Fulton County has the building. It has a plan, worked out with the state Department of Behavioral Health and Developmental Disabilities. It has money to renovate that building — the current Oak Hill Child, Family & Adolescent Center — to house a new Behavioral Health Crisis Center.

What the county needs is money for operations. And county leaders are looking to the state of Georgia.

Securing funds for the crisis center is Fulton County’s top priority in the current General Assembly session, which ends March 29.

Gov. Brian Kemp’s budget for fiscal 2024 — which starts July 1 — includes nearly $5.7 million for the facility. That’s enough for a 15-bed crisis stabilization unit and 18 observation chairs. But it’s about a million less than is needed for the center’s first six months of operation, county officials say.

Plans call for a 24-bed and 16-chair facility, which will need the additional million operating dollars — and $13.3 million a year from the state after that.

Credit: arvin.temkar@ajc.com

Credit: arvin.temkar@ajc.com

Central to the Fulton County plan is a “living room” model, a comfortable and informal area where walk-in patients can talk with staff. Some of those workers will be medical personnel, while others will be certified peer counselors, people who have “lived experience” with similar issues themselves, said Pamela Roshell, county chief operating officer for Health, Human Services, and Public Works.

“The current funding does not include that ‘living room’ model,” she said, referring to Kemp’s budget proposal.

Some people who come to the center won’t need to be under observation or be committed to a bed. They many just need to talk and connect with social services, then go home. The “living room” is designed to get those people the lowest level of formal intervention that will still offer effective care.

The Fulton County Commission has pledged $15 million in federal American Rescue Plan Act funding to renovate the Oak Hill campus.

While other counties relied on the state to build and fund operations of their centers, Fulton is providing a facility built to state standards and only seeking operating funds, County Manager Dick Anderson said.

The county already puts about $16 million a year into mental and behavioral health services, said county spokeswoman Jessica Corbitt. Spending on the crisis center would be in addition to that.

Speaking to a Georgia Senate committee on Tuesday about the amended budget for the current fiscal year, Georgia Department of Behavioral Health and Developmental Disabilities Commissioner Kevin Tanner didn’t mention the Fulton crisis center specifically. But he said the rate charged to the state by private providers of psychiatric crisis beds is rising from $675 to $840 per bed per day, the first increase since 2014. Those providers told the agency that they would stop taking state patients at the end of February unless the rate increased, Tanner told legislators.

Georgia has become more reliant on those private beds as “the safety net of our safety net,” but many are unavailable due to staff shortages, he said. Expanding the crisis center system is part of eliminating the state’s reliance on paying for private beds within five years, Tanner said.

Growing need

Fulton has 10% of the state’s population but no publicly funded crisis center of its own.

The county already offers telehealth services, individual and group therapy, and operates five clinics for the uninsured and underinsured, Roshell said. Meanwhile other nearby counties, including Cobb and DeKalb, have crisis centers.

Dawn Peel, director of the Office of Crisis Coordination for the state department of behavioral health, said there are 13 crisis centers across the state. Altogether, those have 361 crisis care beds, for stays of three to six days; and 92 “chairs” for up to 23 hours of observation, all available 24/7.

Other state crisis services make for a total of 546 beds and 120 chairs, not including facilities under state contract to handle any overflow, Peel said. One of those overflow facilities is Grady Memorial Hospital, she said.

Services provided to Fulton County residents during fiscal 2022 include 530 people in crisis stabilization units, for an average of nearly eight days each. Those were spread across 17 facilities.

Having a crisis center in Fulton should not only take some pressure off those in surrounding counties, but also decrease visits to area emergency rooms, Roshell said.

A state assessment shows that Fulton may ultimately need three crisis centers, Anderson said.

The plans

The Oak Hill center is already used for many community needs, from twice-monthly food distribution and a community kitchen to a childhood hearing test lab. The renovation will reshuffle many of those services but all will continue to operate on the site with improved facilities.

Construction is expected to begin in summer 2023, with the crisis center opening in early 2024. The renovated center will include space for juvenile care.

The adult mental health facility will be built in the courtyard that now exists between the building’s wings. One wing of the current structure will house youth mental health services, once those are developed and funded, Roshell said.

Credit: arvin.temkar@ajc.com

Security will be improved, and the various uses will have dedicated entrances, Roshell said. The new center would have a sally port, a secure entrance for police to transfer people, whether brought from a jail or the street.

Anderson said an outdoor track will remain and trails may be added, while the existing gym may host more community events.

Corbitt said county officials met with the Hammond Park Neighborhood Association and the Neighborhood Planning Unit in November, and that both groups agreed to support the project.

Community representatives let officials know it was important to them to keep Oak Hill’s current services, Roshell said.

Changing patterns

The Fulton crisis center and those elsewhere are part of a broader push to address mental health in Georgia, especially as related to policing.

In a 2010 settlement with the U.S. Department of Justice, Georgia agreed to expand its mental health system and provide community-based services instead of centralized hospital care. The state’s network of crisis centers developed as part of that settlement under federal supervision.

That’s part of a nationwide trend of serving people closer to their homes, Peel said.

Ready access to crisis care is expected to become even more crucial later this year when publicity ramps up for 988, the nationwide suicide and crisis hotline.

Although the 988 hotline started operating in July 2022, the publicity campaign was delayed so local governments could prepare to handle increased demand, Peel said.

That increase is already underway. Between October and December the state took 11,000 more calls for mental health care than in the same period in 2021, she said.

Projections for call volume once 988 is widely advertised indicate the demand for service could more than double, Peel said. The need for crisis beds is likely to increase in tandem, she said.

Georgia-specific information on the suicide and crisis hotline can be found at www.988ga.org.