Dawn Mentzer, CEO of the Rolling Hills Community Services Region, visited the Crawford County Board of Supervisors meeting on September 3 to give an update of recent activity.
The following is an edited and condensed account of the discussion.
Woodbury County joined Rolling Hills on July 1.
“So far it is going very well,” she said. “Overall it was a good move for our region bringing in Woodbury because of their size and some of the services they are bringing into the region - particularly in the area of children’s mental health.”
Woodbury already has some mental health services that will put the region ahead of the game, she said.
Rolling Hills also serves Buena Vista, Calhoun, Cherokee, Crawford, Sac, Ida and Carroll counties.
The Iowa Legislature earlier this year mandated the creation of a new Iowa mental health system for juveniles to be administered by the community services regions.
Rolling Hills is tracking all of Woodbury County’s expenses separately this year to make sure the county is covering its own costs and expenses, Mentzer said.
All counties will be treated equally after the first year, she said.
The Crawford County Board of Supervisors voted in May 1, 2018, to deny Woodbury County entry into Rolling Hills.
One of the main concerns the supervisors voiced was not wanting Crawford County to subsidize Woodbury County if that county did not have enough money to contribute to the region on an equal basis.
The member counties of Rolling Hills voted 5-2 on May 8, 2018, to bring Woodbury County into the region.
Woodbury County is expected to have a shortfall of contributions to Rolling Hills this year because the county did not exit the Sioux Rivers Regional Mental Health and Disabilities Services region with the anticipated amount of funds, Mentzer said.
“There may be a shortfall of around $90,000,” she said, “but they have committed to raising that money next year to make it up.”
She said she has no concerns about whether Woodbury County will follow through.
Representatives from all eight member counties have been meeting monthly since April to create a mobile crisis response service.
“We have two providers within Rolling Hills that are going to be doing a joint effort for mobile crisis,” Mentzer said.
The service will involve sending out a crisis counselor with law enforcement if a situation requires that an individual be evaluated onsite.
“They have 60 minutes to show up on scene, face to face, and assess that individual,” she said. “The hope is that... these people will be appropriately assessed and not hospitalized unnecessarily.”
The individual could be given necessary support or sent to the Rolling Hills crisis home in Sac City.
Siouxland Mental Health and Plains Area Mental Health are the providers working on the joint initiative and plan to implement the service in October or November, Mentzer said.
Supervisor Dave Muhlbauer asked if the Sac City crisis center would need more beds if more people use the facility.
“I can say probably not because we have not been at full capacity and neither has Siouxland Mental Health in their crisis center,” she said. “Hopefully it increases the amount of people that are utilizing that because of the cost of paying for it.”
Mentzer said a new Iowa law is the driving force behind adding nine new adult services to the community services regions by July 1, 2021.
The nine services had previously been additional services but will now be core services.
“They are hugely expensive,” she said.
She noted that the regions are fully funded with property taxes.
Adding Woodbury doubled what the region will receive in tax dollars.
Woodbury County’s levy is $33.63 for the first year in the Rolling Hills.
The other seven counties in the region currently levy at about $10.00 under the maximum of $42.79.
“Obviously, at some point, we will probably be maxed out,” Mentzer said. “We’re not there yet. At some point we probably will be, because these are required services.”
Representatives from all eight counties met in January to determine which of the additional core services would be priorities for Rolling Hills, she said.
The services are costly, so wise investment is needed to develop services that will be utilized by the people the region serves, she said.
Developing an access center was determined to be a priority.
Mentzer described an access center as a “one stop shop for a person in crisis.”
Supervisor Cecil Blum, the Crawford County Board of Supervisors mental health advisory board representative, said access centers are open 24/7, 365 days of the year.
“They are like running a small mental health hospital,” Blum said.
The mobile crisis response service will go along with law enforcement and make an assessment of an individual.
If the individual does not require evaluation at a hospital, the individual will be taken to the access center for further stabilization.
Crisis stabilization is a required function of an access center, Mentzer said.
Developing an access center will cost between $2 million and $3 million, she said.
Blum noted that the Rolling Hills Budget is $8 million with Woodbury County added.
The mobile crisis center does not yet have a name and will not be using the name “Rolling Hills.”
“I didn’t like the implication for liability for the region if we’re not the provider of the service,” Mentzer said.
Rolling Hills is also looking into intensive residential services to meet the needs of people who are revolving in and out of hospitals and need to be stabilized in a community-type setting.
Mentzer said she was not ready to present the information to the supervisors as of last week, but the options under consideration cost $710,000 or $220,000.
She said whatever the region decides to invest in has to be sustainable under a capped budget.
On top of the adult services requirements, Rolling Hills is currently putting together an implementation plan for children’s mental health services, which was required by an Iowa law signed by Gov. Kim Reynolds in March.
At a meeting two weeks ago, 40 to 45 individuals representing education and youth services met to discuss developing the juvenile mental health services program.
Providers will be required to expand the existing and new services for adults to serve children, as well.
A plan has to be presented to the Iowa Department of Human Services on April 1, 2020, Mentzer said.
“We have a lot going on,” she said.
Muhlbauer asked how much a “levy whiplash” would be caused by adding all the new services.
Mentzer said this year’s budget has some flexibility because developing some new core services had been accounted for.
“But we cannot do all of these services,” she said.
Community treatment is another multimillion dollar service to be developed, she said.
“There are other things we need to do, yet,” Mentzer said. “All of this is going to be heavy on our taxes.”
Rolling Hills is partnering with two other regions to share costs, she said.
“We’re going to have to cost-share some of this because we can’t do it on our own,” she said.
Muhlbauer said that some of the individuals at a meeting of the Iowa Association of Counties (ISAC) were not happy about all the new services that will have to be funded by property taxes.
Some counties don’t want to do it, Muhlbauer said.
Mentzer said she expects the system will eventually get down to five or six regions from the 14 total regions at present.
A positive development from the legislature’s 2019 session was that the requirement (from the 2018 session) to reduce fund balances to 20 percent of budget by 2020 had been changed to 40 percent by 2022, she said.
Rolling Hills budgeted this year for balances to end at about 30 percent, she said.
“Barring any unforeseen circumstances, hopefully we end up around there,” she said.
Blum said adding Woodbury to the region has been smooth, so far.
“I think the positives were easy to identify going in,” he said, “but we have to have a track record to find out what pops up in subsequent years.”
He noted that the other counties in the region are largely rural with small urban areas, where Woodbury is an urban county with small rural areas.
“I think we’re going to get exposed to a lot of situations that we never were exposed to before,” he said. “It’s hard to anticipate what those exposures might cost.”
He said he is generally optimistic, however.
“The transition was smooth, thanks to Dawn (Mentzer) and staff,” he said. “The money worked out but we’re still in a lot of uncharted water.”