The Mary Hill Youth and Family Center building has long been at a crossroads overlooking this rural Appalachian town, but its purpose has evolved.
For 65 years, residents of Nelsonville and the hills of southeast Ohio traveled to the hilltop hospital seeking care. Then, in 2014, the 15-bed hospital, which was often without patients, was closed.
Later, the three-story brick building was reopened as a center for health services. With the help of several funding sources, Integrated Behavioral Health Services, a nonprofit social service agency, transformed the building into a place for mental health treatment, primary and dental care and food pantry access.
In June, the organization opened a 16-bed residential mental health treatment program on the top floor of the former hospital. The program serves children in rural southeast Ohio and gives families an option other than sending their children far away — sometimes out of state — for residential care.
“For a long time, we’ve been trying to figure out, ‘How do we support services that are delivered more locally?'” said Samantha Shafer, CEO of Integrated Behavioral Health Services. “Because when you have the programs here, the work you can do with families is more successful, the health outcomes are better.”
Efforts to provide residential mental health services at Mary Hill Center, and in other rural Ohio towns, were boosted in part by a small portion of Ohio’s $5.4 billion allocation from the American Rescue Plan Act, a federal law for covid relief that was approved in 2021.
Congress provided $350 billion to state, local, and tribal governments as part of ARPA, allowing states to decide how to use the funds. So far, dozens of states have allocated relatively little to improving mental health resources. Ohio is one of a small group of states that further divided their allocation to spend a portion on children’s mental health care.
Experts said using ARPA funds is just one way for states to support children’s behavioral health during what health professionals have called “a national emergency in child and adolescent mental health“, which was exacerbated by the pandemic. In an effort led by the American Academy of Pediatrics, multiple organizations wrote to him the Biden administration in October, asking her to declare a federal national emergency on children’s mental health.
“At the time ARPA came out, we were really trying to figure out, as a country, how we could strengthen the mental health, behavioral health systems, because, in my opinion, the systems are really broken,” Isha Weerasinghe said. a senior policy analyst at the Center for Law and Social Policy, a national, nonpartisan group that advocates for policies that help low-income people. “And what ARPA was able to do was provide some core dollars to help strengthen the systems.”
The center has said that ARPA’s funding provisions are “insufficient to combat deep systemic and historical inequalities” in mental health care. However, Weerasinghe said there is an opportunity for the money to have a long-term impact on children’s mental health care if it is applied to organizations that have demonstrated a commitment to maintaining the well-being of children in their communities.
States have until 2024 to allocate their ARPA funds and until 2026 to use it. According to last quarterly analysis by the Center on Budget and Policy Priorities, a left-leaning think tank in Washington, DC, most states have either completed or nearly completed their allocations. Among states, the average allocation for supporting mental health services is about 0.5%, based on CBPP data. For states in the Midwest region, the average is about 3%.
CBPP numbers showed that through August mental health distributions varied widely in largely rural states where suicide rates repeatedly eclipse the national average by double or more. In some of them, including Montana, South Dakota and Wyoming, officials shared less than the statewide average. Meanwhile, lawmakers in Colorado directed nearly 11% of the state’s money toward mental health.
Of the $84 million Ohio officials dedicated to pediatric behavioral health facilities, $10 million will go to rural areas in the southeast of the state. That’s less than half of ARPA’s $5.4 billion state allocation. But clinicians hope it will help address gaps in Appalachian Ohio’s mental health services for children.
In recent studies, the Ohio Children’s Public Services Association, a nonprofit advocacy group, found that because of gaps in services, some children with behavioral health needs in Ohio were placed out of state or in a distant county for care. associations surveyed public child service agencies in 19 counties and found that for most of their cases in 2021, agencies made multiple calls before finding a residential treatment facility for a child.
In April, Ohio Gov. Mike DeWine signed an executive order providing $4.5 million to residential youth treatment facilities to increase their capacity.
In Nelsonville and the hilly, rural country that surrounds it, ARPA money has played a small role in expanding services.
The new residential treatment facility at Mary Hill Center, which serves 10- to 17-year-olds, was designed for 16 beds. But since September, due to a lack of staff, the facility was operating at limited capacity and had served a maximum of five children at a time.
Shafer said non-ARPA money paid for most of the renovations needed to open the floor, but about $1 million from ARPA will help upgrade the elevators and bathrooms.
Her organization will use an additional $7 million to build another residential treatment facility — its program modeled after the Mary Hill Center — in Chillicothe, a town about 55 miles west of Nelsonville. That facility will have capacity for 30 beds, but will start with a cap of 15. Construction will begin in January.
Services at the Chillicothe residential facility will be reimbursed primarily under a new Medicaid program called OhioRISE, which will pay for behavioral health treatment at youth psychiatric facilities. But the facility will also treat children who are not enrolled in Medicaid.
Before rural Ohio projects were approved for ARPA funding, each was reviewed by Randy Leite, executive director of the Appalachian Children’s Coalition, a nonprofit organization that advocates for children’s health. He decided which proposals for ARPA-funded projects from the Appalachian region were submitted to the Ohio Department of Mental Health and Addiction Services.
“I told the people in Columbus that I could give them $300 million in ideas to spend money on, but many of them were not practical and feasible,” Leite said. Instead, he focused on ideas that were “shovel-ready”—so they could be completed within ARPA’s spending time frame—and viable.
“A lot of sustainability is related to services that are reimbursable,” he said.
Leite and the coalition presented Ohio officials with about $30 million in recommendations for ARPA investments, including a project aimed at expanding telehealth capacity in schools. State officials approved only about a third of the total requested. The money went to Integrated Services for Behavioral Health Facilities and Hopewell Health Centers, a federally qualified health center that received about $1.5 million. That money will pay for renovations to its 16-bed pediatric crisis stabilization unit in Gallia County, south of Nelsonville; an expansion of its day treatment program; and improvements to its school-based mental health programs — including one in the Nelsonville school district.
“For students to learn, they need to be in good physical and mental health,” said Sherry Shamblin, chief strategy officer of Hopewell Health Centers. “These supports are really necessary for children to be able to make the most of their educational opportunities.”
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