Safety Center? McNabb Center! How Best to Improve Knoxville's Mental Health Crisis Services

Some 5,000 calls a month pour into Helen Ross McNabb Center's 24/7 crisis service lines. They come from distressed individuals, their family members, hospital emergency rooms, and law enforcement officers.

For many of the callers, some comforting advice or an appointment with one of McNabb's outpatient clinicians will suffice to defuse the crisis. But for those who appear to pose an imminent danger to themselves or others, McNabb's Mobile Crisis Unit will be dispatched for a face-to-face encounter anywhere in the five-county area that it serves.

In extreme cases, this assessment may lead to confinement at Peninsula Hospital with whom the state has contracted for inpatient psychiatric care since the closing of its Lakeshore Mental Health Institute last year. Others may be voluntarily admitted for up to 72 hours to McNabb's own Crisis Stabilization Unit (CSU) at its Center Pointe facility on Ball Camp Pike. Upon release, they are not only furnished medication and a referral for follow-up outpatient treatment, but also in many cases driven to their appointments.

If their mental disorders are accompanied by addiction to alcohol or drugs, as is more often than not the case, they can also become candidates for McNabb's Medically Monitored Crisis Detoxification (MMCD) program, which over a painful period of several days can at least temporarily rid them of their physical addiction. But their chances of longer-term recovery get much better if they undergo a month-long residential rehabilitation regimen of which McNabb's is just about the only one in Knoxville that accepts uninsured indigents.

The state Department of Mental Health and Substance Abuse Services provides most of the funding for the CSU and MMCD programs, and that funding has been augmented since Lakeshore's closing, as has its contribution to the substance-abuse rehab programs.

However, for all the good that McNabb is doing with available resources that also include county funding and philanthropic contributions, it doesn't begin to have the capacity to serve everyone in need. As a result, there are long waiting lists for admission to detox and rehab services (except for pregnant women). And far more psychotic and intoxicated people wind up in jail instead of treatment.

Sheriff J.J. Jones has estimated that around 20 percent of Knox County's 1,200 jail inmates fit this profile and has stated that most of them don't belong there. While McNabb prescribes medications for their mental illnesses, most of these unfortunate and often harmless people get released onto the streets and contribute to what District Attorney General Randy Nichols has called a "revolving door" of repeat incarceration.

In an effort to alleviate the problem and purportedly save the county money, Jones and Nichols have long advocated creation of a "safety center" as an alternative to jail. And they appear to be getting an attentive ear from County Commission as well as the city and the state when it comes to covering the $1.8 million construction and $1.7 million annual operating costs.

McNabb would operate the center, and the preferred location is its main campus on Springdale Avenue in North Knoxville, which has the advantage of being much more centrally located than Center Pointe. As McNabb's CEO, Andy Black, envisions it, the 15-bed CSU and six-bed MMCD would be incorporated into this new facility. Black believes the State Department of Mental Health and Substance Abuse Services is receptive to funding a doubling of its MMCD capacity as an extension of its commitment to use all dollars saved from the closing of Lakeshore for alternative treatment facilities in this area.

But the CSU is already operating at capacity, and six more detox beds doesn't begin to meet the additional needs that would arise if inebriated people were routed to the safety center instead of jail. The new facility's one other component would be what Black terms a "sobering station" that would temporarily hold up to 12 of them.

However, because the safety center would constitute a treatment facility, state law only allows for persons to be held there voluntarily whereas inebriates can be jailed for disorderly conduct or simply being a "public nuisance." So it's anything but clear how many who are admitted would consent to treatment if it were available—rather than elect to walk away and all too often become part of the "revolving door" problem.

To me, as opposed to the sheriff, perhaps the biggest benefit of the relocations to the new facility as envisioned is that they would free up space at Center Pointe for expansion of McNabb's residential A&D rehab program.

"There's a tremendous need for that, particularly for low-income people," Black says. He reckons that the relocations could result in a near doubling of the rehab unit's present 28-bed capacity. The rub comes in finding funding to cover the cost of their 28-day stays, which is the minimum deemed likely to result in longer-term recovery from addictions—and only then if coupled with ongoing participation in support groups such as Alcoholics Anonymous.

While increased state support for detox programs can contribute to temporarily freeing more addicts from their physical dependence, funding to cover the costs of residential rehab services for more uninsured indigents appears more elusive.

The best hope would appear to be election by the state to expand TennCare/Medicaid eligibility to everyone with incomes up to 133 percent of the poverty line. This would take advantage of an estimated $1 billion a year in federal funding that would cover the entire cost of the expansion in Tennessee for three years starting in 2014 under the Affordable Care Act.

TennCare presently covers the cost of residential rehab services, at least in some cases, but only a small fraction of indigents in need of them are presently eligible for TennCare. While it won't resolve their mental illnesses, reduction in their commonly concurrent addictions should make many of them more attentive to their treatment and do more to reduce the "revolving door" of incarcerations than a safety center.