Access Center

1. Iowa City Council Meeting March 7, 2017 Access Center Why do we need a Behavioral Health Access Center? What is the Business Plan? How Do We Pay for It?

2. Steering Committee • Jessica Peckover, Jail Alternatives • Janet Lyness, County Attorney • Jan Shaw, MHDS • Ron Berg, Prelude • Diane Brecht, AbbeHealth • Stephen Trefz, AbbeHealth • BecciReedus, Crisis Center • CrissyCanganelli, 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

3. Crisis ? ? Current Law Enforcement Family / Natural Supports Crisis Center CMHC Emergency Room SA Tx Psychiatric Hospitalization Homeless Shelter

4. 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

5. 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) Homelessness Joblessness / underemployment Criminal justice issues

6. 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

7. Vision ~ 2010 Crisis ? Mobile Crisis Crisis Center Law Enforcement Family / Natural Supports Primary Care Comprehensive Behavioral Health Access Center Outpatient Mental Health Services Urgent Care Appts Homeless Shelter Substance Use Treatment Psychiatric Hospitalization

8. A Vision for a Comprehensive Behavioral Health Access Center (~ 2011) Shelter Sub Abuse Treatment (Inc. detox) Peer Support Psychiatry (tele?) Jail Diversion Behavioral Health Access Center 23 Hour Beds (sobering up) Dedicated 24/7Staff Rapid Rehousing General Emergency Room Crisis Case Management Crisis Stabilization Beds (< 1 week) Primary Medical Care Family & Natural Supports Hospital

9. Looking at other Models • San Antonio’s Restoration Center • Kansas Model • Miami Dade Model

10. Current BH Access Center ModelKey Elements INFLOW OUTFLOW Law Enforcement Drop Off Longer SA Treatment Detox Unit 5- 10 beds Evaluation Capacity Psych PA, BSN/MSW Sobering Unit ~ 10 beds ER / Psych Hospital ER / Hospital Case Management (Short term) 23-46 hr. obs. beds ~ 10 beds Crisis Stabilization Beds (~5) < 1 week Medical i Walk-in Urgent care Primary Care Shelter House Security Mobile Crisis Food Other Housing Low Barrier Shelter (~ 40-60 “bed” capacity) Community Agencies Natural Supports

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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:

17. Assessment - Initial Financials *Municipality and Philanthropy revenue is current support of Winter Shelter **Mobile Crisis revenue is current support of program at current capacity

18. 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

19. Capital Costs Estimates • Renovation ~ $5.2M • New Construction ~$6M • Pros and Cons

20. 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% 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% *5-Year Average **2014 Total Enrollment

21. 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 ---------------

22. Questions?

23. San Antonio CIT & Restoration Center Video • https://www.youtube.com/watch?v=zSbFbv2Bs_0