Keeping true to one of his campaign promises, Ulster County Executive Pat Ryan laid out his plan to bolster mental health resources going into next year.

“Supporting our residents’ mental health and addiction recovery needs remains one of my top priorities,” Ryan wrote in a press release on September 27. “This week, as part of the 2022 Executive Budget, I promise to outline a proactive plan to turn many of these recommendations into reality. We must invest urgently to address the growing mental health and recovery needs of our community.”

A recent press release about the proposed 2022 county budget outlined some of the mental health-related investments. Ryan plans to allocate $3.3 million, sourced from the county’s American Rescue Plan (ARP) money, to design and construct the county’s first-ever Mental Health and Addiction Recovery Center. The first major chunk of the project, the Crisis Stabilization Center, will be developed in 2022. Another $1 million will be spent towards mental health resources in local schools.

Ryan established the Ulster County Behavioral Health Task Force in May to gauge the community’s need for mental health resources and an action plan to deliver them, according to the September press release. Their research included interviews with nurses, caregivers and the community at large. Five topics were chosen as focal points of county investments in its recently released report: outpatient treatment, inpatient treatment, crisis services, social support, and access to care.

Below are some of the highlights from the full report:

Outpatient Treatment

Outpatient care includes one or more mental health services that do not require a prolonged stay at a facility. Although it’s usually associated with addiction, it can refer to a variety of other mental health-related struggles.

The report urged the county to find a way to reduce wait times folks experience when looking for a mental health care provider. The average wait time for a therapist appointment in Ulster County is between 14 and 20 days, while wait times for psychiatrists (who can prescribe medication) range from 23 days to four months, the report read. As of August, three of the county’s adult and youth clinics had a total of 168 residents on their wait list, the report continued.

Part of the reason for this delay came from providers who faced challenges in hiring and retaining clinical experts before the pandemic. This issue only worsened as the need for mental health support soared through 2021 and competition for appointments climbed. Over 81,000 overdoses were recorded in the U.S., in a 12-month period ending in May 2020, which was the highest rate in the country’s history, according to the U.S. Centers for Disease Control. The task force suggested that appropriate treatment rates should be set, providing enticing salaries that would attract more providers to the county.

Only one methadone clinic, run by WMC, exists in Ulster County. Methadone is a medication used to reduce withdrawal symptoms of people in recovery from heroin and opiate use, the report read. Those taking doses are closely monitored for seven to 10 days, to deter drug abuse, before patients can visit the clinic on a daily basis for six to 12 months, it continued. The only problem is that the wait list at the WMC clinic is, at times, 50 people long. For those who desperately need it, that wait can make the difference between recovery and relapse. Otherwise, they must drive outside of the county on almost a daily basis, signifying a barrier towards treatment, the report read. The task force suggested that the WMC facility be expanded or the county look to create additional clinics.

Inpatient Treatment

In 2020, WMC temporarily closed its two mental health units and is in the process of permanently closing them with the New York State Office of Mental Health.

Wait times for inpatient facility admission varies between 40 and 90 minutes, which has negative implications for a vulnerable population, the report read. When it’s time to leave, it’s essential to have connections with local resources in order to make sure a patient’s stable state is maintained, the report continued. Prolonged disconnection from the community can make it difficult to successfully re-enter normal life after hospital discharge. These extended stays also make it harder for families to engage in the treatment process and for patients to find a ride home. Ulster County will petition to reverse WMC’s request and work to maintain or provide alternative inpatient programs over the next five years.

The Health Alliance First Step program, once located in Ulster County, offered rehabilitation and “medically managed detox” beds, before the program moved to Dutchess County in 2020. The new location has made it difficult for Ulster residents to access this support.

The task force wanted the county to set up a medically supervised” withdrawal program, which provides care for patients with mild to moderate withdrawal symptoms who may not live in an sober-conducive environment and will have difficulty remaining clean without suffering from withdrawals. Treatment includes supervision and close support during detoxification, and often occurs in a community residential setting, before the patient is stabilized and moved to a supervised outpatient program. Neither of Ulster County’s two rehabilitation centers offer such a program and folks are required to travel far to find them, the report read. The task force suggested that ARP money could be used to contract an outside provider for this mode of treatment and that treatment should be given regardless of a patient’s ability to pay or immigration status.

Crisis Services

For folks in the midst of a mental health crisis, like those who are suicidal, the developing Crisis Stabilization Center would be able to provide immediate care for emergency situations.

Our municipal neighbors in Dutchess County have their own 24/7 center where folks of all ages can find immediate support through a team of clinical counsellors, peer specialists and addiction professionals. Admission is voluntary and folks can refer themselves or be referred by their family, health care provider, or law enforcement. The State Office of Mental Health is reviewing the Dutchess model and may offer reimbursement to encourage the development of similar centers, the report continued. Dutchess is on track to serve 3,000 patients through its center by the end of 2021, even with the mandated capacity restrictions that came with the pandemic. This is an impressive figure when you consider that the Health Alliance Behavioral Health Emergency Department houses 3,014 patients each year. The task force suggested that the county apply for state funding to develop the center once it becomes available and use the Dutchess model for its operation.

The task force also suggested that the county create a Comprehensive Psychiatric Emergency Program (CEP), which would establish a department capable of holding and evaluating an individual for up to72 hours. Whether patients are admitted to the program voluntarily or not, their need for treatment would be evaluated along with any treatment or referrals they would need before being discharged. This short monitoring window would allow folks to be properly processed before needlessly being sent to inpatient treatment, the report read. It can also serve as a spot to assess the needs of a patient who was just released from hospitalization.

Social Support

Mental health can impact more aspects of life than your emotional state. In fact, folks suffering from mental illness are 10 to 20 times more likely to suffer from homelessness. A lack of stable housing can further degrade one’s mental state, which can lead these folks into a vicious cycle of hospitalization, jail time, and homeless shelter stays, according to the National Alliance on Mental Illness. Children who face housing instability are also three times as likely to develop anxiety and depression, the report read.

The task force said it was important to provide stable and affordable housing in Ulster County, especially after the drastic spike in real estate prices during the pandemic. The county plans to work with Rupco, Family of Woodstock, and Catholic Charities to “reconfigure” the Quality Inn, in Kingston, into 100 supportive housing units. Additionally, the RYAN Recovery House is in the early stages of a similar construction project for folks coming out of treatment.

It’s also important to help treat the trauma of the pandemic, especially in children who have been isolated for up to 18 months and could be returning to class with unaddressed mental health challenges, the report added. The task force created a plan to provide weekly groups (such as anger management and substance support groups) for any interested schools in Ulster County. This will be complimented by a calendar of mental health services offered by Family of Woodstock, Ulster Prevention, and others. The task force also acknowledged that mental health and behavioral issues are interconnected and said that the county will also provide resources for schools to implement “Restorative Justice Circles.” This system would provide group-talk alternatives to suspensions or other forms of discipline. On top of that, the county plans to work harder to connect with school counselors and social workers to support their efforts.

Access To Care

The developing Mental Health and Addiction Recovery Center will help expand access to services by creating a home base that is near transportation services, centrally located near clients, and easy to move from one level of care to the next, the report noted. The aim of this condensed treatment center is to make it easier for patients to reach multiple levels of care (including the Crisis Stabilization Center, Mobil Mental Health, and mental health clinics) and will facilitate communication and collaboration among providers.

The task force is also hoping to develop a system of care where mental and physical health are tied into one during a visit with their provider. It felt that it was the most cost-effective and comprehensive way to tend to folks’ overall wellbeing.

“We now know that physical health is not separate from mental health,” the report read. “In fact, many of the prevalent causes of death and disease are caused by behavioral and environmental factors.”

Both statewide and nationally, the needle is moving steadily toward integrated treatment. Ulster providers, like the Federally Qualified Health Center and The Institute for Family Health, offer co-located primary care and behavioral health services. However, it’s just not enough. In 2020 the New York Community Trust created a model for such a system that explains how to begin screening, referrals to primary care physicians, and how to create a tracking system for follow ups with patients. The task force recommended that existing providers begin implementing an integrated model with the help of one of these frameworks.