Staff members on Monday evening provided two contract recommendations to the program and services committee for providers who could take over the Crisis Now hotline and the mobile crisis response team.
The committee members, many wanting more time to review the providers before recommending the six-month contracts to the full board, were only able to make a couple motions before those either failed or were withdrawn.
“What I don’t want to do is make a hasty decision and services are still interrupted,” said board member Jill Bucaro, who is also manager of holistic defense services for the Montgomery County Public Defender Office.
Community stakeholders and members had also reached out, some of the committee members said, asking the committee not to approve the contracts.
“I feel, as a board member, some of us are basically public enemy number one,” said board member Teresa Russell, who is also the director of criminal justice outreach at the Montgomery County Sheriff’s Office.
RI International lost millions
There were questions of how Montgomery County ADAMHS ended up in this position. The board had previously approved extending its agreement with RI International for five months, between Jan. 1 to May 31, which included waiving the 120-day notice requirement in their original contract should either entity decide to renew or not to renew services.
“What we do know is that they really had a great deal of difficulty blending their rate with the payment system in Ohio,” Helen Jones-Kelley, executive director of the Montgomery County ADAMHS board, said about RI International’s struggles.
She made reference to the reimbursement system from Medicaid as one of the sources of difficulty.
RI International has experienced financial losses with Montgomery County exceeding $2.3 million as of December, according to RI International president and CEO David Covington.
“I’m worried we will be back here again,” Bucaro said, with others sharing similar remarks.
Staff recommendations
The staff’s recommendations for new providers included Netcare Access, who would provide call center services to the end of the year for a contract amount of up to $515,000. DeCoach Recovery Centre, for a contract amount of up to $440,000, was proposed for the crisis mobile response team.
The sources of funding for both would be the county’s human services levy, Ohio MHAS funding, and a federal grant from SAMSHA.
A couple committee members made different motions for a 90-day recommendation of Netcare and DeCoach. They disagreed, though, on other recommendations in the motions, such as recommendations on considering local providers in the future and who could provide input and help vet the providers.
Dr. Brian Stroh, CEO of Netcare, said logistics of providing services for only a 90-day contract would be difficult for any provider.
Why not just use 988?
Jones-Kelley answered questions as to why the county is not just using 988 and what will happen with the crisis receiving center.
“They (the county’s 988 provider) cannot handle the call volume that we will be able to get with Netcare,” Jones-Kelley said.
Montgomery County’s 988 provider is Sojourner Recovery Services in Hamilton and is currently considered a backup to county’s Crisis Now hotline, Jones-Kelley said.
Currently, Sojourner (as 988) handles approximately 60 calls a month from Montgomery County. RI International at the Crisis Now hotline answered approximately 1,200 calls a month from Montgomery County.
In regard to the crisis receiving center, it is likely going to take about a month for Montgomery County ADAMHS to organize a provider recommendation for that site, according to Jones-Kelley.
RI International currently owns the lease for that location, so a new provider would have to take over the lease from RI International.
“We do have a facility that was paid for by them…that was all RI investment,” Jones-Kelley said. No county funds went into that facility, she said.
In reference to the facility only being able to hold someone at the crisis receiving center for 23 hours, it is all RI International could provide by law, Jones-Kelley said, due to RI International not being a hospital.
“I think everybody needs to step back, take a breath, and listen to the people in the trenches, and that’s not what’s happening,” said Montgomery County Probate Court Judge David Brannon.
A lot of police chiefs have a lot of questions about what happened with RI International, said Doug Jerome, president of the Montgomery County Association of Police Chiefs.
Police have concerns with the “pink slipping” process, which is where an individual can get taken to the hospital for an involuntary mental health assessment. Those patients can get released from the hospital shortly after the assessment, or they can get put in a 72-hour hold and potentially get civilly committed, according to mental health experts.
“They oftentimes are back in our communities before the paperwork is done. Within two hours, three hours. We ask these questions. How can this happen?” Jerome said. “We don’t get a lot of answers.”
Previous services, funding
RI International had been providing services in Montgomery County since late 2021, soft launching the Crisis Now hotline in November 2021 and doing a hard launch in January 2022. Its services included overseeing the county’s Crisis Now hotline, mobile response teams and the crisis receiving center located on Edwin C. Moses Boulevard.
RI International’s services were funded through $3.6 million of the county’s human services levy, as well as $1.3 million in state allocated funds from Ohio Mental Health and Addiction Services (MHAS) and $1.8 million in federal funds.
Previous contracts with RI International showed higher amounts, but those were the maximum amount of funds RI International could bill ADAMHS for, Jones-Kelley said. Montgomery County ADAMHS has paid a total of $6.7 million for services RI International rendered for the county.
During its existence in Montgomery County, RI International provided help to more than 30,000 times, mostly through the Crisis Now hotline. The crisis receiving center, which soft-opened last spring, saw an average of 90 people per month, according to data provided by ADAMHS. State and local leaders touted the three-tiered crisis model as the first of its kind in the nation.
Montgomery County ADAMHS receives $21.4 million in human services levy funding from the county to support behavioral health services.
Public stakeholder meetings will be held Tuesday from 3:30-5 p.m. and Wednesday from 9:30 a.m. to 11 a.m. at the board’s office, located at 409 E Monument Ave., suite 102, Dayton. The next board meeting will be Wednesday evening at 5:30 p.m. at the same location.
