Officials were slated to break ground on a $34-million crisis wellness center on Broad Avenue Friday. The 55,000 square-foot building will expand the reach of Alliance Healthcare Services, the largest crisis services provider in the state. The Tennessee Department of Health is contributing $7 million to the new center.
The center will raise the number of Alliance’s beds from 27 to 45. Alliance will also add walk-in appointments for adults and be able to service children and families for the first time.
Alliance works with police and fire departments across Shelby County to help divert those with mental illness from the criminal justice system and into proper treatment. Over a 12-month period, Alliance says its team helps save about $165 million in health care and jail costs.
The center is expected to open in December 2024.
Alliance CEO Laurie Powell gave us more details about the project. — Toby Sells
Memphis Flyer:What services do you offer at Alliance Healthcare Services?
Laurie Powell: We’re the full continuum of behavioral health. We’re a [nonprofit] and we were incorporated in 1973. So, this is our 50th year.
We now have 19 locations, including our outpatient clinic, our housing for those with mental illness, our crisis operation, our emergency-room, and jail-diversion programs. We have over 450 employees right now and we’re growing.
Tell me about the new crisis center. Where did the idea come from? Why is it needed?
We’ve been providing crisis services for adults 18 and over since 2008. That program has really grown. We have 120 employees for just that operation. Our crisis operation is on the second floor of the Memphis Mental Health Institute (MMHI). The state donated that space to us and now we need our own space, because we’ve outgrown it. We serve 13, 000 individuals in that program alone.
And growing, right?
Yes, from service and partnerships we’ve developed over the years. For example [Methodist Lebonheur Healthcare], [Baptist Memorial Health Care], and [Saint Francis Health System]. We respond to people who show up in their emergency rooms who are having a psychiatric crisis. We assess them, and we get them to the level of care they need.
And also with the police and fire departments. I don’t know if you’ve heard about the co-response models to address psychiatric crises, but we have that with police and fire. We’re the mental-health provider for that.
How does this support the mission?
Our mission is to promote wellness in our community, right? That’s to lift up, promote. Everyone deserves quality behavioral health care without equity concerns. So, we don’t ask how much money can you pay us. We have grants to cover the uninsured that have mental health issues and sliding-scale fees.
We’re using the term “no wrong door” for services. We’re really trying to remove barriers to accessing care immediately. At our outpatient clinics. … We’re going to walk-in appointments so people can be seen on the spot.
Anything else new coming with the new building?
The new crisis assessment center, it’s open 24 hours, seven days a week.
The facility we’re in now…can only serve adults. So, we’re going to add walk-in services for kids and families. We imagine there’s a lot of kids and families that need immediate access to care. So, they’ll be able to walk in voluntarily on the outpatient side.
We never had an outpatient program at [our current location]. We didn’t have the space for it. We’ll be going from a 17,000-square-foot space to two floors with 55,000 square feet. We’ll really be able to expand what we’re doing.
The co-response process you mentioned with police and fire seems like it’s caught traction across the country. What does a typical episode like that look like?
The call comes into our crisis center. Somebody is wandering down Union Avenue, dancing, and naked in the street. Our care team gets out there to talk to and see if we can help that individual. The [emergency first responder] will be able to that medical screening evaluation. Then, you’ll have a Master’s-level therapist from Alliance do the [behavioral] assessment.
The police check for safety. It might be that the person has a weapon or a knife. Sometimes that happens. But I do want to emphasize that mentally ill individuals are more likely to be victims of violence than committing violence themselves.
I know there’s been some really high-profile stories in the news where people that were untreated with schizophrenia, untreated with bipolar are not thinking clearly and commits acts of violence. It’s called anosognosia. That’s for individuals who are seriously mentally ill, who do not even know that they’re mentally ill.
All of this is also a good way to keep these people out of the criminal justice system, also, right?
Yes, and we were the first co-response model in the state.
Like the example I gave you of the guy dancing down the street, the mom might be calling us and saying, “I can’t get him to come in anywhere.” That’s when the care team comes in. We can go out, help the family get him in to treatment, and reduce that revolving door. If he were taken to jail, it would be a different outcome. That’s the safety side.
The money side is that the costs savings are $165 million in diversion. That’s cost savings from jail and also diversion out of the emergency room, which can be very costly if you have the fire department taking someone to the emergency room who’s there for hours.
The $165 million … Is that citywide, county-wide?
That’s Alliance Health Care Services. It’s everyone that we diverted over a 12-month period plus the diversion cost of ambulance and the jail time.
How many people have you diverted in a given time period?
Last year’s data show 11,000 people were diverted from hospitalization, emergency rooms, and jails. That’s the best-kept secret of Alliance. We are the largest crisis provider in the state.
Anything I left out or anything you want to add?
We really want to make sure that people know our city deserves this; we deserve this state-of-the-art crisis center. There’s a reason why Memphis has more people in crisis and we could go into all those social determinants of health factors. But this [new building] is going to be in the hub of the city, 15 minutes away from anywhere. I’ve been thinking about this since I became the CEO in 2018. So, I’m just about to fall over. It’s finally happening.
Angry outbursts in public seem more frequent. Anxiety thrums like a background hum. Everyone knows someone struggling with substance abuse, and opioid overdoses are distressingly common. Maybe you are having trouble getting out of bed, connecting with other people, and experiencing anything but sadness and dissociation.
It’s not an illusion. According to the National Institute of Mental Health, before the Covid-19 pandemic exploded in March 2020, 21 percent of all Americans — approximately one in five — had some form of mental illness. At the height of the pandemic, that number rose to 40 percent. Last March, the World Health Organization (WHO) reported that the pandemic had led to a 25 percent increase in depression and anxiety worldwide. “Loneliness; fear of infection, suffering, and death for oneself and for loved ones; bereavement; and financial worries have all been cited as stressors leading to anxiety and depression. Among health workers, exhaustion has been a major trigger for suicidal thinking,” the WHO report read. Furthermore, “The latest Global Burden of Disease study shows that the pandemic has affected the mental health of young people, and that they are disproportionately at risk of suicidal and self-harming behaviors.”
Laurie Powell, CEO of Alliance Healthcare Services (Photo: Courtesy Laurie Powell)
Laurie Powell, CEO of Alliance Healthcare Services, has been on the front lines of behavioral healthcare since 1993, when she started as a therapist in Orange Mound. In August 2020, Powell’s husband died of cancer at the height of the pandemic. She and her two sons were unable to visit him in the hospital. “I just saw on the news that in the United States more people have died from Covid-19 than any other country, and that was kind of hard to hear,” she says. “Now, think about what that is doing to all of those families, how it’s impacting so many on a personal level. I didn’t think my husband would die at age 61. And there are so many stories out there just like that. Many of our staff, if you talk to them, every third person here is going to say either they treated someone whose family member died because of Covid, or because they were so depressed.”
It’s not just Covid. The last two and a half years have also seen an increase in gun violence. “This morning, I got the call at 4 a.m. from one of the community residents to tell me about the shooting of seven people up by the hospital, up the street from our house,” says Charlie A. Caswell Jr., executive director of Legacy of Legends CDC and Shelby County commissioner-elect for District 6.
“We had a mental health epidemic that was recognized by the Center for Disease Control before the pandemic of Covid,” he says. “But I believe the Covid pandemic has produced a new wave in our community, and a large part goes back to last year. It’s been pressed down on people even more now that people tried to get back to doing business as normal, when normal was not even normal! People who didn’t have access to mental health counseling have to deal with what they were already dealing with, and now it’s even more on top of that.”
Dr. Lucas Trautman is a psychiatrist, youth sports coach, and the medical director of Professional Care Services, a community mental health network in rural West Tennessee. When schools closed in 2020, he says, “decreased in-person social connectivity really hurt the public school students’ development because they were out of school for a whole year. I really think that was a developmental detriment, even though we were trying to keep them safe and their families safe. But decreased social connectivity can probably be directly linked to some of this as well.”
Charlie A. Caswell Jr., Shelby County commissioner-elect for District 6 (Photo: Courtesy Charlie Caswell)
No One to Talk to
Today, those who need help the most are having trouble finding it. Alice (who requested a pseudonym to maintain her privacy) is a mother who spent nine months seeking help for her pre-adolescent, who was suffering from intense post-traumatic stress disorder (PTSD). “There are only a handful of places, and they’re all booked up — and none of them take TennCare,” she says.
Employer-based health insurance and Medicare will typically pay $65 for a one-hour counseling session. But due to low reimbursement rates and the spiraling hassles of dealing with insurance companies, many psychiatrists and therapists in Shelby County no longer accept health insurance of any kind. Adolescent care sessions can run from $150 to $175 an hour. “The crisis here in Memphis is that we have so many people living in poverty; there aren’t enough providers who take a sliding scale or who will take insurance at all,” Alice says. “The breakdown in those systems is so much more evident now.”
Dr. Trautman agrees. “We do have a child mental health problem or crisis in Memphis. It’s a public health crisis because of the lack of availability of mental health services but also just because of poverty. We live in an area that socioeconomically struggles, historically. And so I think all those things kind of go together. Why are they having a hard time? Well, they’ve been economically precarious all their lives.”
“Every child living in poverty has elements of PTSD, anxiety, and depression,” says Alice.
According to figures provided by the Tennessee Department of Mental Health and Substance Abuse Services, 7.1 percent of Tennesseans — approximately 378,020 people — suffer from serious mental illness. In Shelby County, 13.7 percent of those seeking treatment in 2019 were uninsured and served by the Tennessee behavioral health safety net. “Looking at the need for services during the pandemic, we actually saw a decrease,” says Matthew Parriott, director of communications for the Department of Mental Health and Substance Abuse.
During fiscal year 2019, Alliance Healthcare, who contracts with the state to provide mobile crisis services, performed 16,317 patient assessments. In fiscal year 2022, which included the worst days of the pandemic, Alliance performed 12,878 assessments — a 21 percent decrease.
Powell says those numbers don’t tell the whole story. “A lot of the calls we get are from emergency rooms, and people were not going to emergency rooms because of the pandemic.”
In contrast, between April and May 2020, the number of calls to the Alliance outpatient help-line tripled. And those call numbers have remained elevated. In July 2019, 540 people in crisis called the help-line; in July 2021, that number was 1,268. Last month, the Alliance crisis line fielded 1,052 calls. “We do have the largest crisis services in the entire state, and probably one of the largest in the country,” says Powell.
Furthermore, “I know that we’re seeing people with more needs,” says Powell. Even as the number of individuals served across the Alliance system went down by about 7 percent between 2019 and 2022, the number of services provided — things like case management, individual and group therapy, and medication — increased by 3.9 percent.
Powell says there is a shortage of mental health professionals, making it more difficult for everyone to receive the care they need. “I’ve looked online, just to check myself, and some of them say, ‘Not taking new patients.’ I used to never see that. There’s just not enough to go around. We’ve had people leave mental health to go into, like, medical social work because they said, ‘I’m not sure if I can continue to be a therapist right now.’”
Dana Wilson, president and CEO of Bridges USA (Photo: Courtesy Dana Wilson)
The Search for Solutions
In January 2020, Dana Wilson became president and CEO of Bridges USA, a 501(c)3 nonprofit that seeks to “unite and inspire diverse young people to become confident and courageous leaders.” Wilson, who had been working with youth leaders at Bridges for more than a decade, already had her sights set on youth mental health when the pandemic struck. “I think the writing was already on the wall prior to the pandemic,” she says. “I don’t want to say the pandemic created a mental health crisis — we’ve been in this for a while.”
Bridges used part of the initial round of funding from the federal CARES act to study access to mental healthcare. “What we found in that initial research was that, while there are services technically available, most of the time you don’t know how to get to them. There’s no coordination system. It seems very fragmented. If someone says, ‘I need this thing,’ and someone over there says, ‘I could do that thing’, there’s no way to get those two together easily or fluidly.”
Another issue uncovered in the early sessions with the Shelby County Youth Council was addressing the shame attached to mental health treatment. “We need to talk about destigmatizing mental health,” says Wilson. “It’s okay to not be okay.”
Abdullah Elahi, an upcoming senior at MUS (Photo: Courtesy Abdullah Elahi)
Abdullah Elahi is an upcoming senior at Memphis University School. “There wasn’t that much of an emphasis on mental health before the pandemic,” he says.
When he became a Bridge Builders Change Fellow, he says, “It really opened my eyes because I was like, oh my goodness, this is something that me and my friends are struggling with so much. … My group is called MEM: Mental and Emotional Health Matters. What we do is try to bring mental health resources to the Shelby County Schools. The other goal we have is, we want to break the stigma surrounding mental health.”
Alice, who struggled to find help for her child, says, “If we don’t provide mental healthcare in the schools, kids aren’t going to get it.”
Among the needs in the schools are early intervention access, says Wilson. “There might be funding and support if you have a diagnosis, but if you don’t have a diagnosis and you’re struggling, you just might need a few counseling sessions to help you get through whatever the situation is. Especially during the pandemic, there was a lot of situational anxiety and depression.”
Mental health professionals also need to be “culturally competent” to meet the needs of their patients. “There’s definitely a need for more Black and Brown therapists,” says Wilson. “In Memphis, for example, the vast majority of the people that we could find were mostly white, middle-class women — a very traditional [demographic] for social work and therapy. There’s a lack of people who can treat students who are non-gender-conforming, LGBTQ+ students who experience mental health issues at a higher rate, statistically.”
The third major reform Bridges identified was the need to stop the criminalization of children for their mental health issues. “Unaddressed trauma is part of what is driving the school-to-prison pipeline,” says Wilson. “If a young person’s getting in trouble in school and there’s not adequate intervention early enough, then the student gets suspended or does something that’s not acceptable and gets pushed out of school. If you get suspended multiple times from school, you’re more likely to drop out.”
Once out of school, troubled adolescents can get pulled into serious, even violent, criminal behavior. Dr. Trautman says the problem is made worse by what he calls “easy access to lethal means.” He and many other specialists believe that the urge to charge teen criminals as adults is misguided and counterproductive. “There’s a mountain of data which shows that the adolescent brain is still very moldable and not set in stone. With proper intervention, you can change their habits. You can change the way of thinking. You can help them integrate into society and be more productive members and also happier. I mean, you’re not riding around killing people because you’re happy and well-adjusted.”
Signs of Progress
Among the reforms MEM advocated was establishing “reset rooms” in schools. “They’re spaces in schools in which students can go if they’re feeling stressed-out,” says Elahi. “They can reset and calm themselves down, center and ground themselves.”
The advocacy was effective, and now reset rooms, staffed with counselors, are a common feature in Shelby County Schools. “They feel really proud of doing it, but the students are the ones who said, ‘We need this,’” says Wilson. “And that’s part of decriminalization, because you’re getting someone the support they need before they get to a point where they can get in trouble for having a problem.”
In October, Dr. Trautman’s group Professional Care Services is opening a new Memphis child and adolescent psychiatry facility at 6601 Poplar Avenue, which will accept health insurance. “Right now, we have three [doctors], but we will grow to the need,” he says.
The state is committing significant new resources to mental healthcare. “Our current fiscal year budget which just started on July 1st is truly historic,” says Parriott. “Thanks to the generosity of Governor Lee, the Tennessee General Assembly, and our federal partners, we have more than $560 million to support the mental health and substance use prevention, early intervention, treatment, and recovery needs of Tennesseans — most of whom have no means to pay. We’re especially excited about the $18 million we received for provider rate increases. This funding has already gone out to our contracted community mental health and substance use disorder providers to allow them to increase pay rates for staff retention and recruitment. We’ve heard from folks across the state that this funding is already making a huge impact.”
Alliance Healthcare will soon be opening a new telehealth center in Binghampton. “A lot of people reaching out to us have access barriers, so we’ve increased telehealth during this pandemic,” Powell says. “That’s exploded. We went from maybe 5 percent telehealth to 80 percent telehealth during the pandemic, and some people really want to continue telehealth. So we’re going to offer that, if that would remove the barrier to getting help.”
Is therapy by videoconference as effective as a traditional office visit? “I think it depends on the person and the age,” says Powell. “Kids really like it.”
Caswell, a longtime advocate for mental health in the Black community, launched his successful run for county commission “to go upstream and push policy changes that address many of those issues we face downstream. … I would say to the community as a whole, we have to be intentional. Shelby County can become a trauma-informed, trauma-responsive community. That means, for all of the employees and the work that we do, we do it with more empathy and more understanding, coming out of this pandemic. If someone is coming in for help or calling for help, it’s not because something is wrong with them. We ask, ‘What happened to them?’”
