES as the program matures and expands,” Marianna Yamamoto, a government innovation fellow at the Harvard Kennedy School, said at the Thursday meeting.  

Through the initiative, the county hopes to address capacity building for the future expansion of CARES, as well as new diversion protocols and workforce challenges, said Carrie Simon, the urgent care manager in the county Department of Human Services. 

“It’s important to remember that while CARES is an exciting new approach to crisis response in our community, it represents only one segment of a continuum of crisis services,” Simon said at the Community Justice Council meeting. “CARES is operating within the city of Madison with limited hours and limited days. We’re first looking at what’s happening now and whether we are making the right choices about how expansion happens.” 

She added, “We don’t feel like CARES as it is itself is necessarily the right solution for the more rural areas of our county.”

Challenges reaching rural Dane County

Ché Stedman, assistant chief of medical affairs for the Madison Fire Department, oversees the CARES program along with Journey Mental Health Center.

RUTHIE HAUGE

Ché Stedman, the assistant chief of medical affairs for the Madison Fire Department who oversees CARES, said it wouldn’t be too complicated to expand the program into Fitchburg, Verona and other neighboring municipalities. The Dane County 911 center, which dispatches CARES teams, already responds to calls in neighboring cities. It’s just a matter of creating a partnership.

However, moving farther out from Madison gets more complicated, Stedman said.

In more rural parts of the county, many fire departments rely on volunteer staff. Rural communities have been hit hard by financial and staffing struggles that slow the response to 911 calls for all types of emergencies, and those communities experience their share of mental health crises.

Stedman has been on calls for the past month with the Harvard Kennedy School Government Performance Lab and said the aim of the initiative is to figure out how to have a program similar to CARES across the county.

“What we’re trying to decide is if the county wants to pay the city of Madison to hire more workers and actually respond out into the county. CARES is willing to do that, but right now we’re just in the exploratory phase of figuring out what’s best,” Stedman said. “When you get way out into the corners of Dane County, the more rural areas, there’s just a different need there.”

Dane County Sheriff Kalvin Barrett said he is excited about the collaboration. 

“You have our 100% support,” the sheriff said on Thursday. “We are providing people with the best service possible and we understand that we have taken a role in responding to mental health calls, but we are not the best to do that. We look forward to other alternatives to do that and we will support those.”

The Harvard Kennedy initiative launched in September 2021. This year’s other cohort members include Los Angeles; Portland, Oregon; Alexandria, Virginia; Baltimore, Maryland; Tucson, Arizona and others. 

Allison Garfield joined the Cap Times in 2021 and covers local government. She graduated from UW-Madison with a degree in journalism and previously worked as a government watchdog reporter for USA TODAY NETWORK-Wisconsin and was the state capitol intern for the Milwaukee Journal Sentinel.

Support Allison’s work and local journalism by becoming a Cap Times member. Follow her on Twitter @aligarfield_.

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CLEVELAND — Historically, police have been the first responders to behavioral health crises, regardless of circumstance or risk of violence. Often, this response does not meet the needs of the person in crisis and can sometimes lead to injury or death, as with Tanisha Anderson here in Cleveland and others throughout the country.

Part of the solution lies in “care response” -– a paradigm shift where unarmed behavioral health clinicians and trained peers with lived experience in the behavioral health system respond to individuals experiencing behavioral health crisis instead of police. This brings the specific expertise the individual needs to help in time of crisis and permits police to engage in other important public safety duties.

Care response is part of a comprehensive community crisis care system, that includes “hotline” services (988), community response, and facility-based care. Care response provides expert clinical assessment, mental health crisis care, linkage to services and shelter, frequently resolving crises in the community without transfer to crisis facilities or hospitals. Care-response services have shown impressive results, including reduced need for police response, reduced crime in the areas covered by “care response,” and improved safety for all involved.

In late May, Dr. Mark Hurst, a co-author of this guest column, presented recommendations for the development of a “care response” program to the Alcohol, Drug Addiction, and Mental Health Services (ADAMHS) Board of Cuyahoga County. The recommendations were the result of a monthslong process by a coalition of mental health advocates, stakeholders, and other experts, with support from The George Fund Foundation, The Cleveland Foundation, and Mt. Sinai Health Foundation.

Dr. Mark Hurst is former medical director of the Ohio Department of Mental Health and Addiction Services and of the Ohio Department of Health.

The ADAMHS Board of Directors and staff were receptive to the coalition’s recommendations and have made implementation of care response in Cuyahoga County a priority to provide safer and more effective care to individuals experiencing behavioral health crises.

In collaboration with partners, the ADAMHS Board of Cuyahoga County is evaluating the entire crisis system, including the development of care response teams, to determine how best to meet future community needs. Important advances have been made, including the expansion and further development of telephone crisis services (988), increased crisis intervention team training (CIT) for police, continuation of “co-response” teams composed of a police officer and a mental health professional, and oversight of Cuyahoga County’s diversion center to avoid needless incarceration of individuals in crisis. All are important components of an effective crisis care system, and partnership among all these components. Care response is essential to achieve best results for the community.

Scott Osiecki is CEO of the Alcohol, Drug Addiction and Mental Health Services Board of Cuyahoga County.

The recommendations are only the first step. Extensive preparation and community partnership are needed to assure that care response and the other components of the comprehensive crisis care system work collaboratively with one another, with the broader health care system and with the community as a whole. The ADAMHS Board of Cuyahoga County is committed to lead the charge that assures the mental health crisis care system is safe, compassionate, respectful, and effective in meeting the needs of people experiencing a crisis, their families and the community.

Together, we can redefine mental health crisis intervention and provide the support and care that individuals in crisis truly deserve.

Dr. Mark Hurst is former medical director of both the Ohio Department of Mental Health and Addiction Services and the Ohio Department of Health. Scott Osiecki is CEO of the Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board of Cuyahoga County.

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Pierce County Council approved $30 million to fund behavioral health programs in the county on Aug. 22, 2023.

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In December 2020, the Pierce County Council passed a one-tenth of 1% sales tax to fund behavioral health and therapeutic court programs within Pierce County, including mental health and substance abuse disorder treatment.

On Tuesday, the council approved the Human Services Department and Behavioral Health Advisory Board’s recommendations for how that funding should be spent in the 2024-2025 calendar years, around $30 million in total. Five members of the council voted in favor, none voted against and two members were excused from voting.

Council chair Ryan Mello thanked the advisory board for its time and expertise in vetting the list.

“I’m really hopeful about those investments and what movement we can make in the behavioral health workforce challenge and the millions of dollars we’re putting out the door for communities all across Pierce County — in schools and in permanent supportive housing sites and communities all across the county — to get these kinds of really critical resources,” Mello said.

Of the 28 programs recommended for funding, the Pierce County Sheriff’s Department will receive the most funding – about $3.8 million for its crisis response team.

The Behavioral Health Advisory Board recommended $29,998,250 be spent in all, according to county documents. A vast majority of the funding will come from the behavioral health tax and $522,000 will come from the county liquor tax revenue, said Pierce County policy analyst LeighBeth Merrick at the council meeting.

Most of the funding is going toward crisis and inpatient services, outpatient and community-based services, rural behavioral health, community education prevention and early intervention, as well as services offered to children/youth or families/parents, according to the funding recommendations. You can find a full list of the programs and their funding online.

Despite these investments, need remains. When the Human Services Department opened up proposals for this funding, the department received 60 proposals to fund substance abuse disorder and mental health treatment programs in the county, requesting over $63 million in total funding, according to the council agenda.

Which programs are receiving the most funding?

The Pierce County Sheriff’s Department will receive $3.78 million for its Pierce County Co-Responder Program, which embeds mental health professionals with law enforcement when responding to 911 calls for people in a behavioral health crisis. It is proposed to serve 3,200 people and provide eight designated crisis responders, contracted from MultiCare’s Behavioral Health division. Funding will continue operating the program at its current staffing levels, according to the council agenda.

Comprehensive Life Resources will receive a little more than $3 million for its School Connect Program, which provides outpatient behavioral health treatment and navigation services to youth in the Puyallup School District, Peninsula School District, Orting School District and White River School District. It is proposed to serve 950 individuals, according to county documents.

Seneca Family of Agencies will receive $3 million for its Wraparound with Intensive Services program, outpatient services and therapeutic case management services offered to high-risk youth and families in Pierce County, especially multi-stressed families who are uninsured or underinsured, according to the county.

Not-for-profit health care organization Greater Lakes Mental Healthcare will receive $2.1 million for its Jail Diversion team services, assisting individuals with mental health or substance abuse disorders who have committed a non-violent felony to participate in treatment and rehabilitation. Full engagement in their “rigorous” program can result in lower or dropped charges, according to county documents. It is expected to serve 40 people. The goals of the program are to assist jailed clients in transitioning into services in the community and prevent people “who are likely to require competency restoration” from entering jail in the first place, according to the organization’s website.

WorkForce Central will receive about $2 million for establishing a county behavioral health association focused on recruiting, training and retaining a diverse and high-quality behavioral health workforce to meet the growing needs of adults, youth and children in Pierce County, according to the county. Funding will include workforce training for 150 people, 20 apprenticeships and 200 interns.

Becca Most is a reporter covering the Pierce County Council and other issues affecting Tacoma residents. Originally from the Midwest, Becca previously wrote about city and social issues in Central Minnesota, Minneapolis and St. Paul. Her work has been recognized by Gannett and the USA Today Network, as well as the Minnesota Newspaper Association where she won first place in arts, government/public affairs and investigative reporting in 2023.

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