A proposed 16-bed facility-based mental health crisis center will be back on the table for discussion in a Wilkes County commissioners work session at 3 p.m. Thursday.

Keith Elmore, chairman of the commissioners, said he called the public meeting to help bring clarity to issues involving $1.4 million included in the 2018-19 state budget for building the facility as an addition to the Daymark Recovery Services building at West Park, North Wilkesboro.

Although legislation providing the $1.4 million said the funds would be used to build a facility-based mental health crisis center with beds for extended stays, a report released in October proposed using it instead to expand Daymark’s current walk-in clinic by keeping it open 24 hours a day, every day.

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

The four-page report was submitted by Daymark, Wilkes County government and Asheville-based Vaya Health, according to the cover of the four-page report.

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. Concord-based 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.

“There are unanswered questions and some confusion” related to certain financial and other issues, said Elmore.

For example, he said, Vaya officials say their fund balance is smaller than what some legislators say. This impacts Vaya’s ability to fund the proposed facility-based crisis center’s operating costs. Elmore said Vaya’s recent estimates of the cost of the proposed facility-based crisis center have been as high as $5 million.

State legislators have pressured Vaya and LMCs/MCOs in parts of the state to use their fund balances, but the LMCs/MCOs have responded by saying these funds are already committed and that cuts made in state funding made it hard for them to deliver needed behavioral health care.

Wilkes County Commissioner Gary Blevins serves on the Vaya board and said he has come to understand that Vaya doesn’t have the flexibility to use these reserve funds as state legislators assert.

The report released in October recommended that the legislation be amended to allow using the $1.4 million to expand Daymark’s current walk-in clinic.

Shirley Randleman of North Wilkesboro, credited with securing the $1.4 million in her last year as a state senator, said language in legislation providing the funds said the $1.4 million must be returned to the state’s general fund if not spent on brick and mortar for facility-based mental health crisis services.

Randleman also said she opposes using the funds for alternative purposes.

“Our area of the state has been underserved for more than a decade and we have reached a critical point” in mental health needs, said Randleman. Under the original plans, the facility-based crisis center would serve residents of Wilkes, Alleghany, Ashe, Watauga and Avery counties.

Elmore cited data affirming the great need for mental health crisis care in Wilkes. He said Wilkes Sheriff Chris Shew has voiced concern about deputies being tied up at the Wilkes Medical Center emergency room with involuntary commitment mental health care cases.

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 made public in late May.

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

Elmore said he expected to see Ingraham at the meeting Thursday. He said he hoped West and others involved in behavioral health care in Wilkes attend, as well as Randleman and current state legislators representing Wilkes.

The report released in October said Daymark’s current 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 said facility-based crisis care is necessary for Wilkes residents requiring inpatient stabilization and/or detoxification. It said these needs are being met by 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.

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