At an Aug. 3 county budget workshop, Montgomery County commissioners asked Evan Roberson, Tri-County Behavioral Healthcare executive director, on the status of the center’s closed crisis stabilization unit, or CSU. Roberson told commissioners it would require nearly $2 million per year to restaff the program—which closed in November 2021—and pay competitive salaries.

Tri-County Behavioral Healthcare is a federally qualified health center serving Montgomery, Walker, and Liberty counties, according to its website. In an interview with Community Impact Newspaper, Roberson said people admitted to the 16-bed crisis stabilization unit are generally uninsured and require hospitalization.

“Generally the stay, historically, was about five days,” Roberson said. “Some people would stay longer, some shorter—we’d stabilize them and move them out.”

Roberson said demand for mental health services is high because “people are not doing well.” Tri-County statistics show that as of June 2022, the center has served 4,251 people in crisis—3,426 adults and 825 children—with the center seeing more children in six months than in the four full calendar years prior.

The Psychiatric Emergency Treatment Center, which houses the CSU, remains open, according to Roberson, and county law enforcement continues to bring some patients to its crisis assessment center. However, with the CSU closed, officers need to transport patients to other facilities, which Roberson said takes time.

During a July 26 Commissioners Court presentation, Precinct 1 Constable Philip Cash and Lt. Brian Luly, who head the county’s mental health unit, said they had received 1,276 calls from January-June 2022, comprising over a quarter of total mental health calls.

Roberson had planned to request $4.2 million in American Rescue Plan Act funding from Montgomery County, having received $6 million for the previous fiscal year. Aside from ARPA funds, Montgomery County pays $211,525 annually as part of a contractual match through the federal Health and Human Services Commission.

Precinct 3 Commissioner James Noack said it should be Roberson’s priority to get the crisis stabilization unit up and running.

“[Having those beds] is one of the biggest needs for this county, for law enforcement,” Noack said. “Not having them is a disservice.”

Roberson told commissioners at the Aug. 3 meeting that he had been discouraged from requesting ARPA funds for “operational” usage such as salaries at the previous year’s budget workshops, clarifying his funding source needed to be ongoing.

Staffing shortages, ARPA usage

Roberson said high turnover was not uncommon in the CSU due to demanding shift schedules. However, during the summer of 2021, Roberson said he noticed less applicants due to nurses seeking out positions he could not afford.

Tri-County was paying registered nurses about $32 per hour, or about $65,000 annually, but nurses were leaving for positions that could pay $50-$60 an hour, or nearly double their annual salary.

“We had to do a series of market surveys in December [2021] that showed we weren’t paying near enough; then we went to the HHSC and asked for funding, and they declined,” Roberson said. “And then I've been making the rounds with everybody; all of the county partners have heard me talk. And nobody has volunteered any ongoing operational dollars, which [is] what I need to get it open.”

To run the CSU, Roberson said two registered nurses were needed per shift. The unit also employed licensed vocational nurses as well as psychiatric technicians to perform regular evaluations of patients as well as nondegreed staff. A fully staffed CSU would have 16 RNs, but by the time the center closed, Roberson estimated that number dropped to 10.

Montgomery County awarded Tri-County $6 million in ARPA funds in the fiscal year 2021-22 budget, which he used to open a clinic serving youth in Porter in May.

Roberson told commissioners he projected just over $4 million of funds being spent by the end of the year and told Community Impact Newspaper he did not know what would happen to the rest. A financial transparency report showed Montgomery County still had $40 million in ARPA funds at the end of 2021.

ARPA funds can be used to provide additional, or “premium,” pay for low- to moderate-income essential workers on top of their regular pay. Tri-County has spent over $1.4 million on premium pay in FY 2021-22 and had a request for $1.8 million in FY 2022-23 at the budget workshop.

However, Roberson said he does not want to staff full-time positions using ARPA funds, as concerns would rise when the money runs out.

“I don't want to use ARPA funds to [pay] enhanced salary because they're gonna go away,” Roberson said. “And then how do I keep paying the salary?”

County commissioners have also previously stated their opposition to using ARPA funds for full positions and salaries during Commissioners Court sessions.

At the Aug. 3 workshop, commissioners asked Roberson to return to the court’s ARPA committee at an unspecified date to discuss potential future funds. No funding was immediately approved for Tri-County.