Sponsor: Social Services
Title
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Personnel Complement Increase in the Social Services Department
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Recommendation
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Approve an increase in the personnel complement of the Social Services Department by 4.0 full-time equivalent (FTE) positions in the Mental Health Professional and/or Mental Health Practitioner classifications: 2.0 FTEs for Adult Mental Health Crisis and 2.0 FTEs for Children’s Mental Health Crisis.
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Background
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Minnesota Statute requires county boards to provide enough emergency services to meet the needs of adults, children, and children's families who are experiencing an emotional crisis, emotional disturbance, or mental illness. Emergency services must provide an immediate response 24-hours-a-day, seven-days-a-week (Minnesota Statutes section 245.484 7 subdivision 1 and section 245.462). A team of 16 mental health professionals, 11 mental health practitioners, and two peer support specialists are providing Mental Health Crisis Services in Ramsey County. Because of increasing need for crisis services, four additional staff are required to provide effective and timely responses; two for Children’s Crisis and two for Adult Crisis.
Extensive community outreach has increased awareness of Children’s Mental Health Crisis Services leading to more demand for services from residents. During the 4th quarter of 2019 (October - December), phone calls were up 189% compared to the year before. Face-to-face assessments and outreach visits were up 144% for the same time period. Increasing staffing levels for Children’s Mental Health Crisis Services is critical for the stability of children and families in Ramsey County.
Adult Mental Health Crisis needs additional staff because of a change in the way the County is providing coverage during the overnight shift, increasing demand due to recent events that have created anxiety and stress, and increased collaboration with the Emergency Communications Center.
On July 1, 2020, Ramsey County terminated its agreement with Dakota County Crisis Response to answer adult crisis phone calls during the midnight to eight a.m. shift. At times, long-term clients with severe emotional disturbances need phone contact throughout the day or night to manage their symptoms. Calling the crisis line to manage symptoms is part to their treatment plans. Generally, they do not need face-to-face visits from Crisis staff. County staff heard from some of these long-term clients that Dakota County staff would not accept frequent calls and referred these clients back to the police. Data from Dakota County for the seven weeks prior to the contract ending shows their staff answered an average of 31 calls per week during the night. Since assuming coverage for the overnight shift, Ramsey County staff have averaged 67 calls per week over nine weeks. By providing coverage for the overnight shift, Adult Mental Health Crisis will be able to help some clients maintain stability through ongoing phone contact and avoid more restrictive care.
Stress related to COVID-19, the murder of George Floyd, and community unrest have fueled increased need for crisis services among adults. COVID-19 led community mental health providers to rapidly adopt telehealth services. The level of illness experienced by residents often exceeds the capabilities of telehealth services. In addition, persons needing Mental Health Crisis Services frequently lack the technology required for telehealth. Ramsey County Mental Health Crisis staff have continued to provide in-person, mobile crisis response as well as in-person, urgent care services at its Urgent Care for Adult Mental Health facility throughout this period of upheaval. The staff within the Ramsey County Mental Health Crisis teams have displayed unwavering courage and commitment to the needs of the Ramsey County community throughout the pandemic, even in the early days when personal protective equipment was unavailable. The ability to meet face-to-face with a crisis clinician during this time of overwhelming stress has been of great benefit to many in the Ramsey County community.
In addition to the increased usage of Mental Health Crisis Services caused by recent events and the change in overnight coverage, Adult and Children’s Mental Health Crisis supervisors have been collaborating with the Emergency Communications Center (911) to route more calls related to mental health needs directly to the crisis phone lines rather than to police dispatch. Crisis supervisors have provided training to 911 staff and have made themselves available to answer questions about crisis response capabilities. This change increases the work of Mental Health Crisis staff but provides a more appropriate intervention for mental health crises.
During the first quarter of 2020 (January -March), inbound calls to Adult Mental Health Crisis averaged 584 per week. During the second quarter (April - June), Adult Crisis received an average of 774 calls per week with a high of 822 calls during the week of July 6, 2020. This represents a 33% increase. The onset of the COVID-19 pandemic initially reduced face-to-face assessments, primarily for walk-ins to the Urgent Care for Adult Mental Health site at 402 University Ave East. From May to June, however, face-to-face meetings to attempt or complete an assessment increased by 59%.
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County Goals (Check those advanced by Action)
☒ Well-being ☐ Prosperity ☐ Opportunity ☐ Accountability
Racial Equity Impact
Black, indigenous and people of color (BIPOC) are overrepresented in the corrections and child protection systems. Adequately staffing Mental Health Crisis Services decreases reliance on the police and child protection to respond to mental health crises. Collaboration between Children’s Mental Health Crisis and Child Welfare Early Prevention staff has kept children within their family networks when the family system is stressed rather than placed outside the home and/or involved in the child protection system. Timely Mental Health Crisis Services increases the number of adults and children who are successfully served in the community. This results in better health outcomes and better life-long outcomes in education, employment and community engagement.
Community Participation Level and Impact
Families have reported to crisis staff that they prefer calling the Mental Health Crisis lines for a mental health outreach visit over calling 911 for a police response. The increase in calls to the Mental Health Crisis lines and acceptance of face-to-face visits also indicate this preference.
As mentioned above, some adults who need to call the Mental Health Crisis line to manage symptoms reported that they could not access this service under the County’s contract with Dakota County. The change in overnight coverage is a response to this stated need.
The Mental Health Crisis teams have made many efforts to inform residents about Mental Health Crisis Services by attending educational fairs, resource fairs, Ramsey County Children’s Mental Health Collaborative meetings, joining with Ramsey County Public Health for an online Facebook event, visiting homeless shelters, and outreach to the Karen Organization of Minnesota, resulting in crisis staff joining the Karen Organization Community Health Advisory Committee. Crisis staff also go out with St. Paul Police Officers on co-response visits to engage residents in community-based mental health services in an effort to divert them from correctional involvement.
☒ Inform ☒ Consult ☐ Involve ☐ Collaborate ☐ Empower
Fiscal Impact
The four additional FTEs will cost approximately $400,000. Sufficient funding for the positions is in the Social Services Department’s budget. Costs are being offset by the following:
• Because of demonstrated need, the Minnesota Department of Human Services (DHS) increased the County Crisis Grant by $65,744 per year for calendar years 2021 and 2022.
• A peer support specialist position budgeted at $65,000 will not be refilled.
• The joint powers agreement with Dakota County for night-time crisis response services has been eliminated. The amount allocated for the last six-month contract was $33,564.
• Decreased use of on-call staff and over-time hours to staff Mental Health Crisis Services.
• Decrease in the number of children and youth placed in higher levels of care.
County Manager Comments
County Board approval is required to increase personnel complement.
Last Previous Action
On August 20, 2019, the County Board authorized acceptance of a grant from the City of Saint Paul and approved the addition of two mental health professionals or practitioners to the Social Services personnel complement to co-respond with police officers on calls involving individuals with mental illness (Resolution B2019-199).
Attachments
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