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The Collier County Commission is preparing to vote on two key elements of a plan to build a $25-million center to address growing demand for mental health and addiction treatment in the region.
Commissioners will be asked at their May 25 meeting to sign off on five acres that will be donated to the county from the David Lawrence Center, the dominant provider of mental health services in the community, according to Scott Burgess, chief executive officer of the nonprofit organization.
The new complex will be built using local sales tax proceeds on the five-acre parcel that is immediately east of the David Lawrence campus off Golden Gate Parkway near Interstate 75.
A second agreement outlines how David Lawrence will have a 30-year lease and operate the center that will be a central receiving facility, where anyone facing a mental health or addiction crisis will be assessed and linked to the services they need, Burgess said.
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Law enforcement, the courts and mental health officials have grappled for years with people cycling through jails and emergency rooms, or being sent out of county, for care because there are not enough crisis beds and the county’s population is increasing.
When a local mental health advisory committee in 2018 unveiled a five-year plan to address needs, Collier’s population was 373,000 and expected to increase by 40,000 new residents by 2023. Census data shows Collier’s population was 393,000 last year. Projections place the county’s population at 500,000 residents by 2030.
David Lawrence’s case volume of people who are detained under the Baker Act law increased 33% from 2013 to 2018 to nearly 1,600 adult cases, data shows. The law allows people to be committed involuntarily for up to 72 hours for mental health evaluation.
In fiscal year 2020, David Lawrence admitted 1,014 adults and 448 children in the crisis units, which was down in part due to the COVID-19 pandemic, but this year combined admissions are projected to exceed 1,600, Burgess said.
A key issue is that people today are facing a higher level of illness and staying longer, which ties up beds, he said.
The mental health center has 66 treatment beds, of which 30 are for Baker Act admissions and others in crisis. The new assessment center will have 100 crisis beds for adults, according to the center.
“We have seen exponential growth in admissions,” said Ariella Vanhara, director of acute care services at David Lawrence. “From a patients’ perspective, we need more bed space to keep them in county. We average seven Baker Act admissions a day, sometimes it’s more.”
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The county does not have beds now for people committed under the Marchman Act for substance abuse treatment; David Lawrence will gain that designation with the new assessment center, Burgess said. The Marchman law allows family members to petition the courts for a loved one to be ordered for assessment and treatment.
Getting the project started is critical for addressing need now and into the future, supporters say.
“It’s a fundamental shift in how we deal with this as a community,” Collier Commissioner Andy Solis said. “It’s a game changer.”
Solis spearheaded a community-wide effort starting in 2017 to address shortcomings for mental health and addiction treatment in the community that resulted in the committee’s creation.
Committee members represented law enforcement and the courts, mental health and social service leaders and met 21 times before disbanding. The group developed a list of priorities with the assessment center at the top of the list.
Also on the list is increasing housing support for people with mental health illness or substance addiction; launching a data collection and outcomes database, and increasing capacity in the courts to serve people with mental illness or substance addiction.
The last two priorities are addressing non-emergency transportation for people needing treatment and improving prevention programs.
Solis said the mental health crisis needs to be tackled on many fronts, yet a critical first step is getting people out of jail and into treatment, which the assessment center will accomplish.
“It’s going to give us the capacity that we need,” he said.
Florida historically ranked 49th among the states in terms of per capita spending on mental health but dropped to last place in recent years, Solis said.
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How the center will be financed
The planned 55,000-square-foot mental health assessment center will be built for $25 million, using a portion of proceeds from the 1 percentage point increase in the local sales tax, from 6% to 7%, that Collier voters approved in 2018 for a variety of projects that include sidewalks and roads.
The sales tax increase is in effect for seven years or until $490 million is raised, whichever comes first.
The estimated $3 million operating costs annually for the mental health assessment center will not be paid for from sales tax proceeds, Burgess said.
David Lawrence receives about $7 million from the state and federal government for mental health and substance abuse treatment, he said.
Pam Baker, who was co-chairwoman of the mental health committee, said the county must match the state’s contracted support to David Lawrence, which is about $2 million annually. Baker is executive director of the National Alliance on Mental Illness in Collier.
A state formula shows there should be 30 crisis beds for every 100,000 population, so Collier should have 100 to 120 beds, Baker said.
Having a centralized assessment center is an industry model, she said.
“It ensures there is coordination when people are brought in and when they are discharged, and it allows us to have an addiction receiving facility,” she said. “Right now we have not had that, and people are sent to the jail even if they haven’t committed a crime.”
Construction expected to last one year
David Lawrence now is limited to three beds for emergency assessments, and that contributes to delays for admission or people being sent out of the county, Burgess said.
“In the new space, that will go to 10 beds,” he said. “Right now we have many cases where deputies are holding people in their (patrol cars). That will make a huge difference in how quickly deputies can transition someone to us.”
People are sent to treatment centers in Fort Myers, Sarasota or to centers on the state’s east coast, Vanhara said.
“Some clients do refuse to go out of county,” she said. “(The new center) will definitely allow clients to get the support they need without being transferred out of the county.”
The Marchman Act designation will be an improvement for people who need treatment for their substance abuse addiction and haven’t been receiving it, Burgess said.
“Police are taking people to jail but will bring those folks here directly,” Burgess said.
If the commission approves the land donation and operating agreement documents, the next step is for the county to advertise for proposals from architects and contractors to design and build the complex.
The construction time would be about one year once contracts with architects and builders are signed.
“The last estimate I had heard was it would be two and a half years before doors to the center opens,” Burgess said.
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More crisis services for children
David Lawrence plans to expand its crisis services for children using space that will be vacated when the adult crisis beds move to the new assessment center, Burgess said.
Right now, the center has 11 crisis beds for children. Last year, 448 youths were admitted, data shows. The number admitted to the children’s crisis unit has increased to 506 in the 10 months from July 2020 to the end of April this year.
The plan is to go from 11 children’s beds to 30, which will not be funded by the county sales tax revenue, according to the center.
“The children’s expansion is a completely separate project and will be done by the David Lawrence center,” Burgess said.