Wednesday, December 8, 2021

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Graham, NC 27253
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Majority of commissioners not ready to allocate funds for mental health crisis and diversion center

Alamance County’s board of commissioners has declined to earmark $13.2 million in federal pandemic relief funds to set up a new mental health crisis center for people who may otherwise clog up the emergency room or end up languishing in Alamance County’s jail.

The county’s governing board ultimately voted 4-to-1 against this proposed allocation after a spirited debate that consumed much of its latest regularly-scheduled meeting last Monday, November 15.

Had they approved this eight-figure allocation, the commissioners would’ve effectively tied up some 40 percent of the $32.9 million that the county expects to receive under the American Rescue Plan (ARP), which Congress adopted in March.

By rejecting the proposed set-aside, a majority of the commissioners preserved this revenue for other potential uses. Yet, in doing so, they bucked the entreaties of various high-ranking county officials, including their own chairman and Alamance County’s sheriff, who has long sought a mental health “diversion center” to offload certain low-level offenders from the county jail.

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The sticking point for the allocation’s opponents wasn’t so much the project itself: all of the commissioners were at some pains to point out that they support the new crisis and diversion center in principle. Most of them nevertheless balked at the project’s $13.2 million price tag, and their unease seemed to increase when it emerged that this figure stemmed from an actual offer that a local developer had quietly pitched to the county.

Commissioner Bill Lashley aptly summed up the prevailing mood of the board when he openly confessed his reluctance to commit any funds to this deal.

“Why the hell would I want to give a guy money if I can go and buy a damn building?…It’s a smelly deal. I’m just telling you straight up.”

– county commissioner Bill Lashley

 

“I like the diversion center,” Lashley admitted before the board’s 4-to-1 vote against the proposed allocation. “I just don’t have enough information to hang my hat on…I believe we can do it cheaper than $13.2 million.”

 

An idea whose time has come?
The back-and-forth over this proposed allocation wasn’t exactly the first conversation that the commissioners have had about crisis services for the mentally ill. In fact, the county has long subsidized a walk-in crisis center, which was originally run by a now-defunct government agency that once oversaw publicly-funded mental healthcare in Alamance and two neighboring counties.

The county managed to salvage this walk-in facility even after the aforementioned agency was forced to dissolve during a state-mandated push to privatize public mental health services. Since the agency’s demise, the county has farmed out these crisis services to a private company dubbed RHA. RHA currently operates the walk-in center in a building that the county leases along Anne Elizabeth Drive, within a stone’s throw of Burlington’s Holly Hill Mall.

In addition to its original functions, the county’s crisis center has expanded its repertoire of services to include emergency treatment and referrals for substance abusers and mentally ill individuals who are arrested by local law enforcement. The center took on this additional role as a “diversion” facility as part of a so-called Stepping Up initiative that the local sheriff’s office launched several years ago with funds from the U.S. Bureau of Justice Assistance.

During Monday’s discussion, Alamance County’s manager Bryan Hagood reminded the commissioners that he and other top-ranking county officials have continuously sought ways to enhance and expand the crisis center’s operations. He recalled that, at one point, he and his colleagues had hoped to set up this new and improved center in a county-owned building along Martin Street not far from the county’s human services center along Graham Hopedale Road. Hagood added that this site was eventually deemed inadequate for the proposed use, although he noted that the county still has a nest egg of grants and donations that were originally rustled up to upfit the Martin Street building.

Hagood told the commissioners that the creation of a new, full-scale diversion center wasn’t really in the cards until Congress signed off on the American Rescue Plan, which released some $1.9 trillion in the U.S. economy for mental healthcare and other needs that have arisen in the wake of the coronavirus pandemic.

“We’ve seen an increased need in Alamance County for mental health services to divert people from both the emergency department and from detention,” he added. “It has obviously been established that our community values this… and it can be opened by this time next year. That is a possibility. But it would take ARP funds to do it.”

The county manager told the commissioners that, in all likelihood, the county would be able to use a portion of its federal pandemic relief funds to set up a full-service crisis and diversion center in a brand new facility within easy reach of Alamance Regional Medical Center. He added that such a facility would offer several advantages over the temporary location along Anne Elizabeth Drive, including room for more patients and the capacity to operate 24 hours a day.

Hagood said that the current vision for the county’s crisis and diversion center entails round-the-clock outpatient services as well as inpatient care and counseling programs. The county manager added that this revised plan would cost an additional $2 million to operate, and he estimated a cost of $9.2 million to purchase or construct a building to house these expanded services.

Hagood went on to encourage the commissioners to allocate $13.2 million from the county’s pandemic relief funds toward such a facility. He acknowledged that, once the three-year window for expending these funds has expired, the commissioners will need to find other ways to cover the center’s increased operating expenses. He added, however, that this outlay seems, to him, like a particularly good use of the funds that the county has received from the feds.

“I would recommend that the commissioners consider allocating funding from ARP toward this project,” he advised the commissioners. “I think using ARP dollars to do this project is the only way it’s going to happen…There is no doubt in my mind that there is a once-in-a-lifetime opportunity with these dollars that have come to use them for this service.”

 

A man with a plan
Monday night’s meeting wasn’t the first time that the commissioners had been asked to dip into the county’s pandemic relief funds to bankroll a new crisis and diversion center. In fact, Hagood had given this same project top billing two weeks earlier when he presented the commissioners with some $48.2 million in departmental spending requests for the $32.9 million at the county’s disposal.

This proposed outlay got another boost last Thursday when the commissioners held a public forum to solicit additional spending suggestions from nonprofit representatives and others outside of county government. Among those who took the floor that evening was Mark Gordon, the president of Alamance Regional Medical Center, who explicitly called on the commissioners to use their pandemic relief funds to set up a “county-owned” urgent care center for mental health.

Although Hagood had also presented the $13.2 figure when he first pitched this project to the commissioners on November 1, the county manager didn’t go into much detail at that time about the basis for his estimate. It wasn’t until Monday that the curtain was finally whisked aside by John Paisley, Jr., the chairman of Alamance County’s commissioners.

“My personal opinion is that this developer is giving us a tremendous discount…This thing can work and work relatively soon and save many, many lives…My question is, while we keep fooling around with this how many people are going to die.”

– John Paisley, Jr., chairman of Alamance County’s commissioners

During Monday’s discussion, Paisley acknowledged that the county has received an offer from Chad Porterfield of Chadco Development to build the facility on land that he owns on the periphery of Alamance Regional Medical Center. Paisley added that Porterfied has proposed a lease-to-own arrangement for this 26-bed facility, which he added would offer all of the amenities in Hagood’s vision for the new center.

Paisley went on to acknowledge that Porterfield has already brought his plans for this project to a rather advanced stage – with input from county officials and others who have a stake in its development.

“He has already started the footing on this project,” the board’s chairman declared. “The conceptual design is to a large degree, for the exterior of the building, complete…RHA was a part of that design. The sheriff’s department was consulted. The county administration was consulted. So, I think all the players are heavily invested.”

Although Paisley didn’t pin down the exact location of this proposed facility, he and other county officials later revealed that the site under consideration comprises several parcels at the intersection of Longpine and Kirkpatrick roads that currently belong to a limited liability partnership called Montgomery Assets.

Paisley added that the county still needs to hammer out an agreement with Porterfield in order to spell out the precise terms of this property’s transfer or lease. Hagood, for his part, assured the commissioners that any such deal would have to obtain their approval before it is firmed up. The county manager nevertheless added that the county will need to offer Porterfield some assurance quite soon that it wants to pursue this project with him as a partner.

“The individual with Chadco has indicated that if we want to go with this model, he would like to know something by the end of this month,” the county manager told the commissioners

.

No deal
During last Monday’s discussion, Paisley exhorted his fellow commissioners to sign off on the proposed allocation in order to seize the opportunity that Porterfield has presented the county.

“My personal opinion is that this developer is giving us a tremendous discount,” he said. “This property, if we are in fact smart enough to approve it, is adjacent to the hospital…This site has so many positives, and I don’t know of any negatives.

“This thing can work and work relatively soon and save many, many lives,” the board’s chairman added. “My question is, while we keep fooling around with this how many people are going to die.”

Paisley proceeded to call on Alamance County’s sheriff Terry Johnson to provide him some backup in his pitch to the rest of the board. Johnson insisted that the project would be worth pursuing from a purely financial perspective since it would spare him the cost of detaining low-level offenders with mental illnesses or substance abuse problems.

“It would save $80 to $85 a day per bed per inmate,” Johnson told the commissioners, “and the medical costs for someone coming into our [jail] are tremendous.”

Yet, the sheriff’s endorsement wasn’t enough to persuade Paisley’s fellow commissioners to allocate $13.2 million in anticipation of a potential agreement with Porterfield.

The numerous unanswered questions about the prospective deal proved decisive for commissioner Craig Turner, who declared his intention to vote against the proposed allocation.

“There’s so many unknowns that still exist…I think it sequesters money that we could use for other projects, and there are other properties that are very close to the hospital and are available…I think we need to slow down a second and take a longer look.”

– county commissioner Craig Turner

“There’s so many unknowns that still exist,” Turner told the rest of the board. “I think it sequesters money that we could use for other projects,” he added, “and there are other properties that are very close to the hospital and are available…I think we need to slow down a second and take a longer look.”

The offer from Porterfield also raised some qualms for commissioner Pam Thompson, who balked at the prospect of leasing a building for $9.2 million rather than buying it outright.

“Why are we paying for it if we don’t own it? I can’t see paying $9.2 million to a dude that’s going to build a building and it’s going to be his.”

– county commissioner Pam Thompson

“Why are we paying for it if we don’t own it?” Thompson inquired rhetorically. “I can’t see paying $9.2 million to a dude that’s going to build a building and it’s going to be his.”

The lease-to-own option drew an even more visceral response from commissioner Lashley.

“Why the hell would I want to give a guy money,” he asked, “if I can go and buy a damn building?…It’s a smelly deal. I’m just telling you straight up.”

In the end, Paisley managed to get the board’s vice chairman Steve Carter to second his motion to approve the proposed allocation. Carter nevertheless joined Lashley, Thompson, and Turner in the 4-to-1 vote rejecting the motion, which only Paisley supported.

After a 10-minute break, Carter tried to salvage the situation with a second proposal that, in lieu of allocating funds, the commissioners merely authorize the county manager to pursue negotiations with Porterfield over the property along Longpine Road and explore any other locations that may also suit the county’s needs.

“This is too important of a project for us to just walk away from,” he told his fellow commissioners in hindsight. “I know there is a time window on this project and I’d hate for us to lose it.”

The commissioners went on to give Carter’s motion a unanimous nod after commissioner Craig Turner proposed an addendum that the board also instruct the manager to negotiate agreements on the facility’s services.

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