Word spread quickly in July among frequenters of the Stabilization Center, a 24-hour walk-in resource facility for mental health and substance use crises based in Poughkeepsie: the center’s nurses were gone. The news shocked Dutchess legislator and Vassar history professor Rebecca Edwards (D-Town of Poughkeepsie), who said the county laid off the six licensed practical nurses (LPNs) without warning legislators or informing the community. The center suspended in-person visitations and moved to telepractice on March 20.
The Dutchess Democratic Legislators Caucus rang alarm bells about the layoffs in a press release on August 4. Democrats slammed the county for what they perceived as budget cuts to mental health and substance addiction services at a time when they are most needed. “It appears the county is withdrawing funding for the Stabilization Center, which no longer has medical personnel to offer diagnoses,” said legislator Brennan Kearney (D-Rhinebeck/Clinton). “The timing could not be worse, as people struggle with the impact of COVID. We strongly urge the executive to reconsider.”
The caucus released the statement without contacting the county executive’s office, a decision County Executive Marc Molinaro criticized but that Democrats stand behind. The county later clarified with news outlets that they replaced the LPNs with a head supervisor, case manager and mental health clinician. While the county and the center’s partner health agencies defended the layoffs, their decisions have left Edwards and other legislators with more questions than answers.
The Stabilization Center provides mental health assessments; refers visitors to other community resources and agencies; and counsels individuals through mental health and substance abuse crises, among other services. The LPNs issued medical diagnoses through a health questionnaire and taking visitors’ blood pressure.
MidHudson Regional Hospital, one of the facility’s partners, financed the center’s licensed practical nurses’ salaries with a Delivery System Reform Incentive Payment grant. The federal government did not renew those funds after the last of them ended in January. The end of the grant and the county’s plan to replace the funds are outlined in the 2020 county budget. “That was clear to the legislature—including the Democratic minority that chose to issue a press release without talking to us—last year,” said Molinaro.
While the budget communicates plans to allocate new funds for the nurses, it does not indicate that the center would later replace the LPNs with a head supervisor, case manager and mental health clinician. “The budget says that the funding is running out, and here is the budget line where we are going to replace it,” Edwards said. “[The county and health agencies], in fact, made a different decision.”
Molinaro said the county and the center’s partners shifted their plans when the COVID-19 pandemic hit. This opened up talks about how to better respond to the community’s greatest needs.
“If we’re making a change to staffing to try to better [serve] the community, I don’t know if we’d reach out and have a community discussion about it,” said CEO of Mental Health America of Dutchess County Andrew O’Grady. “You also don’t let everybody know weeks in advance certain people are gonna unfortunately be removed from their position. That’s not something you make public to the people.”
Visitors’ diagnosis trends showed that the center needed more mental health professionals, not nurses, according to Deputy Commissioner of the Department of Behavioral & Community Health Jacqueline Johnson. “The data shows that most of the visitors we have there are presenting with mental health issues,” Johnson said. “The Stabilization Center’s mission is to meet the community where they are at when they walk in. That mission has not changed.”
The center served 3,088 visitors with mental health disorders between 2017 and June 2020—70 percent of their over 4,500 visitors. Staff have assessed other visitors for alcohol, opioid, non-opioid drug and cognitive issues. Molinaro said the initial health questionnaire and blood pressure test dragged out wait times for those needing immediate mental health care. “It’s like creating two separate hospitals, only in our hospital, we can’t provide you any medical help,” Molinaro said. “You’re going through a screening that delays you from getting the services you really need.”
The facility is not licensed to provide medical care. The center’s new mental health clinician and case manager will decrease visitors’ wait times and connect them with resources appropriate to their needs, according to Molinaro. Those with medical emergencies are rushed to nearby partner hospitals, though these cases are rare.
“If someone is decompensating to that degree psychiatrically, they’re not walking themselves into a stabilization center,” Johnson said. “The center fits that middle ground between not knowing where to go when there is nowhere for [someone] to go and someone who needs inpatient psychiatric intervention.”
Johnson stressed that the center is a hub for de-escalating crises, assessing visitors and referring out to other resources appropriately. Opioid and drug related cases are typically referred out to other health clinics and agencies. While they do not provide medical care, the center provides NARCAN kits, NARCAN training and fentanyl-detection strips for opioid overdose prevention and detection. “In terms of the opioid crisis, are we a treatment center? No,” Johnson said. “We try to avoid a duplication of services. Our job is to make sure there is a strong network of providers and clinics so that we can link people to services the same day.”
Despite the county’s reassurance that the new positions improve services, Edwards argued that the nurses’ removal, and therefore their medical diagnoses, diminish the center’s role in handling drug related cases. “The Stabilization Center needs to be clear about who they’re serving.” She continued, “If they don’t feel that they’re serving people who are in an addiction crisis or substance use crisis and those folks need to go to the emergency room, they should be clear about that.”
Since the center’s move to telepractice, the county has advertised the center as fully operational—all services are available through their telehealth number. Edwards is skeptical of the facility’s ability to fully serve the community through telecommunication, noting that other non-essential services in the county have opened while the center remains closed. Between April and June, the facility served 106 people. The center’s 24/7 HELPLINE received more than 22,400 calls since January, according to Dutchess spokesperson Colleen Pillus.
Johnson said the county is awaiting directives from the state on when it is possible to safely reopen. Telehealth will continue into September, but the center also hopes it can resume walk-ins within the same month.
While the shift in focus on mental health resources is a response to months of community trends, Johnson said that the county and its partners are also looking at future needs.
“When you talk about the licensed practitioner nurses leaving and substituting that with mental health professionals, yes that’s based on the data, but it’s also based on our projections,” Johnson said. “Because of COVID-19, we’re already seeing a tremendous rise in mental health [crises] and will continue to. We have to be prepared for that.”
If you or someone you know is experiencing mental distress or substance addiction, you can contact the following numbers:
Stabilization Center Telehealth: (845) 486-2849
24/7 HELPLINE: (845) 486-9700
Coronavirus Hotline: (845) 486-3555
Correction 8/17/20: A previous version of this article misstated the LPN abbreviation. It stands for Licensed Practical Nurse, not Licensed Practitioner Nurse.