With need for mental health growing, Collier needs to do more

More must be done to improve access to affordable mental health care in Collier County, especially for veterans, seniors and low-income residents.

More must be done to improve access to affordable mental health care in Collier County, especially for veterans, seniors and low-income residents.

That was the consensus of 47% of 6,072 respondents who participated in the Collier County Community Assessment; they also cited accessibility challenges due to service locations, hours of operation and provider availability.

“This is a vital area that non-governmental entities in Collier County could prioritize to address community needs, notably for lower- income individuals,” said the report by Q- Q Research Consultants Inc., which conducts the assessment every five years for the Richard M. Schulze Family Foundation and the Community Foundation of Collier County to help county leaders, commissioners, government officials, non-profits, civic groups and others determine the county’s future needs.

Despite a pressing need for mental health care, only 23% of respondents said mental health care should be one of the county’s top three priorities, although the percentage was higher for lower-income respondents. It ranked No. 6, following affordable housing (65%), managing growth and development (63%), the environment and emergency planning (41%), bringing better jobs to the area (32%) and public education/workforce training (24%).

Collier County’s situation is more dire than other areas due to low Medicaid rates for mental health care, a high number of uninsured residents and a shortage of resources.

Survey and focus group participants cited health challenges faced by senior citizens, including limited mental health care services and a lack of affordable retirement and nursing- home options. Parents and youth need greater access to mental health services, they said, while mental health experts and others said the stigma and attitudes toward mental health care posed challenges, and cited a need for more comprehensive substance-abuse education and awareness programs.

The veterans focus group said homelessness and inconsistent care at Veterans Affairs (VA) facilities presented challenges and that other mental health facilities were often filled to capacity. As a result, veterans said awareness about available mental health and substance-abuse resources is needed. A state report says there were 28,000 veterans in Collier in 2020, but Vietnam veteran Dale Mullin, president of Warrior Homes of Collier Inc., believes it’s down to about 22,000, with about 75% Vietnam veterans. For years, veterans have sought help, and County Commissioner Burt Saunders has championed the cause of their health.

Collier County plans to build a 120-bed nursing home that also would offer outpatient therapy, adult day care and short-term rehabilitation on 18 acres of county-owned land, the former Golden Gate Golf Course. The total cost, which keeps increasing, is currently projected at $120 million, with the federal VA paying 65% for construction costs and the county footing the state’s share, 35%.

“A major issue on the mental health side that is not being addressed—because we don’t have the resources to address it and the county doesn’t either—is that many senior veterans have cognitive issues and we have no place to put them,” Mullin said. “The nursing home does not solve that problem. It doesn’t even address it. There’s nothing for memory care.

“We are having issues trying to house people with memory-care issues,” he continued. “The most many will have is about $1,200 a month in Social Security benefits. The minimum for memory care in Naples is $4,000$5,000 a month.”

Instead of trying to build something new, Mullin said, Warrior Homes is working on a plan to house these veterans somewhere and pay part of their monthly rent.

“Right now they’re sleeping on benches, in their cars, in the woods. They’re just totally neglected. Their families can’t manage them,” he said, adding that county commissioners should help.

Mullin noted that the majority of homeless veterans have mental health or substance-abuse problems. Because the homeless veterans population wasn’t counted until five years ago during the Point In Time annual count, the numbers are low so Collier County doesn’t get funding and hasn’t applied for federal HUD-VASH (Veterans Affairs Support Housing) vouchers, which are part of the Section 8 housing program. However, he said, Lee County receives more vouchers than it uses, so it’s been providing Collier veterans with vouchers and five live in Warrior Homes housing.

The Florida Department of Veterans Affairs operates eight skilled-nursing facilities and one assisted-living facility, but those that offer beds for memory care or Alzheimer’s disease and dementia are far from Collier County. They’re in Orlando, Port St. Lucie, Land O’ Lakes, Pembroke Pines, Port Charlotte, St. Augustine and Panama City.

Adults and children who aren’t veterans have options that include the non-profit David Lawrence Centers, Healthcare Network, NAMI, The Willough at Naples and Crossroads Behavioral Health Center.

County officials and non-profit David Lawrence Centers are working on a county-owned mental health complex, the Collier County Behavioral Health Center. The 87-bed facility would be built on five acres next to DLC’s campus off Golden Gate Parkway near Interstate 75. DLC, which will operate the center, will donate the land to the county. But in less than a year, the cost of the project grew from $44 million to $50 million and the square footage shrunk from 64,000 to 60,000, while the need continues to increase.

Over the years, the project has faced opposition from neighbors, delays due to zoning issues, increases in costs due to the pandemic and supply chain issues and more.

At a March 12 public hearing on the project, Collier County Sheriff Kevin Rambosk told the Board of County Commissioners that holding inmates who are mentally ill costs $160-$180 daily, so having a mental health care option will save his office money and staff resources.

DLC CEO Scott Burgess told commissioners that 20-25% of its patients aren’t insured and Medicaid only covers roughly 40% of costs for care. DLC hopes to generate more funds through donors and naming opportunities.

Commissioners voted unanimously to continue working on the final design. The center is among projects receiving funding from the county’s 1-cent sales surtax, which ended in December and may be contemplated again. Commissioners still must approve a final price and general contractor.

So what else can be done for mental health in Collier County? Are there best practices used elsewhere that county leaders could consider? The Naples Press asked mental health experts for their suggestions.

Scott Burgess

CEO, David Lawrence Centers for Behavioral Health

The last several years have brought significant challenges to individuals and families in our community who have been impacted by a global pandemic, isolation and loneliness, life transitions, economic hardships and more. The need is greater than it has ever been. One in four people are experiencing at least one mental health illness. We know mental health services are clearly a priority in Collier County as demonstrated by Collier County leaders’ efforts to expand services to children, adults and seniors in need throughout Southwest Florida. Our community has made significant strides to address challenges related to mental health and addiction services since the previous Collier County Community Assessment was released for 2017-2018. These steps, such as the creation of the county’s mental health and addiction services five-year plan and the approval of the new Collier County Behavioral Health Center, have enabled Collier County to improve resources for mental health and addiction treatment services.

Yet, we know more work needs to be done to ensure that all Collier County community members have access to affordable mental health care. That includes recruiting and retaining highly trained and experienced mental health professionals; increasing access by expanding programs and telehealth opportunities; and expanding available in-patient care for individuals in crisis. We know that the ratio of availability of mental health professionals to residents in Collier County has been demonstrated to be worse than Florida at large and stands dramatically worse than the national average, so supply is low and demand for care is high.

Unfortunately, historic low Medicaid rates for mental health care, coupled with Collier County having some of the highest rates of uninsured individuals in the country, drive a lack of resources and access to care for some of the most vulnerable in our communities. That is why funding support for providers like DLC, who do not turn anyone away for care, regardless of income or insurance status, are so critical. Yet, the demand versus resources to supply the support is often out of balance and can create waiting lists for care.

At David Lawrence Centers for Behavioral Health, we are committed to working closely with our community partners to expand access to mental health and addiction services in Collier County. Our “Hope for Collier: Building Stronger Minds Together” initiative builds on the success of our programs and partnerships to ensure that these life-saving services are available to anyone who needs them.

Dale Mullin

President, Warrior Homes of Collier Inc.

For decades, veterans who’ve served our country with dignity and honor have grappled with higher rates of mental illness, substance abuse and homelessness and are at increased risk of suicide. The problem is particularly acute here in Collier County, where housing prices are among the nation’s highest. Veterans commit suicide at twice the national average, at 19 per day, and are 50% more likely to become homeless. We have documented 51 homeless veterans in Collier County as of the last official (Point in Time) count in 2023.

Ninety percent of all homeless veterans have some level of mental health issues. That’s a published number in the industry, so if you don’t have some level of mental health issues, if you’re homeless for very long, you will have a mental health issue—and some can turn into pretty serious problems.

That’s why you always hear the No. 1 priority for veterans is housing and No. 2 is mental health, because in most situations, they go together. Housing is a major part of getting veterans back on track and getting them stabilized with their mental health issues.

Over the past several years, Warrior Homes of Collier has secured four properties to house local veterans:

  • Alpha House, a short-term, transitional residence for those in recovery from substance-use disorders and other mental health disorders such as PTSD and TBI (traumatic brain injury).
  • Bravo and Charlie Houses provide longterm supportive housing for six seniors on fixed incomes who receive rent subsidies based on income.
  • Delta House, a supportive housing complex with 10 apartments for up to 20 men and women veterans.

We average about seven to eight veterans a year in Alpha House for substance-use issues. They stay an average of seven months, but we now have a waiting list because we don’t have enough beds. We have seven beds. This is the first time we’ve experienced this, so I don’t know whether [demand is] up or whether we’re just doing a better job of getting the word out.

In addition to getting veterans off the streets, we connect our residents with support services, such as mental health counseling and peer support through the David Lawrence Centers, as well as educational opportunities, including college scholarships.

Thanks to the generous support of private donors and philanthropic groups in our community, our goal of ending veterans’ homelessness in Collier County gets closer to reality each day. The day that we end veteran homelessness in Collier County we can truly say we are a “veteran-friendly community.”

We commend the county for pursuing projects in support of the men and women who served this country with duty and honor and applaud efforts to make Collier the most veteran- friendly county in the state. Our concern, though, is that the immediate needs of this vulnerable population aren’t being met— and this (veterans nursing home) likely won’t come to fruition for years. It also doesn’t benefit current county residents in need of additional assistance.

In the last four years we have housed 65 veterans and are now at full capacity. We have a waiting list for prospective new residents. We continue to provide emergency assistance through our homeless prevention programs, including rent and utility payment support and food cards.

We can’t do it alone. Through our efforts we have organized and lead a coalition of 17 local organizations all committed to a single mission that “no veteran in need is left behind in Collier County.” The shortage of local housing for veterans is a community-wide crisis that requires leadership, advocacy, innovation and investment from the public and private sectors, organizations and individuals. The Collier Community Foundation, which Warrior Homes proudly counts among our supporters, concurs, having identified homelessness and seniors as a top local priority in its 2023 Community Needs Assessment.

Our approach isn’t just the right thing to do – it will save taxpayers money.

Consider the statistics. At Warrior Homes, it costs about $30 a day to house a resident and at St. Matthews House, it’s $55. If homeless veterans end up in the Collier County jail, those costs increase to more than $200 a day. If they are Baker-Acted at David Lawrence Centers, the costs are even higher, $1,200 per day. [The state’s Baker Act allows doctors, mental health professionals, judges and law enforcement to commit a person to a mental health treatment center for up to 72 hours if they display certain violent or suicidal signs of mental illness.] These brave warriors need the support of our community and deserve safe, clean and accessible housing, as well as greater support for mental health and wellness.

Warrior Homes of Collier urges Collier County to expedite the process of allocating sales tax surcharge revenue or other sources of revenue toward its committed projects, including the state veterans nursing home. We also urge, encourage and challenge the county, businesses, philanthropic groups and private citizens who care about veterans to invest in proven local resources that can deliver help today. Every day’s delay is a day that more and more veterans are at risk of falling through the cracks.

Jamie Ulmer

CEO, President, Healthcare Network

Healthcare Network has implemented same-day consultations integrated within medical visits at the point of care to promptly address concerns as they arise for both adults and children. Patients can follow up in their primary care clinic where they are already established, which helps increase access and reduce the stigma associated with seeking mental health care. In addition to sameday consults/integrated behavioral health, Healthcare Network has added traditional therapy services to cater to patients requiring more frequent or specialized care.

Healthcare Network continues to promote telehealth as a strategy to overcome social and logistical barriers to accessing care and maintaining treatment plans. Primary care providers have also expanded telehealth visits specifically for psychiatric medication management for established patients.

The future plans for Healthcare Network include workforce development to increase capacity with a focus on specialists in population health and integrated behavioral health care. This will simultaneously help expand the network’s reach and penetration of behavioral health services.

On June 1, Healthcare Network will be launching enhanced services related to Substance- Use Disorders (SUD) and Medication- Assisted Treatment (MAT). SUD/MAT involves the use of medications in combination with counseling and behavioral therapies to offer a comprehensive, whole-patient approach to treating substance-use disorders. Research indicates that this combination of medication and behavioral therapies is the most effective method for treating these disorders.

Beth Hatch

CEO, National Alliance for Mental Illness Collier County

The stigma is not something that we talk about, especially in Collier. That’s the glory of being able to talk about it and letting people know all the resources, because the numbers are there. We’re serving one in four people in Collier, including children. It used to be one in six. We’ve had to take children into that next level, which we call Care Coordination. This year especially, the numbers are growing leaps and bounds and the need is growing. Mental health does not discriminate, just like Hurricane Ian didn’t discriminate. It hit some of our fancy areas and some of our poorest areas.

The Community Foundation and others support us and we are very grateful, but we still have work to do. We have to let people know that (mental health issues) can happen to all of us, someone we know, our brothers, sisters, family and neighbors. It’s not the criminals that we just see on TV. It’s everyday people.

We’re seeing a lot of comorbidity. We do a lot of autism screening for children. The silver lining is that we’re seeing anxiety and depression and can diagnose that. Once upon a time, they’d say he or she doesn’t make eye contact and they play by themselves. It’s not always about a magical pill. It’s about giving them tools in their toolbox so they and their families can feel a bit better.

Children’s need for mental health services has more than tripled this past year. We’ve screened over 2,000 children this past year. We have an agreement with the school system and work with pre-K through grade 12, and early learning providers, most funded by the Naples Children & Education Foundation. Most are in areas of poverty, so that’s a sector we are trying to help.

We added a clinical team this past year. NAMIs don’t include children, it’s mostly adults, but we’re fortunate to have supporters in Collier County. We were in crisis because if we were to just advocate for family and refer family out for additional evaluations after our initial screening, that wasn’t helping anyone because the wait is eight months to a year or more. Then if they don’t have insurance, it’s another problem, so we were able to bring a clinical team on to do evaluations in-house. Early intervention is so important, especially for children, because we can put things in motion.

It’s about helping the whole family, because it affects the whole family. We moved to a new location (on Castello Drive) about a year ago, so our numbers have almost quadrupled because of our space and the ability to have more people in our adult program, which is from age 18 all the way to seniors and veterans.

People ask me all the time, “Will you put them all together?” I do because they can learn from each other. It’s a participation-driven model, life skills and supportive employment. So many of our adults, unlike children, don’t have someone to advocate for them in this world of difficult healthcare systems. We can help by attending a medical appointment with them and act like a compass. Sometimes mental health can be that stability. It doesn’t have to be a huge success story.

Part of being that compass is keeping them on track, and sometimes we have to scaffold up and scaffold down a bit, especially for adult seniors and veterans. It’s definitely a Florida thing. They simply don’t have anybody to support them. Many people don’t have family here. As we get older, we have to relearn things. Applications for assistance are not easy to navigate. Our services help them take the next step.

I always use Hurricane Ian as a perfect example. No one was saying, “Oh, let me see how my mental health is doing” after they were completely flooded. We were out, boots on the ground, checking for mental health (issues), letting them know they’re not alone and we’re here.

Our children’s mental health program is called HUGS (Health Under Guided Systems) and serves infants all the way to age 18, or 22 if they have developmental disabilities. We’ve screened over 2,000 children. If they score in the threshold of concern or their referral is such that we need to take the next step, we work with the schools, parents, guidance counselors, doctors and pediatricians. If we need to take the next step, we roll them into Care Coordination, where we decide if they need a further evaluation. Do they need a diagnosis? Do they need a different placement in school? We attend school meetings and doctor appointments. We help them navigate through those level of care cycles and we go into the children’s homes, which is a lot of time and effort for our team. We want to make sure it’s safe, No. 1, but we’re able to identify many other needs.

We’re very blessed in this community with a lot of nonprofits and providers that have different services. Asking for help or knowing where to look for help is sometimes one of the hardest things. We can identify not just mental health, but other barriers in the home, and then we can make progress.

Our adult program, from age 18 to seniors and veterans, is Monday through Friday and the door is open to everyone. It’s life skills, supportive employment, socialization and belonging. We want everybody to be active and participating because they encourage each other. We try to get them engaged, moving and grooving because sitting around doesn’t help. We can do yoga, meditation, take walks, eat healthy foods, learn how to help them. As we get older, it doesn’t have to be a diagnosis of bipolar or schizophrenic, people may have had brain injuries and have to relearn skills.

In the past week and a half, we helped five people get jobs for supportive employment. We’re not just putting them in jobs and saying, “Good luck to you.” They still stay connected to our programs, and that’s important because most don’t have anybody else, so that’s a connection that can sustain their mental wellness.

We have a good infrastructure for housing. We’ve made relationships with lots of landlords. All our services are free, but (housing is) the only program that participants pay a small portion for continued sustainability because you need a place to live. You can’t live in your car or the woods. That’s a huge issue, and we hide it a lot in this beautiful resort town. When it’s seniors and veterans, that pulls at our heartstrings more. We make lunch every day and then we’re sending healthier things home.

(Mental health issues) really can tear apart a family. We know that it breaks up marriages. It’s tough and we have to pay attention.

To read the Community Assessment, go to: bit.ly/2023ccca.

Source: https://www.naplespress.com/2024/05/17/with-need-for-mental-health-growing-collier-needs-to-do-more/

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