The Morrison County Board of Commissioners is examining how it can allocate American Recovery Plan Act (ARPA) funds to improve mental health services in the county.
During the past two weeks worth of Board planning sessions, Health and Human Services Director Brad Vold, along with supervisors Jeff Bowman and Melanie Erickson, presented options to the Board on where a portion of the $6.5 million in federal funding could make the biggest impact. When discussions on ARPA allocations first began in January, county department heads identified mental health as the area that most needed addressing.
Vold detailed three ways to fund mental health — and one other idea for Health and Human Services funding — in Morrison County with those ARPA funds. In coming up with those ideas, he consulted with Bowman and Erickson, along with superintendents at local schools and mental health providers within the county.
“Anything that commissioners would like to move forward on is going to require some collaboration with our mental health partners, our schools and other individuals who might be participating in any of that creative activity we do to support mental health,” Vold said.
The first plan would allocate a total of $68,020 in ARPA funds to help develop a mental health coordinator in Region V, which also includes Todd, Crow Wing, Cass and Wadena counties.
The five counties are already engaged in a five-county mental health initiative for the Greater State of Mind Report. Sourcewell recently funded an assessment of mental health services in Region V, which was conducted by the National Council of Behavioral Health.
If all five of the counties get on board, Sourcewell would hire the position and Morrison County would reimburse the organization $34,010 per year. The regional coordinator would enter into a two-year contract.
Action items identified in the report included building community collaboration, reducing transportation barriers, adding mental health workforce and more.
“We know that we have to improve our communication between hospitals, schools and providers as we build our mental health system,” Vold said. “Unfortunately, our initiative does great work, but it’s the supervisors from each of the counties that don’t really have time beyond what they’re doing with the initiative.”
Crow Wing and Todd counties are already looking into supporting the position, according to Vold. Wadena and Cass counties are still in discussion about how they can help with funding.
“One of the reasons why we wanted to look at a regional focus is because a lot of providers support our entire region,” Bowman said. “They’re not just localized to Morrison County. They are servicing our whole area, so it made sense for us to go down that road.”
The second option came from conversations with schools about how to improve services between the schools, kids, families and providers.
Vold said school-based mental health services are available to students in all school buildings across Morrison County. That is provided via a clinical model, meaning students can get therapy. However, those providers’ ability to respond immediately to a crisis or to consult with support staff is limited.
One option under this plan would allow schools to hire a staff member who would be able to provide the services currently available, while also helping students enroll in school-based mental health. The county would fund half of that position through ARPA dollars, while the rest would come from mental health dollars.
“Sometimes schools struggle getting parents to sign,” Vold said. “Social workers, school staff are not able to go to the home as efficiently as others. Of course, when school’s in session, staff are working and most of the staff are working during the business day.”
Another option would be to help provide in-home services to students in need of the most care, along with their families. The thought there is to provide funding to incentivize school-based staff to provide those in-home services outside of school hours.
Vold was not able to provide a cost estimate for this option. He said there were staff members on vacation at Northern Pines — which provides mental health services to local school districts. He planned to meet with them later in the week to get more information.
“There was some hesitancy from one of the staff at Northern Pines with the ability to encourage school-based staff to do in-home, so that’s what we really have to discuss; if they’re interested,” Vold said. “Initially there was interest. I’m not sure if that does not happen anymore.”
The third option Vold provided was similar in that it would help provide in-home services. In this case, however, those services would be made available to children and families receiving services through the county via a partnership with a local provider.
It is estimated this would come with a total price tag of $71,100 for a two-year investment. Of that, $32,000 annually — $,2667 per month — would be additional funds provided to attract in-home therapy work. The other $7,100 would cover three weeks of training and startup costs.
“I have been doing this work, I suppose, around 30 years, and in-home family services has and is — research has proven it to be the most effective tool in order to address children’s mental health, and we can’t get it ,” Erickson said.
Vold said Health and Human Services staff members have had conversations with a provider who believes it could recruit an employee to provide in-home services specifically for Morrison County, if the position was funded. They could provide home family therapy to any children in programs such as children’s mental health or child protection.
He said in-home service positions are the most difficult to fill within mental health.
“They operate at a loss,” Erickson said. “If you were a clinician and you could make the same amount or more money sitting in an office, or you would go into some of the homes in the evenings and be in the middle of some very chaotic, difficult situations, similar to what our law enforcement face sometimes, frankly, you’d be thinking that you should be able to make more money in order to do that. I think that’s what we’re looking for in this. This is hard work, and it takes a really high-level person to do it, but it’s effective.”
The last item he presented involved helping the Central Minnesota Council on Aging provide Meals on Wheels for Morrison County residents. Vold said the organization is no longer able to take referrals, and Executive Director Lori Vrolson informed him the organization’s Title 3 funding has been stagnant or cut.
“They are currently in a deficit and are not funding any new individuals for Meals on Wheels unless they either are able to pay or have a funding source, such as the waiver,” Vold said.
As of Tuesday, Vold said there were seven individuals in Morrison County who were on a waiting list to receive Meals on Wheels. It is unknown when they’ll be able to come off the waiting list.
Morrison County Lutheran Social Services and Catholic Charities get the meals out to local individuals, according to Vold.
This would be the cheapest of the four areas of funding. At $5.50 per meal, five days per week, funding meals for each person on the waiting list would cost $27.50 weekly. If the county began funding the program May 30, through the end of 2022, that would equal $852.50 per person.
Vold recommended planning to fund meals for 25 people, bringing that total to $21,312.50.
In all, funding the three on which costs are known for 2022 – 2023 would be $160,432.50.
When asked directly by County Administrator Matt LeBlanc which one he would recommend, Vold said his first choice would be option three, and his second would be option one. With option three, he said he would like to “build a more robust in-home services program” and work with multiple providers.
“I have to ask you then, when we look at number three and number one, does providing in-home services — does that address the greatest need that we see in addressing mental health in the county?” asked Board Chair Greg Blaine. “That’s kind of the lens that I, myself, personally, am looking at this. The topic could be perceived to be very broad, so I want to look at, where is that greatest level of need?”
Vold said, in his 30 years of working in the field, he has found in-home services to provide “significant help” with kids and families in crisis. He also said both schools and mental health providers identified that as the “biggest gap” right now.
“I believe that is where the greatest work is done,” he said. “That is where a lot of the challenges occur. It’s great to teach parents, kids the skills to navigate the community, school, work. However, they come back home and that’s where their lives are mostly spent. That is where the work needs to happen, because a lot of times it doesn’t transfer over to that other area.”
Erickson said, in her own research, she has found children’s mental health services can help divert detention, jail, mental health crises and hospitalizations down the road. All of those come at greater costs than any of the plans presented.
She said having a child in residential, out-of-home placement costs $10,000 – $12,000 per month.
In looking at entering into a two-year contract as part of options one or three, Commissioner Mike Wilson asked what happens when those two years are up.
“I think it’s incumbent upon us in working with providers who we’re developing relationships to do these added services to track, to monitor, to provide data to see that it works,” Vold said. “I think that’s what we want to learn. Is it truly going to help keep kids out of the juvenile justice system? Out of out-of-home placement?”
Blaine said, while mental health issues have always been present in society, his perception was that changes to education during the COVID-19 pandemic were accentuating those problems within school-aged children. He asked if, now that COVID has “settled down a little bit” and schools have mostly returned to a more traditional education model, if mental health is improving with students.
“Anecdotally, our applications continue to go up,” Vold said. “Our conversations with the schools still seem to feel like they’re struggling to get back on track, because it was a good year of not being so normal in terms of what we did with our kids and our families. I also think people are still managing COVID in different ways and still trying to figure the trauma of that out.”
Blaine asked, in terms of addressing the issue, if it could be viewed as a two-year project to help get back to that pre-COVID baseline.
Erickson said she did not think COVID was to blame for all of the added mental health issues among children. Though she said the pandemic likely did make matters worse.
“Our kids are so much more in a crisis mode,” she said. “A lot of hospitalization, a lot of suicide ideation. More than I’ve seen, ever. Some of it, I’m afraid, is due to social media. They cannot get away from some of the bullying, harassment. It is a big tool and they don’t know how to manage it. Parents are struggling to know how to help them. I’m not sure it’s all COVID.”
She said she is hopeful that there will be skills that are learned to cope, in the long run. That has often been the case when something significant happens to society as a whole. Though she said she doesn’t believe there will be a 100% turnaround.
Commissioner Mike Wilson said, Tuesday, that he would support all three initiatives on which a price has been established. He particularly liked the fact that the five counties in Region V were working together on improving mental health services throughout the area.
Commissioner Mike LeMieur agreed, and he encouraged Vold to continue his work with Northern Pines and the schools to drill down on making that initiative happen, as well.
“I spoke with the superintendent of Pierz and he said the amount (of kids) they were servicing in 2012 to today is considerably more,” LeMieur said. “They’ve got two vendors now to help with mental health issues, and the cost is expensive.”
Commissioner Jeffrey Jelinski said he was also in favor of funding Meals on Wheels. Ultimately, the Board said they would be comfortable with Vold coming forward with a resolution at the May 10 board meeting to fund options one, three and four.
“If we have people that are hungry that are living next door to us and we’re not taking care of it, we’ve got a real big issue,” Jelinski said.
“All three of these before us are important issues,” Blaine said.