The five million dollars in federal ARPA money allocated for the provision of mental-health services provides the spark of creativity with which Ulster County can organize its programs more effectively, according to Tara McDonald, the first commissioner of the unit newly separated from the county’s health department. The uptown Kingston resident hopes to make the most of the opportunity.
In its 2022 budget, Ulster County government earmarked approximately $16 million to address mental-health needs. The biggest portion of that considerable allocation was for the county’s first mental-health and addiction recovery center.
On April 26, the county announced it had bought the former Medical Arts Building at 368 Broadway, which it described only as “an existing commercial office building,” for two million dollars of ARPA money. Ulster County said it plans a crisis stabilization center at the location which will allow individuals in need of mental-health or addiction services to connect immediately with an integrated team of professionals for support and treatment options.
In partnership with the county, the non-profit multi-location Access: Supports for Living had set up a clinic on Suite 205 there last year, well before the purchase of the 368 Broadway building. The clinic is open from 10 to 6 Monday through Friday and the rest of the time virtually. This service connects the county’s urgent-care and mobile mental-health teams. Therapists are available 24/7 by phone and through telemedicine.
An unusual feature of this particular office building is its connection via a second-story covered walkway over Foxhall Avenue (clearance eleven feet eight inches) to next-door Kingston Hospital, part of HealthAlliance of the Hudson Valley, owned and operated by the Westchester Medical Center (WMC), with which Ulster County executive Pat Ryan has been engaged in a bitter two-year feud about the location of behavioral-health facilities for Ulster County residents.
Since at least September 2020, WMC has been seeking state decertification of 60 in-patient beds in Kingston — 40 for mental health and 20 for detoxification. These services will be offered in Dutchess County, WMC said.
Ryan felt the WMC decision, which the health system has stuck to ever since, was very damaging. “Our supposed partners have pulled the rug out from underneath us,” he said bitterly at that time. He has argued that the inpatient beds should be located in Ulster County, with the other elements of the health system, rather than distant from them. The last thing vulnerable people need is alienation from their support.
Ryan plays the long game
It is difficult to see the choice of location at 368 Broadway as unconnected to that feud. Ryan, McDonald and their colleagues have been busy creating a strategically placed beachhead for behavioral-health services cheek by jowl and physically connected with a WMC facility. Is there a long game being played here?
Last May, Ryan assembled a group of 30 persons as a behavioral health task force under the chairmanship of Tara McDonald, at that time deputy commissioner of mental health within the county health department. Meeting monthly, the task force was tasked with an analysis of the gaps and opportunities of the county’s system. “It is our intention,” said McDonald at that time, “to focus on the challenges of accessing services and to recommend additional pathways in which residents can connect to immediate support.”
In September, the task force recommended an integrated system that included the return of inpatient psychiatric services. The county executive budget for 2022 acted on many of these recommendations.
With support from the county legislature, the decision was made to form a separate county mental health department that would be designated by the state as a Local Governmental Unit which would oversee funding for mental health, substance abuse and developmental disabilities.
An integrated vision
A search for a head of the new department was held, with a pay of $97,807 offered. McDonald, a veteran of 13 years with the State Office of Mental Health in the field in Albany before coming to do youth work for Family of Woodstock in Ulster County, was selected as commissioner on March 24 of this year. She said she expects to maintain her offices on Golden Hill until the new digs at 368 Broadway are ready, hopefully in about 18 months.
Fifteen people currently under the new commissioner’s purview. She expects that number to expand to 19 on the near future.
The treatment of mental health is a very stressful occupation, not made any easier during Covid. McDonald said that workforce recruitment and retention takes a lot of her time. The crisis has created a focus on bonuses for retention, she noted.
Therapist turnover is a problem for patients, of course. Too many patients who badly need support have had to work with three different therapists within six months.
Though it may help, a bridge between buildings doesn’t create a relationship between their occupants. Ulster County and WMC are still poles apart when it comes to their visions of an integrated system of behavioral health.
Ryan, McDonald and their colleagues know that. But the county’s actions of the past year must put some pressure on WMC grudgingly to accept the more holistic local vision of behavioral health as more appropriate than their own.
Hey, you never know.