Top 17 recommendations of Mental Health Care Assessment Task Force win County Commission approval this week

New advisory board proposed to help with funding allocations for programs

This graphic explains the task force members’ approach to their work. Image courtesy Sarasota County

After dedicating about two hours to the topic on Jan. 25, the Sarasota County commissioners voted unanimously to accept the recommendations of a task force appointed to analyze gaps in mental health and substance abuse services in the community.

The majority of the board members voiced support for the task force’s focus on services to young people as a means of preventing chronic mental illness, which could lead to incarceration for crimes and potentially homelessness, as the commissioners noted.

Commissioner Nancy Detert offered some scenarios to underscore her support for such programs. Among her examples, she talked of a situation in which “you’re eating at an outdoor dining area and having a wonderful time and now it’s ruined because homeless people are coming up to take your food or chat with you.”

She also pointed to the prospect of even more youth starting to use methamphetamine or fentanyl, adding that such drug use has “ruined whole communities and whole states, even,” and she noted “teenagers who talk about suicide or shooting up their classroom.”

The task force began its work after the commissioners, in May 2021, approved the establishment of a countywide Mental Health Care Special District that they would oversee.

Commissioner Michael Moran. File image

However, during their discussion this week, the commissioners also agreed unanimously that they need more time to make funding decisions regarding the task force recommendations. Commissioner Michael Moran’s formal motion directed staff to work with the task force in regard to what he called “a governance structure” that would fine-tune funding allocations for the 17 programs the task force made its top priorities.

Commissioners discussed the potential establishment of an advisory board that could handle that work.

As Moran noted, “We do tons and tons of advisory boards … for stuff way less important than this. … Somebody ultimately has to account for this money. Obviously, we have final sign-off.”

Moran is the commissioner who first championed the establishment of the special district, as allowed under state law.

Chuck Henry, director of the county’s Health and Human Services Department, suggested that such an advisory board include subject matter experts on mental health and substance abuse issues, as well as representatives of major insurance carriers in the state and persons from the community foundations. “Obviously,” Henry continued, “staff would want to be involved because we manage so many of these different [programs].”

“I’d love to keep some of our task force members,” Henry told the commissioners, though he was not certain they would have the time or willingness to take on a new responsibility.

These are the task force members. Image courtesy Sarasota County

“We’ll work to get you back here as quickly as possible,” Chair Alan Maio told Henry, who had handled part of the Jan 25 presentation. “And it will be quick,” Maio added.

In the meantime, Henry asked that the commissioners review the task force’s rankings of its recommendations, which was included in the detailed report provided to the board. An estimated range of the expense for each was noted on the chart, Henry pointed out. Staff could start working “relatively quickly,” he added, on the programs that do not carry “huge dollar amounts.”

Materials that Moran provided to his colleagues during the discussion showed that the total funding available is $15,225,974. That includes $8 million that the commissioners agreed to dedicate to mental health and substance abuse needs out of $84.2 million that the county has received from the federal American Rescue Plan Act (ARPA).

The rest of the $15.2 million is made up of the funding the county dedicated this fiscal year to mental health and substance abuse services out of the county’s overall budget.

This is one page of a handout that Commissioner Michael Moran gave his colleagues on Jan. 25. He used it to show that the overall funding the county has for mental health and substance abuse services can be adjusted by ‘plugging’ figures into an Excel spreadsheet. Image courtesy Sarasota County

Commissioner Christian Ziegler, however, was the first board member to point out that the ARPA money is a one-time allocation. Therefore, Ziegler said, he would not like to see it used for programs that would require recurring county funds, as that situation could necessitate a future property tax increase.

Last year, as they worked on their budget for the 2022 fiscal year, which began Oct. 1, 2021, three of the commissioners — Moran, Maio and Detert — initially supported an extra one-tenth of a mill tax to pay for services that would be provided through the Mental Health Care Special District. Yet, both Ziegler and Commissioner Ron Cutsinger pointed to promises they made their constituents during their campaigns for their seats: They would not vote to raise taxes.

As a result, Chair Maio announced at their last budget workshop in 2021 that it made no sense to approve the new millage, as the board likely would not even be able to start funding new mental health or substance abuse priorities until the final quarter of this fiscal year. Because of the increase in county property values last year, he noted, staff was able to find $1.6 million in the county budget that could be allocated for such programs this year.

That figure represented about a quarter of the anticipated $6.5 million that the one-tenth of a mill tax increase would have raised, Maio said.

In fact, Maio pointed out during the Jan. 25 discussion, it is possible that the property values will rise enough this year to provide sufficient funds for mental health and substance abuse services in the 2023 fiscal year, without the necessity of a higher millage rate.

This is a funding model included in the task force report. Image courtesy Sarasota County

The task force recommendations

On Jan. 25, Dr. Andrea Blanch, co-chair of the task force — whose members Henry had appointed last year at the commission’s request — presented details about the top 17 recommendations out of the 44 that the group had included in its report.

“We know that mental health services are in crisis across the country,” she told the board members. Yet, she added, “There are very few local communities that have come up with a coherent, systemic response to the crisis that they’re facing.”

Dr. Andrea Blanch addresses the commissioners. News Leader image

She also pointed out, “This is not a widely popular issue, so I applaud you guys … for recognizing what people don’t recognize.”

Blanch explained that the task force members had agreed on dedicating 87% of the funding resources to developing, expanding and strengthening programs and services already in place; 8% to testing innovative approaches; and 5% to developing infrastructure and planning.

The top priority in the first group, she continued, as noted in the report, is “Respond to young children with emerging emotional and behavioral problems by providing immediate behavioral health consultation upon request from childcare settings where a child in need has been identified. Improve the capacity for both early identification and effective response.”

“When very young children are anxious or fearful,” Blanch explained, “they can’t tell us what’s going on, and they act out. … Unfortunately, they often get labeled as bad kids, as hyperactive kids …”

If such children could get immediate help from trained mental health consultants, Blanch pointed out, the children — and their families — would be able to learn skills to use in handling the youngsters’ outbursts.

The second recommendation on that initial list, she continued, calls for developing or strengthening a 24/7 “walk-in community crisis assessment and stabilization capacity to provide a safe location” where a person could go or a law enforcement officer could take a person, instead of that individual’s ending up in a hospital emergency room. “All of [assessment and stabilization] could be done in a comforting, welcoming community setting,” Blanch said.

Moreover, she noted, beds could be provided in such a facility so people who need residential services could stay for a night or two until their crises had been resolved.

Yet another recommendation called for the development of “specialized coordinated … care services” for young people or adolescents having their first episodes of psychosis — what Blanch described as “a really scary break with reality.”

With such services, she continued, people would learn how to manage their symptoms, which, in turn, would “prevent a great deal of what we call chronic mental illness.”

These are the top priorities that the task force members presented to the commissioners. Image courtesy Sarasota County

Another recommendation, she noted, is for “a therapeutic group home for the most difficult-to-serve young people …”

Explaining that she worked in Vermont for years, she added that that state’s population “is very, very close to the population of Sarasota County.” When she was there, Blanch said, the state had no therapeutic group homes for youth. As a result, the state was sending “a fair number of youth” out of state for assistance — with some going to facilities as far away as Colorado and Utah. That approach was “extremely costly [and] very ineffective,” she added.

The young people were pulled away from their families and their communities, Blanch stressed. Therefore, they had difficulty adjusting when they returned to their homes.

Finally, she pointed out, the state created a facility with six long-term care beds and two “crisis respite beds.”

“With that one program,” she added, “we were able to totally stop sending kids out of state. … I can’t tell you how many millions of dollars we saved,” and the young people who were helped close to home had much brighter futures than they would have had otherwise.

A dedicated phone number for help

During the discussion, Commissioner Detert also was adamant about the need for a dedicated phone number — like 911 for law enforcement emergencies — that the public could use in mental health and substance abuse crises.

Henry of Health and Human Services pointed out that people have been able to call 211 for such assistance.

This map shows the locations of mental health and behavioral health service providers in the county. It is included in the task force report. Image courtesy Sarasota County

However, he added, the state in July is expected to launch a call center number that people can reach — 988. It is a number used on a national basis, he added, though he told the board members he is not certain at this time about how well that will work locally.

Henry did note that the task force’s report included information about the state plans.

Listed among “Middle Tier Priorities,” that section said, “In anticipation of transition to 9-8-8 behavioral health crisis call line, develop a consolidated crisis hotline/response system to improve efficiency and divert calls from 9-1-1, including training 9-1-1 operators and conducting public education about where to turn for help in a crisis.”

Detert stressed the need for widespread marketing of whatever number ends up being established, as well as public education about the programs that the county will fund for crises, so people will know what to do if they see individuals suffering with mental health and substance abuse problems.