Linn County Mental Health Access Center hopes to expand programs, hours after first year

CEDAR RAPIDS — In the first year since the opening of the Linn County Mental Health Access Center, over 70 percent of its patients said in discharge surveys they would not have sought services if not for the new mental health crisis center.

The center opened in March 2021 and offers services designed to help assist people with mental health needs. Since the center receives funding from the East Central Mental Health Region, it is open to individuals from nine counties — Benton, Bremer, Buchanan, Delaware, Dubuque, Iowa, Johnson, Jones and Linn. The counties’ property taxes help fund the access center.

Linn County supervisors provided $3.5 million in startup funding for the center, which is located in the building that formerly housed Linn County Public Health at 501 13th St. NW, Cedar Rapids.

“It has been rewarding to see all the work over the last few years come together,” Director Erin Foster said. “It has been intense some days. It has been really difficult sometimes, trying to make connections we want to make for patients while weeding through the system and being advocates for them.”

Services include crisis triage and counseling through Foundation 2, mental health evaluations, referrals to other providers and peer support through AbbeHealth. A key part of the center is that it provides law enforcement a place other than jail or a hospital emergency room to take people who are experiencing a crisis.

“Our ultimate goal is to function like an urgent care where they don’t need appointments or referrals. We want people comfortable knowing they can come in and have amazing staff and connections to resources,” Foster said. “Whether they stay with us for a couple days or go somewhere else, it’s really this all encompassing, holistic approach.”

For after-hour services, individuals can call Foundation 2 Mobile Crisis Teams at (319) 362-2174. The center cannot serve minors, people in need of immediate medical care or people who are violent upon arrival.

Foster said that in the first year, the center saw 532 walk-in patients. Seventy percent of all patients reported they would not have sought any other services if not for the center. The same percentage said they found out about the center through the media or social media.

“The number of people walking in that door just blows my mind, with the percentage of people who wouldn't have sought anything else,” she said. “That was something we never even thought of capturing. Even numbers for already-existing programs are increasing due to putting those programs into an access center.”

Supervisor Ben Rogers, who helped lead the establishment of the center, said when he was told it received its first patient last year he got emotional.

“I can’t imagine our community without these critical services under one roof,” Rogers said. “These services help people navigate through and understand the nature of their crisis and substance-use disorder with compassionate, empathetic and understanding staff who do not judge a person or their circumstances.”

Currently, Iowa has seven mental health access centers around the state, including in Johnson County, with the majority opening in the last few years. Marissa Eyanson, the division administrator of community mental health and disability services for the Iowa Department of Human Services, said the state has seen an uptick in need over the last couple of years.

“We’ve also seen additional acceptance about talking about mental health,” Eyanson said. “We are catching people earlier in the cycle of needing mental health care. We’re catching them before they may need an emergency room and that’s a good thing. It gets them a better shot at getting treatment and earlier intervention is much better.”

For now, the Linn County center is operating Monday through Friday, from 8 a.m. to 10 p.m., but will expand to seven days a week in the next month, Foster said. The goal is to be open and staffed around the clock, which has been difficult due to the workforce shortage affecting many industries.

Foster said, ideally, the center would have 10 to 15 more staff members to function full time.

“The shortage is the No. 1 reason we’re not open 24/7 right now,” Foster said. “We need nurses here. It’s really hit us just like any other industry. We’ve had to be innovative and creative but it’s definitely had an impact.”

Another challenge for the access center is having sustainable funding, which Foster said will always be a challenge in Iowa. Having a certain number of mental health access centers is required by the state, but they don’t receive any state funding.

“I can’t think of one center outside of the state that doesn’t have some sort of state funding attached to them,” Foster said. “As we’ve become more well-known, we are seeing a higher level of complex needs and it’s about working through and figuring out how we get them to the best level of care, which may not always be us. We work to advocate for them and get them wherever they will be most successful.”

Rogers said since Iowa has one of the nation’s lowest Medicaid reimbursement rates, adequate and predictable funding will be the challenge.

“Because these services do not get reimbursed for the full cost of providing the service, we have to ensure that the access center continues to receive funding from the ECR Mental Health region,” Rogers said. “It is not atypical that for every dollar a nonprofit services provider accepts from Medicaid, they have to find the same amount from private donations, fundraising, grants, philanthropy and any other means necessary to just provide that service. That is how bad Iowa’s Medicaid reimbursement rates are.”

Eyanson said she thinks that between local regions funding access centers and that the access centers are also billing out services to insurance providers, the funding model is sustainable.

“The one thing that changes as we go forward with legislation, those local property tax-levy dollars do become state dollars,” she said. “That gives the access centers a reasonable expectation for the next year rather than being variable. Funding in a way that’s more predictable, a percentage, is one of the things that might make sense going forward.”

Another barrier for access centers in Iowa is transportation. While law enforcement can bring referrals to the center, ambulances cannot bill under state code to bring someone to an access center.

“Local EMS can only bring them to the ER because that’s the only option. They may not even need to go to the ER,” Foster said. “That needs to change at the state level along with funding. There’s not one good answer, but we need more options, more things in our toolbox to make this functional and work for people.”

Foster added she is looking forward to the rest of 2022 at the access center. She said she hopes the center will be open full-time this year and that two more services get added: crisis observation and medically-monitored detox.

“Crisis observation is a program if we just need extra time to figure out what a patient’s needs are so they can go into observation for 23 hours or less and work with staff to dig into what the needs are, and a community based detox program will be huge for this center and our community,” she said.

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