Costs fluid as 4 Arkansas counties prepare for crisis centers

As details for Pulaski County's awaited crisis stabilization center come into focus, and the county secures a medical provider, startup costs remain a moving target.

Stabilization centers are places where mentally ill people, who also may have committed low-level crimes as a result of their illnesses, can be taken instead of to jail.

The idea is to divert those people away from lockups and toward treatment.

Four 16-bed centers, including one in Pulaski County, were approved by Gov. Asa Hutchinson last year, to be funded at $1.6 million each.

Each center will serve its surrounding area. Pulaski County's center will accept patients from Saline, Perry, Garland, Grant, Faulkner, Lonoke and Jefferson counties.

Under Act 423 of 2017, which authorized the centers, the state will pay for the medical services while the four hosting counties will provide the buildings and pay for utilities and maintenance.

On Dec. 28, County Judge Barry Hyde signed a service agreement with the University of Arkansas for Medical Sciences, Little Rock to provide the necessary medical expertise for the Pulaski County facility.

Salaries and wages for a roster of nurses, security guards and physicians, including Dr. Pedro Delgado and psychologist Lisa Evans, who will run the center, will total $2.15 million in the first year, according to the proposal.

Pulaski County will act as a conduit for the money doled out by the state, said Justin Blagg, who directs Quorum Court services and is a project lead for the crisis center.

The county will pay UAMS $133,000 a month once the unit opens, totaling $1.6 million in a 12-month period.

After paying UAMS, the county will ask the state Department of Human Services for reimbursement, provided the county turns over certain data that must be collected under Act 423.

UAMS also expects to take in a net $550,000 in Medicaid payments, according to its proposal, submitted in November. If a patient has insurance coverage, that provider will be billed, a UAMS spokesman said.

Based on predicted expenses and income, the center should just about break even, with only $1,500 in net income expected, the proposal says.

The unit should be operational at the beginning of March, Blagg said.

Before that happens, the county will incur startup costs, estimated at $110,000, though that figure is still malleable.

UAMS itemized the required equipment, which the county will pay for. Cost estimates cover small necessities -- gloves, gowns and masks -- and more expensive essentials such as suicide safe beds, a glucose monitoring machine and pill lock boxes.

After reviewing the proposal, the county has been able to knock thousands of dollars off UAMS' initial $130,000 estimate to land on $110,000, roughly, Blagg said.

"We've basically been pillaging our surplus furniture. We would love to have the fancy chairs in there, but it's probably not going to happen," he added.

Still, some items are affixed to a price point, like certain medical equipment and supplies.

"Diapers cost what diapers cost," Blagg said.

The state Department of Human Services agreed to allocate some startup funds for the four centers to get going. Each center is entitled to request up to $121,400, said Jake Bleed, Hutchinson's director of fiscal and agency operations.

If state money doesn't cover all initial costs, Pulaski County has agreed to put up no more than $20,000. Anything bought for the center is automatically county property.

Another expense is renovating the center, which will be in the county's juvenile jail complex at 3001 W. Roosevelt Road in Little Rock.

Two unused detention pods will be remodeled to fit the necessary 16 beds, triage rooms, lab and office space. The unit will be completely walled off from the rest of the facility, Blagg said.

In October, the Quorum Court appropriated $1 million for the center, $900,000 of which is for construction and renovation.

"We do not want to use that much money for it, but it's better to have it and not need it" than to dip into the county's general fund, Blagg said.

The remaining $100,000 will cover routine and annual maintenance, waste disposal and utilities.

To offset that annual cost, counties and cities that will use the facility entered into an agreement with Pulaski County.

Each municipality will pay $50 per day, for the length of stay, for each person sent to the center for treatment. Ideally, patients will stay less than 96 hours, or four days, the UAMS proposal says.

When fully functioning, each unit will be able to serve 1,900 to 2,000 people annually, the Council of State Governments Justice Center estimates.

County officials hope the agreement will defray expenses. However, until the center is operational for some time, cost estimates are fuzzy, Blagg said.

"We're kind of in uncharted territory," he said.

The agreement with UAMS expires in three years, though state funding isn't tied to that timeline. The state's budget for fiscal 2018 allocated $5 million, and the additional $1.4 million came from Arkansas' rainy-day fund.

"There was a point where we were unsure whether or not they would fund it beyond this year," Blagg said. "We got some assurance that it's built into the budget, it's ongoing."

When operational, the center will serve adults suffering mental crises who come across trained law enforcement officers.

Patients must exhibit symptoms of crisis, like disorientation, but cannot be imminently suicidal or homicidal, according to the criteria outlined by UAMS. Those symptoms require an in-patient hospital setting.

Patients must volunteer for treatment, and they can't have committed a felony while encountering law enforcement officers.

By using jail data, Pulaski County officials identified a "cohort group" of 84 people who could be best served by the center. These people were arrested three or more times in a year's span and were diagnosed with serious mental illnesses at the jail.

A serious mental illness is defined, in general, as major depression, bipolar disorder, schizophrenia or borderline personality disorder.

A patient at the crisis center will get a bed, a shower, clothes if necessary, and three meals a day. Each person will be screened for a host of issues, including substance abuse and post-traumatic stress disorder.

Patients also will undergo psychiatric and general wellness assessments.

Medication will be available. The center will accept people 24 hours a day, seven days a week, 365 days a year.

Patients also will speak with social workers and counselors to determine what help they need after leaving the facility.

Staff members will follow up with each person in seven days and again in 30 days after the patient leaves the center.

The other centers are planned for Sebastian, Craighead and Washington counties.

A Section on 01/08/2018

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