This article was originally written and published by Randy Petersen of Post Bulletin.
With facility expected to open in July, the Southeast Regional Crisis Center will provide immediate mental health services and support for residents of 10 counties in an effort to address growing needs and reduce pressure on regional inpatient system.
Colleen Lamon said her mental health crisis didn’t need to extend to weeks.
“Somebody could have brought me back to reality within three days,” she said, snapping her fingers to symbolize how quick the response could have been compared to the ordeal she faced.
Lamon, who now works as volunteer and event coordinator for the local National Alliance of Mental Illness chapter, said her latest crisis started with a bottoming out in 2019.
“There was a very traumatic event in my life that caused the symptoms of my depression (to increase), and my personality disorder was affecting the symptoms as well,” she said.
As a result, she became suicidal.
“I very much did not want to live,” she recalled.
Instead of acting on the negative feelings, she went to a neighbor for help and was taken to the emergency room at Saint Mary's Hospital.
It wasn’t her first trip. She faced her first crisis 11 years earlier, and others since, so she knew the routine: She’d be taken to a bay for up to 72 hours of observation.
“You feel like you are in jail,” she said of the experience. “It’s very non-conducive to getting healthier mentally.”
At that point, her only hope was for an in-patient bed to become open.
From experience, she knew she wanted to go to Mayo Clinic’s Generose Building for inpatient care, but she was told -- after three days of waiting in the emergency room -- that she’d be taken to Hutchinson Health, 140 miles away from the support of family and friends.
"Within 24 hours, if you have the right tools, and you are asked the right questions, and you begin following your plan immediately, it only takes maybe 24 hours, maybe, at the most, three days." - Colleen Lamon
“After I was there for a month, I wanted to get transferred back to Rochester,” she said, but a lack of available beds meant she was sent to United HealthCare in St. Paul.
Three weeks later, she was able to get a bed at Zumbro Valley Health Center, where she could stay for a week and reconnect with family members who would take her home for two weeks until a spot in an outpatient program opened.
The process took more than 10 weeks, and Lamon believes her crisis could have resolved within hours or days if the Southeast Regional Crisis Center had existed.
“Within 24 hours, if you have the right tools, and you are asked the right questions, and you begin following your plan immediately, it only takes maybe 24 hours, maybe, at the most, three days,” she said.
Lamon’s experience is not unique.
“In general, there is a gap in services in the mental health care delivery system,” said Bruce Sutor, Mayo Clinic psychiatrist and chairman of the crisis center’s executive team.
The crisis center, which is expected to open at 2121 Campus Drive in the Olmsted County government campus in Southeast Rochester, is intended to fill that gap.
“Really it’s trying to create an additional level of care within the mental health system,” said Nicole Mucheck, the center’s executive director.
Sean Kinsella, executive director of the southeast chapter of Minnesota NAMI, said it’s been a gap that has required many people in crisis to first determine a suspected diagnosis and then try to find an appropriate appointment, if they want to avoid the emergency room.
“The old system really wasn’t a system,” he said.
Sutor said the lack of anywhere else to turn in a crisis has overwhelmed area emergency rooms for years.
“Right now, for people in crisis, the only place is the emergency department, which may be the right environment for certain people, but for other people, it’s probably not always the best answer,” he said.
Data shows the needs are increasing.
From 2007-2014, Minnesota’s hospitals experienced a 49 percent increase in all mental health emergency department visits, which included substance abuse, for all ages.
Nikki Niles, who oversaw Olmsted County's community outreach program before recently being named to head Dodge-Fillmore-Olmsted Community Corrections, said the social workers who ride with Rochester police and Olmsted County sheriff patrols responding to potential mental health crises frequently sees a need for more help than they can provide on the spot.
She said at once a week someone is taken to the emergency room for mental health care, and sometimes it happens several times a day.
Niles said the team’s goal was to ensure safety and connection to the best care available. She said she expects the crisis center to enhance both efforts.
“It’s getting clients connected to services as early as possible with a holistic approach in mind,” she said.
Sutor said past increases have appeared to level off locally, even during the pandemic.
“The trends month-by-month over the course of the past couple of years have been pretty steady,” he said.
What has gone up is the number of people staying for longer periods in the emergency department as they wait for someplace to stay or receive help, due to a lack of available inpatient beds.
He predicts the crisis center will help open more beds for people who need long-term stays at other facilities, including Generose.
“If there is something that can get people out of the hospital more quickly or help to avoid the need to go in the first place, it will help provide access to those who need in-patient hospitalization,” he said.
It’s one of the reasons so many partners are working together to open the center.
“I see it as being incredibly valuable for being able to respond to people, to provide the right care at the right time, and most importantly at the right place.” - James Hoffman, president of Olmsted Medical Center
The coordinated effort was a big part of the process that led to the crisis center’s existence.
As soon as Sen. Dave Senjem, R-Rochester, suggested $30 million in funding to create such facilities throughout the state, local advocates banded together to help push for the legislation.
Once $28.1 million was approved, the group, which included 10 counties, Mayo Clinic, Olmsted Medical Center, the southeast chapter of Minnesota NAMI and other partners, switched the focus to developing a local proposal.
The collaboration continues, with many of the participants represented on the center’s executive team, and others planning to extend services into the facility.
“It is a very unique and extraordinarily collaborative effort,” said James Hoffman, president of Olmsted Medical Center and a member of the crisis center's executive team.
While the OMC emergency department doesn’t have the ability to admit people who are in a psychiatric crisis, Hoffman said staff does see a need for added care and options.
A practicing obstetrics and gynecology physician, he said it’s important that all healthcare responses remain nimble and meet people where they can provide the best treatment.
“I see it as being incredibly valuable for being able to respond to people, to provide the right care at the right time, and most importantly at the right place,” he said of the center.
To aid that goal, Crisis Response of Southeast Minnesota will be working closely with the center, with some staff stationed at the site to provide access to needed resources.
Also planning to be a regular asset at the center is NAMI staff. Monica Yeadon, NAMI’s program director, said peer support specialists will be there three hours a day, boosting it to six hours on Saturdays.
Additionally, many of NAMI’s support groups and other programs will use space in the center.
Yeadon said the goal is to make it a comfortable place to turn for help.
“If someone is coming to a support group every week, and they have a crisis, what is the most logical place for them to go? The place they’ve been going to every week,” she said.
All that is on top of the 46 staff members hired by Nexus Family Healing, which was selected by the executive team to oversee day-to-day operations at the center.
“Within the clinic we have 23 hours to do a full assessment and really assist people in making connections,” said the center’s executive director, Nicole Mucheck, who is part of the Nexus staff.
"It’s a great place to get assessed, and if you’re not safe, it’s a great place to be kept safe until the proper environment can be there. " - Bruce Sutor, Mayo Clinic psychiatrist and chairman of the crisis center’s executive team
Mucheck compares the crisis center to an urgent-care clinic with a focus on mental health. The goal, she said, is to determine the best course of treatment for each individual in need.
The onsite staff assessment will provide medical and psychological evaluations, help with coping skills and a comforting environment as resources are made available. If more than 23 hours of support is needed, inpatient services will provide private rooms with access to community areas until the next steps are ready, whether that’s at a facility that provides longer inpatient care or in an outpatient program.
“It’s a great place to get assessed, and if you’re not safe, it’s a great place to be kept safe until the proper environment can be there,” Sutor said.
Lamon said she believes the crisis center could have shortened her path to recovery in 2019, as well as provided other options.
Noting people with mental illness don’t get better but learn to manage, she said the center will be her first choice if she faces another crisis.
“I will absolutely be at the crisis center if I need it,” she said. “I will not be hesitant. I will go there over the ER any day.”
Youth will find added help at crisis center
Stephanie Podulke has seen first hand what can happen when a teen in crisis lacks access to appropriate mental health care.
A former in-home family therapist, the Olmsted County Board chairwoman said she’s taken several young people to the emergency room, worried about their safety, only to have them released from care.
“Kids have a way of presenting much better than their true symptoms are,” she said, noting they might deny past statements or hide their true feelings.
When that happens, she said it can be difficult to convince a medical doctor more help is required.
As the Southeast Regional Crisis Center prepares to open with half the facility dedicated to working with children ages 10 and older, and their families, Podulke said she’s hopeful the focused attention means more youth will get the help they need.
Amy Rauchwarter, Olmsted County’s director of Child and Family Services, said the ability for youth and family members to walk in without an appointment will assist in providing that help when most needed.
“Youth and families will now have an option for support and intervention at a time when symptoms are worsening and there is concern that without intervention, things will escalate to a point of needing more intensive services such as the emergency department, inpatient hospitalization or residential treatment placement,” she said. “We know that it can be challenging to get timely appointments with mental health professionals in the community.”
It’s a need seen nationwide.
According to the Centers for Disease Control and Prevention, the number of mental health–related emergency department visits increased 24% last year among children aged five to 11 years and 31% among adolescents aged 12 to 17 years from January to October 2020, compared with the same period in 2019.
On the outpatient side of the crisis center are rooms to provide youth and family members to stay together, while also offering individual privacy when needed.
Executive Director Nicole Mucheck said the center’s design provides flexibility to respond to unique needs of each case.
Half of the center’s 16 inpatient beds will also be available for short-term stays, something that is lacking throughout the 10-county region.
Another four beds are dedicated for adult use, but the final four are “swing” beds, so the facility can provide eight or 12 youth beds at any time.
“It was designed that way to meet community needs at any given time,” Mucheck said, adding that the need for youth beds is expected to be most common.
Sutor agreed. “I’m betting that is where it will be utilized most quickly,” he said.
Seven things to know about the Southeast Regional Crisis Center
The Southeast Regional Crisis Center is expected to open in July after more than three years of effort to secure state funding and design the program.
- The opening is delayed.
Original plans called for opening the crisis center at 2121 Campus Drive on the Olmsted County government campus in June, but construction delays and the COVID-19 pandemic combined to push back the date.
Marketing Manager Tera Girardin said a date for a grand opening ceremony is in the works for July, with the plan to start accepting patients afterward.
- No appointment is needed.
Crisis Center Executive Director Nicole Mucheck said the operation will be a culture shift for people who are used to scheduling treatment.
“Individuals really don’t need to call to make an appointment,” she said, noting that the center will be open 24 hours a day, seven days a week.
Walk-in clients will be accepted, as well as referrals from local providers, schools, the regional crisis response team, law enforcement and others.
“We aren’t going to ask you to schedule your crisis for a Thursday at 3 o’clock,” Mucheck said.
- Response is certain.
Crisis center officials and others say they don’t know what to expect when the facility’s doors open.
Bruce Sutor, the chairman of the center’s executive team, said he’s anticipating a trickle but is ready for a flood.
“We’re ready to be serving folks at full capacity, but I think part of it’s going to be a gap of people not knowing it exists,” said the Mayo Clinic psychiatrist, adding that awareness of the facility will likely increase referrals.
- The 16-bed limit is set by federal guidelines.
State Sen. Dave Senjem said lawmakers needed to limit the number of inpatient beds at each to 16 when earmarking funds for several similar centers throughout the state.
He said the federal limit is designed based on a desire to ensure state’s do not recreate mental health hospitals.
Even with the limits, he said the goals will be met.
“The idea is a place to go, where you are not going to get turned away and you are going to find some care,” he said.
- More facilities could be added.
Mucheck and others said the 16-bed limit doesn’t keep counties from expanding to other locations.
The executive director said part of the group’s contract with Nexus Family Healing, involves tracking where clients are coming from throughout the 10-county area throughout the next three years.
“I know there is an interest in growing the service,” she said.
- The length of stays will vary.
The crisis center will cater to the needs of people who need a few hours to help cope with a crisis to others who need to stay for days.
Mucheck said up to a 10-day window will be considered for most cases when someone needs more than a 23-hour outpatient visit.
- Cost of service can be covered in many ways.
Mucheck said insurance will be billed for crisis center services when available, but staff will also use MNsure navigators and other programs to cover costs.
Counties also could tap into funds from existing programs to help people pay for services.
“We are really trying to limit any cost burden,” Mucheck said.
2018 -- Minnesota Legislature sets aside $28.1 million to create or renovate facilities to house services that treat people with mental illness or chemical-dependency disorders. Ten southeast Minnesota counties, along with other partners, began working on a proposal
February 2019 -- The Southeast Minnesota effort was informed it would receive $5 million to build a facility. It is the largest award available under the legislation.
Construction has begun on the future site of the Southeast Regional Crisis Center on Tuesday, June 23, 2020, at the Olmsted County government campus in Rochester. (Andrew Link / firstname.lastname@example.org)
June 2020 -- Construction of the facility begins on the Olmsted County government campus in Southeast Rochester.
August 2020 -- Nexus Family Healing signs on as the operations partner to handle day-to-day operations of the facility.
December 2020 -- Nexus names Nicole Mucheck as the center’s executive director.
June 7, 2021 -- Staff starts moving into the facility as construction continues and final occupancy is arranged.
July 2021 -- A ribbon-cutting ceremony is planned.