Old Hillcrest part of the solution
PAGE 1 MAIN Q&A
Waco Tribune-Herald - 9/2/2017
q&A on mental-health needs in central texas and beyond
Cut through all the fighting and rancor over sanctuary cities, school vouchers and transgenders in public bathrooms and one finds at least some consensus in state leadership regarding growing mental-health needs.
Two reasons: First, law enforcement officials are increasingly vocal about the time, cost and logistical challenges involved in transporting mental-health patients across the state if necessary to find facilities that can treat them - a hill higher to climb given a shortage of state mental-health hospital beds. Law enforcement recognize such people don't belong in city or county lockups. Second, almost every family - including those of state legislators - has occasion when a loved one experiences a mental-health crisis.
A comprehensive plan for state-funded inpatient mental-health services released in August by Texas Health and Human Services shows Waco may well figure pivotally in the solution through proposed renovation of the old Hillcrest Baptist Medical Center campus in North Waco into a state-run, 339-bed mental-health hospital for patients whose treatment is almost complete, to the point they're nearly ready for release back into society. Glenn Robinson, president of Baylor Scott & White Hillcrest Health Care, says while the state may only gradually occupy the old hospital, 339 beds would be an "easy capacity" for it. And if the state decides to do semi-private buildings, the number of patients served could expand.
If the state reaches an agreement to buy the old hospital facility on Herring Avenue from Baylor Scott & White Hillcrest- a total of nine floors, 600,000 square feet and 14 acres of land - it would represent, in Robinson's words, "a wonderful opportunity to pick up a facility that is in great shape, great condition, and be able to have it as an asset so the state can continue to grow into it." Robinson says it would also be a bargain at just under a million dollars - "pennies on the dollar" for the state in cost. And its role in the overall plan to address mental-health needs makes the proposition, to quote business and civic leader Bill Clifton, "bigger than just Waco and McLennan County," even as the campus would rejuvenate the surrounding neighborhood and possibly make the medical hospital one of the city's top employers.
Discussing the proposal in a Trib Q&A are Robinson, Clifton, Baylor Scott & White board member and civic leader Lyndon Olson, McLennan County Judge Scott Felton, City of Waco Manager Dale Fisseler and Republican state Rep. Charles "Doc" Anderson, who worked with Robinson in alerting state health officials to the potential of the old Hillcrest campus.
Q This is a pretty exciting proposal, both for what it could do in addressing a serious shortage of mental-health beds statewide and as an economic shot in the arm for Waco. Yet this all has come about pretty recently.
Baylor Scott & White Hillcrest President Glenn Robinson: Early in the legislative session, the Legislature was doing a great amount of work in trying to develop a special appropriation to expand mental-health beds in Texas and I contacted Doc [about this possibility]. He immediately wrapped his arms around the project. And in the midst of this busy legislative session, in five business days, he had a team of four professionals from the state who drove up to Waco. We spent almost the entire day walking through the Herring Avenue [hospital] campus, stem to stern. In that group was a fellow by the name of Mike Maples, deputy commission for the Department of Health and Human Services. He brought a chief nursing officer from one of our state mental hospitals and the operator of one of our state hospitals to look at it through their eyes. Most importantly, he brought an architect who works with the state on all state hospital renovations, keeping them to the latest standards. Whenever we do a project, at the end of the day it's really the architect who's going to tell us what it all costs. So the team went back and, under Doc's direction, put together a report for the state office.
Q Pretty fast work.
Robinson: A couple of weeks ago we were in Austin and had the pleasure of testifying before the commissioner of health and human services, Charles Smith, sharing with him the idea of this project. To us, the thing that makes sense about this project is that the state, of course, never has as much money as it would like to have. If they were to go ahead and try to build a 300-bed mental hospital, they'd be looking at a minimum of millions of dollars to build it. The Herring campus offers the state, we believe, several ideas that would be embraced by the Legislature and Department of Health and Human Services. One was the estimate we were seeing of about $65 million total to be able to acquire it, renovate it and bring it up to the latest standards of mental-health care - and be able to bring it online with a full 339 beds if they decided to do it. But another attractive element of the Herring campus is that the state could do all this in phases. They wouldn't have to do it all at one time. They could bring on so many beds in one phase, then bring in a few more beds in another phase. And then you geographic location, our being centrally located in the state. In that sense, Waco is very, very attractive. Doc advised me early on that it's important the county, the city and other stakeholders are supportive of this as well. And the people around this table today have been there with us since Day One, guiding us and advising us.
State Rep. Doc Anderson: When Glenn called me and talked about this potential, there was no doubt in my mind it was time to strap on the pads and get after it. We've been fighting this battle over a shortage of mental health beds [statewide] for years.
Q We've heard stories from our local law enforcement, including the anecdote about law enforcement officers taking a mentally ill person all the way to El Paso and breaking down on the way, all because there aren't enough mental-health beds statewide.
Anderson: Yes, and in too many instances [people suffering mental-health episodes] have to be locked up in one of our [jails] or end up in a facility simply not designed for mental-health issues. So many of these issues are where you have people with underlying mental-health problems and they self-medicate. Anyway, everyone is very excited about this, not only because it's a central location but because it's on the statewide growth corridor [Interstate 35]. There are two big phases. The first: Purchase the facility [for under $1 million]; second, do a forensic study [of the building for renovation as a mental-health facility, again at a cost of about $1 million]. And then we fight the battle of appropriations next legislative session  to actually fund renovation, but the commissioner is recommending this, so that's a big plus. [Note: Texas Health and Human Services reports that the cost for renovating the facility for its needs at $62.5 million.]
Q So this would become a state building.
Robinson: Yes, and it has a tremendous amount of office space as well. The state hasn't said anything about this, but it would not surprise me that, being the good stewards they are, if you look at a lot of the different state offices scattered around our community, the state might want to bring all those [and relocate them] on this campus, especially MHMR. They could move those to this building and realize additional savings to the state.
Q Everyone here knows how bad the mental-health situation has been in Texas, including Judge Felton in working with Sheriff Parnell McNamara in overseeing these people when they sometimes wind up at the jail. Is the situation getting any better?
County Judge Scott Felton: The picture is really bigger than just what they're considering for Waco. The state is committed to working on a lot of its existing facilities and making them more functional, so they can run at a higher level. Even if this building were not in Waco, it adds more beds and that helps us all. The challenge we get into is we have folks with mental-health challenges coming into the jail and you can't really get them to a place there for treatment because, well, the jail just isn't designed for that. And we've kind of retrofitted it from a staffing standpoint to deal with some mental-health issues, but when you have to wait in line to get a bed (at a state mental hospital) for some of these people - well, it places us side by side with (conventional) hospitals also waiting for those state mental-health beds. The fact the whole Legislature is taking the mental-health situation seriously is good.
Q Seems like Texas House Speaker Joe Straus has really pursued this issue during the past legislative session.
City Manager Dale Fisseler: Everyone is working together to try to make a better situation out of a tough situation. All of the partners here have been working together on a common problem and that's helped ease some of the challenges we face daily, but it's not going to actually fix the problem. This project, I think, actually helps fix it.
Robinson: So many of our community members really have no idea, but aside fr
om [video-based telepsychiatry], we have no inpatient [mental-health] unit at Hillcrest at all, yet we house [mental-health] patients in our emergency room. Just imagine your loved one going through one of the lowest moments of his or her life, a mental-health episode or mental-health crisis, and the only place we can keep them is in our emergency room. And for their safety, we have to provide them one-on-one nursing care most of the time, 24 hours a day, and it's not unusual for those patients to sometimes stay with us three, four, seven, even 12, 14 days, while we're waiting on a bed to open up at Austin State Hospital or Rusk State Hospital or Terrell State Hospital or wherever. That's not an unusual situation - and it's not just Hillcrest, that's every hospital in Texas. And I know the judge can talk even more to this, but often many of our citizens have mental-health episodes in a public setting and law enforcment is called. And that individual has done nothing wrong criminally. Yet the only safe place for them till a mental-health bed opens up is one of our county lockups. Our county sheriffs in this state are just continuing to face it. I'm so proud of our legislature, and in a tough budget year, still earmarking these kind of appropriations to make the very comprehensive [Texas Health and Human Services] plan. The bulk of the money goes to Kerrville and Rusk, which are expanding their maximum-security units. Those two facilities take care of those patients who require that type of security level. That, of course, is not what we're talking about here in Waco at all. One of the things I learned from Rep. Anderson and his staff is that the state health commission is looking at a new model of mental-health care that involves transitional care. They see the Hillcrest Herring campus being a site for that type of care.
Q Transitioning to...?
Robinson: That patient may have been at one of our state's other hospitals, but they're getting better and no longer need that acute setting. They need to get back to loved ones closer to them. The idea is for the state to transfer a patient like that to a facility like this. They're then just one step away from re-entering back into the community.
Anderson: The other thing that's important for local folks to know about this facility is that these patients will be civil commitments and transitional commitments - not forensic.
Q By not being forensic, I assume you mean no criminal cases would be coming here.
Anderson: Right, this would just be civil or transitional. The maximum-security types would be at other facilities.
Robinson: One interesting thing concerns the state's question of how do they staff this facility. Where will we get those types of professionals? We've reached out to Johnette McKown, president of McLennan Community College, and she has reached out to peers at other community colleges such as Temple, Corsicana, Hill College, and they would love to begin retooling their academic programs to be able to produce psych techs, psych nurses and train many of the people in our region for job opportunities here. In addition, at Baylor Scott & White, we have our own teaching program in Temple and Dr. Glen Couchman, who leads us as chief medical officer, has met with the department chair of psychiatry about all this. If the state moves in this direction, we would like to look at expanding our residency to here in Waco. The numbers they're discussing are three or four residents per year and it's a four-year residency, so at the end of the fourth year, we would have 12 to 16 psychiatry residents that would be here in Waco, plus their faculty, so that would supplement the state's staffing and clinical obligations.
Q So what is it that makes the Herring site perfect for this kind of thing?
Robinson: Without a doubt, the condition the building continues to be in. We continue to run air conditioning, we continue to run heat, we continue to employ a full-time maintenance man who has been there since last summer when we finally shuttered the facility. He continues to do routine maintenance and keep the building in good, working order. Secondly, the location geographically is tremendous. And, again, the third thing is the state's ability to phase in this type of expansion.
Lyndon Olson: For this town and that neighborhood, this is huge. I think it's going to end up rejuvenating the neighborhood and addressing a fear everyone had - which has kind of come true - that you were going to have this big vacant building over there [after Hillcrest moved to its new campus at State Highway 6 and Interstate 35]. This is a wonderful opportunity for Baylor Scott & White to participate in this community and the life of the state by being able to dedicate this hospital for this much-needed purpose and at a tremendous savings. And it's good philanthropy.
Q What does this mean for this community in terms of economic impact, Bill?
Business leader Bill Clifton Jobs: Let me throw a few numbers at you. I can't really substantiate them because we're all working on estimates right now. Of course, the key thing now is whether the Texas Legislature budgets operating money to make the thing work [in 2019]. That's ultimately what provides the jobs here. But we're guessing there's going to be a thousand jobs in the hospital, based on 339 beds, so of course you have to phase that in. You start off with, say, a hundred [beds], then you start with a third of that number [in terms of employees]. The other thing is the multiplier effect. The multiplier used in this type of setting is 1.8, so that means that would bring another 806 jobs if we have 1,000 jobs. And I really think that thousand jobs is a conservative estimate because if you look at Glenn's hospital, he's got 237 beds and over 2,000 jobs. Of course, that's a different deal. We won't have trauma and acute care and a lot of the other things Glenn has to offer. And you need to understand we don't have the maximum-security type stuff you're talking about at other [state mental-health] entities. This really is a transitional type of setup, which to me intuitively is really good. If you're trying to get someone ready to return to society, here they can be close to family and friends and neighbors or whatnot instead of being off in, say, El Paso or a long, long ways off to where it's impractical to visit or support them. And that's just more helpful in terms of the therapy. The number I've heard on the legislative side is that if it were fully funded, it would require $95 million a year [to operate]. About two-thirds of that will be salary. We anticipate in our model that would be about $67 million, so those kinds of numbers - well, you don't have to look too far when thinking about sales tax and people going to Waco ISD and other fringe benefits.
Anderson: There's this synergestic effect that could be so great for our community with Providence [Health Care], Hillcrest, the VA [hospital], MCC and Baylor University each having involvement. And that could help us recruit high-quality people for all these slots. MCC would love to train the psych nurses so they're excited about that. This might be the best thing in three decades, maybe more, for us in addressing this particular need. We, of course, do want to manage expectations. This is a proposal here, a phase-in thing, which is one of the advantages for the state. They can do it as they need to [in terms of filling the hospital with beds at their own pace]. But I think it's also important for the community to understand what it is and what it isn't. It's not going to be like what they have in Kerrville or Rusk [with maximum-security patients]. That's kind of why we wanted to meet with you and update you on where we are.
Q I mean, are you concerned about this? There are always some people who worry and say, "Oh, we're going to have crazy people on the loose in our neighborhood!"
Clifton: Look what happened when [the substance abuse treatment center] Cenikor wanted to move into [the same neighborhood in 2012]. I sure won't forget. We had a gal, Elizabeth Smith, who doesn't weigh 95 pounds [and who has long lived near several houses employed as substance abuse treatment centers], who took that crowd on and really did a good job talking to them about lots of things [and reassuring people]. I mean, you write about this all the time in the Trib - the emotional, alternate right and left-type stuff that gets thrown around and doesn't have a lot to do many times with actual facts in an issue or as a solution to problems.
Robinson: You ask about the neighborhood and that's a great question. We remain invested in that neighborhood. We remain committed to that neighborhood. When I arrived in this awesome community 10 years ago, there were five buildings in and around that [old hospital] campus that were either already shuttered or were destined for closing, perhaps even marked for demolition. First, you have the Waco Medical Arts Building, between Herring and Lyle. We now fully occupy that building at 100 percent with our staff, our support staff, people who used to be in business office staff functions - medical records, that sort of thing. So we completely filled that building. It's that multistory medical office building. Then you look at what used to be a church and later became a Hillcrest senior clinic that was shuttered when I arrived here in 2007. Today that's Rapoport Academy's second campus. Then coming on around the other side is the MacArthur Building and that building was only 50 percent occupied. Today it's 100 percent occupied with physicians who are thriving in medical practices dedicated to that neighborhood and community. Then the Waco Community Clinic was completely closed and that's now Cenikor. And then, of course, in the heart of all this was a 10-story, 100,000-square-foot office building destined for who knows what. Thank goodness for our partnership with the city, it's now our new police headquarters and evidence storage facility. It's also another security anchor in that community. So every building that was either vacant or occupied is now filled and you've got police headquarters right in the middle of it. And I'm not aware of a single incident Cenikor [in its involvement with mental-health cases] has ever caused the neighborhood since its arrival.
Fisseler: And it recently got renewed without any opposition.
Robinson: One final thing. Think about this neighborhood up till the 1990s when Providence moved out and [then in 2009 when much of the Hillcrest campu relocated to I-35]. You've got some beautiful streets and neighborhoods, such as Maple and Colcord-
Q There are some gorgeous homes over there.
Robinson: And I think Bill's numbers are not only accurate but conservative. You start considering those kinds of people [employed at a hospital] looking for houses, just think of what that's going to mean for that neighborhood. Those psychologists, psychiatrists and administrators - that's the only hospital they'll be working at regularly, so they may want to live in those neighborhoods. This project gives even further stability to the neighborhood. And we [at Baylor Scott & White Hillcrest] are not backing away. We remain very invested in that community.
Fisseler: There's another multiplier from the city standpoint and that's infrastructure. If you're thinking about building a brand new facility somewhere, then the taxpayers and ratepayers are on the hook for extending the infrastructure to it. But what we've got here is great infrastructure. We're redoing that water storage facility. But if you don't reuse these things, if [the buildings] just get torn down, then all that infrastructure is just sitting there unused and we've basically already paid for it. So this really sort of re-establishes use of those facilities that the taxpayers and the ratepayers have already paid for.
Q Doc, where are we in the legislative process to move forward with all this?
Anderson: They started with $750 million [for statewide mental-health needs] but cut that down in conference committee to $300 million. That's statewide. It's all basically for rehab [of aging mental-health facilities already online]. There's no new construction around the state. And this is the only purchase in that whole project, so we're thrilled to have that in there. And let me say that state Sen. Brian Birdwell is on board and we've kept state Rep. Kyle Kacal in the loop.
Q It does seem in the last few legislative sessions that mental health is being taken more seriously.
Clifton: In terms of mental-health needs, people don't really get interested in mental health till a loved one and you have a personal experience. Who carries the flag on this issue? The last one I can remember was Tipper Gore. It's just not a popular issue, but it's one where, as the state grows, we need to address. This is an infrastructure issue to me because you're going to have a problem in areas of mental health with any population and we have a large population in Texas. But everyone sweeps it under the rug or doesn't think about it till it affects them personally.
Olson: For so long, nobody wanted to spend any money and mental health was not a priority in the Texas Legislature. The Meadows Mental Health Policy Institute, chaired by Tom Luce, about five years ago funded, and with millions and millions and millions of dollars, an effort to create a comprehensive survey and study about mental health in Texas. What you see resulting and forming now is a very positive story for a very divisive legislature. I think Doc would agree with me that mental health has ended up being the one issue in the Legislature that has had as broad a bipartisan support as you could ever get. The Meadows Mental Health Policy Institute introduced 26 pieces of legislation, of which about 24 passed. So this didn't just come out of someone's political interest. It came out of a tremendous contribution by the Meadows Foundation to develop this statewide comprehensive plan and it has now been bought into. I think it's probably also a reflection of how mental health is the one thing that touches each of us in this state. There are a lot of people pulling for this locally. I'm excited about it. I mean, I'm a little anxious about the appropriations process [in 2019] but the fact it's been recommended [by state health commissioner Charles Smith] is a huge story.
Robinson: If you look at just our acute-care medical hospitals in Texas like Hillcrest and Providence, at least 25 to 30 percent of our medical-surgical patients on any given day also experience underlying mental-health issues. That's how prevalent mental-health incidents are in our society. If you went to a ballgame or a church or the checkout line at H-E-B, 50 percent of us standing there will experience at least one mental-health episode in our life. This is something where we really want to help our community understand that we have the opportunity to be a part of the solution for our great state.
Interview conducted by Tommy Witherspoon and Bill Whitaker. It has been condensed and edited for clarity and space.