A committee will be appointed to consider and make recommendations on use of $1.4 million included in the 2018-19 state budget for building a facility-based mental health crisis center in Wilkes County.

Gary Blevins, chairman of the Wilkes County commissioners, said at the end of the commissioners’ meeting Tuesday night that he would appoint members of the committee before his term as chairman ended at the board’s Dec. 3 meeting. Commissioners elect a chairman at the first meeting in December and Blevins said he wouldn’t be a candidate.

He said that when he, Commissioner Keith Elmore and representatives of Asheville-based Vaya Health and Concord-based Daymark Recovery Services met earlier Tuesday, discussion focused on using the $1.4 million to establish a walk-in outpatient clinic open 24/7 instead of a facility-based mental health crisis center.

Vaya is the state-designated local management entity/managed care organization (LMC/MCO) for mental health care in Wilkes and 22 other western North Carolina counties. It is funded by Medicaid and the state. Daymark, which replaced New River as primary provider of mental health care in Wilkes, Ashe, Alleghany, Watauga and Avery counties, works through a contract with Vaya.

Legislation including the $1.4 million in the 2018-19 budget said the funds would be used to construct a facility-based mental health crisis center with beds for extended stays for residents of Wilkes, Alleghany, Ashe, Watauga and Avery counties, said Sen. Shirley Randleman of North Wilkesboro, credited with securing the funds.

Randleman said language in legislation providing the funds said that the $1.4 million is non-recurring and must be returned to the state’s general fund if not spent on brick and mortar for facility-based mental health crisis services. She opposes alternative uses of the funds.

“Our area of the state has been underserved for more than a decade and we have reached a critical point,” said Randleman, referencing mental health needs addressed when the $1.4 million was included in the budget.

The facility-based mental health crisis center was to be constructed as an addition to Daymark’s current facilities at West Park, North Wilkesboro, and would have been operated by Daymark.

Vaya CEO Brian Ingraham and Daymark CEO Billy West both hailed announcement of the original plans for the $1.4 million as great news when they were made public in late May.

Vaya said in a press release then that it would partner with Wilkes County government, Daymark, local hospitals and others on the project, which it said would “provide a safe, therapeutic option for local residents seeking treatment for mental health, alcohol/drug use or developmental disability needs.”

An Oct. 16 four-page report that proposed using the $1.4 million to expand Daymark’s current walk-in clinic by keeping it open 24 hours a day, every day as an alternative to the facility-based crisis center was made public earlier this month. The report’s cover said it was submitted by Wilkes County government, Vaya and Daymark.

The report said the $1.4 million was for construction only and was non-recurring, so funds were lacking to cover the proposed facility-based center’s annual operating costs estimated at over $2 million.

The report said Daykmark’s walk-in clinic provided immediate access to care for 1,111 people and diverted 331 people from the Wilkes Medical Center emergency department last year. It said 2,614 people received outpatient care there between 8 a.m. and 5 p.m. Monday through Friday, excluding holidays.

If the clinic was expanded to 24/7, the report said, more people would be diverted from inappropriate use of hospital emergency departments, more would be engaged in preventive care and people would be allowed to stay up to 24 hours.

The report concluded that facility-based crisis care is necessary for Wilkes residents requiring inpatient stabilization and/or detoxification. It said these needs are being met by existing beds at Synergy Recovery in Wilkesboro, which also operates under contract with Vaya, and through Daymark’s out-of-county, 64-bed network.

“Most Wilkes residents who experience behavioral health crisis require a less intensive level of care that is more appropriately met by around the clock access to walk-in crisis services. To that end, the $1.4 million allocated to Vaya Health in Senate Bill 99 would achieve the greatest community benefit” if $500,000 is used for construction and $900,000 for supporting costs for a 24-hour advance access/walk-in clinic,” the report said.

It said $900,000 would be enough for two years, and during this time ongoing funding sources would be explored.

The report recommended that the legislation be amended to allow this change in use of the $1.4 million.

Blevins said the committee he was creating would explore what would be needed to allow changing how the $1.4 million is used. He said he has talked to Sen. Deanna Ballard of Boone and Rep. Jeffrey Elmore about submitting amended legislation.

Blevins is one of the 18 voting members of the Vaya Health Board of Directors and a member of Vaya finance committee.

In the summer of 2016, Vaya officials announced plans for building a 16-bed crisis care center as a 10,000-square-foot addition to the Daymark facility at West Park (at that point owned by county government). A few months later, Vaya announced that it lacked funds for following through with these plans due to state budget cuts.

State legislators have pressured Vaya and LMCs/MCOs covering other parts of the state to use their reserve funds. The LMCs/MCOs have responded by saying these funds are already committed and that the cuts have made it hard for them to deliver needed behavioral health care services.

Blevins said that since joining the Vaya board, he has come to understand that Vaya doesn’t have the flexibility to use these reserve funds as state legislators assert.

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