Linn County Access Center looks to expand as facility marks two years in service

CEDAR RAPIDS — Two years ago, Linn County celebrated the opening of its mental health access center — marking a key step in efforts to meet the community’s critical mental health needs.

When it opened in March 2021, the facility offered crisis stabilization but didn’t immediately have walk-in access. Nonprofit Foundation 2’s mobile crisis team was used to place people at the center.

Later that season, the center began to accept walk-ins during typical business hours and staff have since continued to expand access to walk-in hours and all center services, taking law enforcement referrals, adding sober units, crisis observation and other services.

Center Director Erin Foster said the facility also has expanded its scope of community partners that are involved when patients present to center staff with anything — whether they’re a veteran, in recovery, or in situations involving domestic violence, housing access or sexual assault.

“We've really broadened the outside partners of the access center to be able to come in here and physically work with our patients that we have here on site,” Foster said. “The last few years we’ve had a lot of growth on our side of things, but also what services we provide in-house at the access center.”

So far, there have been 710 walk-ins and 88 law enforcement referrals since fiscal 2023 began July 1, 2022. In the center’s first full year of operation — July 1, 2021 through June 30, 2022 — it saw 785 walk-in patients.

The East Central Mental Health Region on March 23 is slated to consider budgets for the access centers within its nine-county area including Benton, Bremer, Buchanan, Delaware, Dubuque, Iowa, Johnson, Jones and Linn counties.

Regional Chief Executive Officer Mae Hingtgen last month presented a fiscal 2024 budget — spanning July 1 to June 30, 2024 — to the regional governing board made up of county supervisors. Board members indicated they would not vote to adopt a budget that underfunded access centers while the region sits on a nearly $6 million surplus, sending her back to the drawing board to draft a modified proposal.

Foster said staff hope to make walk-in hours available 24/7, hopefully by this summer. But funding sustainability remains a challenge to the facility’s expansion.

Here’s what Foster had to say about the progress the access center has made since it first opened its doors at 501 13th St. NW in Cedar Rapids.

Q: Since you mentioned wanting to move up to offering 24/7 service still this year, what else is on the horizon in terms of expanding services?

A: Physically here at the Access Center, obviously our goal for walk-in services 24/7 is a big focus of ours. Our other large focus would be opening our community-based withdrawal management program, otherwise known as a detox program here on site, so individuals who are withdrawing from substances wouldn't have to go to the hospital first before receiving our services. They could actually be in a medical withdrawal management program here on site with us, so that is our next big program that we are hoping to open on-site.

Q: What would you say are the biggest challenges facing the center right now, especially as the center looks to undertake some of these growth efforts? What are the barriers?

A: First and foremost, sustainability of funding is always going to be a barrier. When it comes to both mental health and substance use disorder funds, we need to be funded in a different manner in which other mental health services currently are funded within the region.

Obviously, the point of an Access Center is to have access to services when an individual is in crisis and that is not a Monday through Friday, 8 to 5, scheduled out type of recurrence. And so any sustainable payment mechanism that pays for accessibility, pays for staff to be prepared to address anyone's needs regardless of the time is a really important piece.

I think a piece that differentiates us from other mental health services in this realm that the region is already funding is when you have an entity like this that is completely voluntary, we don't schedule when people walk in and we don't schedule when people leave. At any point, it can go from filled to empty within a matter of minutes or hours. And not viewing the service with a sustainable payment mechanism in order to literally have staff here ready when a crisis comes on hand really defeats the point of having an Access Center. The equivalent that we give a lot is we are not paying firefighters per fire that they go to or EMTs per emergency call that they go to. There is a payment mechanism in place for them to be ready when the call goes out. And that's how access to these need to be funded as well.

Q: Do you have any specific thoughts on how the center could be better funded? Would that be up to the mental health region? Would you hope for state law changes?

A: I think our region is really in a good place where I know they're trying at the state level to put some pressure and make some movement on consistency among the access centers across the state. And this lack of mechanism is not just unique to us or unique to GuideLink in Iowa City. It's one that all of the access centers across the state are facing.

I would hope that our region would see the value in paying to be prepared and paying to have access available. At the same time being one of the biggest regions, I think they can really come together and create — whether it's a formula for access or it's a payment mechanism that can be put in place for empty beds — those are two pretty viable options and that I believe are on the table. I think we just need to move forward as quickly as we can and make them sustainable in order to help the issues that we are currently facing, and not ones that we think we’ll be facing in the next couple years.

Q: For the people who use the Access Center and benefit from its services, what do they typically say about it and how does it help them and successfully keep people out of emergency rooms and jail?

A: One of the things that we do is a post-discharge survey for individuals that come into the Access Center. And we have very high success rates of individuals who feel that they have felt cared for and that we created really strong discharge plans to them.

Q: Why is it important to have a facility offering these services?

A: I think these types of facilities are really leading the way to get a lot of people connected to services for the first time. One of the questions that we collect is what would you have done if the Access Center didn't exist? And one of the pieces that's a little bit surprising to us is the number of people that note that they wouldn't have done anything — that this was the first time they've ever looked for mental health or substance use disorder help.

We obviously know there's a stigma tied to both talking about it, getting help and that type of thing. We hope that we can continue to be that door that's always open, that “No Wrong Door” approach that we can help people with different pieces. But we're glad that people are seeking services, whether it's for the first time or the 100th time, that we're always here to help them figure out what this looks like.

We know that mental health and substance use disorder structure in the state of Iowa can be messy and it can be confusing and it can be frustrating at times. Part of our job is to help people figure that out and we are always happy to do that for people.

Comments: (319) 398-8494; marissa.payne@thegazette.com