An influx of Covid relief funds is helping to fill gaps in mental health services for children in rural areas

NELSONVILLE, Ohio — 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 rolling hills of southeast Ohio have traveled to Hill Hospital seeking care. Then, in 2014, the 15-bed hospital, which was often without patients, closed.

Later, the three-story brick building was reopened as a center for health services. With the help of several funding sources, Integrated Services for Behavioral Health, a nonprofit social services agency, transformed the building into a place for mental health treatment, primary and dental care and access to a food pantry.

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 — to residential care.

“For a long time, we’ve been trying to figure out, ‘How can we support service delivery more locally?'” said Samantha Shafer, executive director of Integrated Services for Behavioral Health. “Because when you have programs here, the work you can do with families is more successful, the health outcomes are better.”

Efforts to offer residential mental health services at the Mary Hill center and in other rural Ohio towns have been fueled in part by a small portion of the $5.4 billion Ohio was awarded from the America’s Rescue Plan Act, the federal Covid-19 relief law that was adopted in 2021.

Congress gave $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 a relatively small portion to improving mental health funding. Ohio is one of a small group of states that have further split their appropriations to spend a portion on children’s mental health care.

Experts said using ARPA funds is just one way states can support children’s behavioral health during what health experts have called a “national emergency in child and adolescent mental health” that has been exacerbated by the pandemic. In an effort led by the American Academy of Pediatrics, multiple organizations wrote to the Biden administration in October, urging it to declare a federal national emergency for 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 and behavioral health systems, because, in my opinion, the systems are really broken,” said Isha Weerasinghe, 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 foundation dollars to help strengthen the system.”

The center said ARPA’s funding provisions are “insufficient to address deep systemic and historical inequities” in mental health care. Regardless, Weerasinghe said the money has the potential 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 them. According to the latest quarterly analysis by the Center on Budget and Policy Priorities, a left-leaning think tank in Washington, DC, most states have completed or are close to completing their allocations. Among states, the median allocation to support mental health services is about 0.5%, based on CBPP data. For states in the Midwest region, the median is about 3%.

CBPP figures showed that through August, mental health spending varied widely in mostly rural states where suicide rates repeatedly exceed the national average by double or more. In some of them, including Montana, South Dakota and Wyoming, officials awarded less than the national median. Meanwhile, Colorado lawmakers directed nearly 11% of state money to mental health.

Of the $84 million Ohio officials have committed to pediatric behavioral health facilities, $10 million will go to rural counties in the state’s southeast. That’s less than half a percent of the state’s ARPA amount of $5.4 billion. But clinicians hope to help address gaps in children’s mental health services in Appalachian Ohio.

In recent studies, the Public Children Services Association of Ohio, a nonprofit advocacy group, found that service gaps are causing some children with behavioral health needs in Ohio to be placed out of state or in remote counties for care. The association surveyed public children’s service agencies in 19 counties and found that for the majority of their cases in 2021, agencies made many calls before finding a placement in a child’s treatment facility.

In April, Ohio Governor Mike DeWine signed an executive order providing $4.5 million to youth treatment facilities to increase their capacity.

The Mary Hill Youth and Family Center overlooks downtown Nelsonville, in the Appalachian region of Ohio.(Christina Saint Louis / KHN)

In Nelsonville and the rural, hilly country surrounding it, ARPA money played a minor role in expanding service.

The new residential treatment facility at Mary Hill Center, which serves children ages 10 to 17, is designed for 16 beds. But since September, due to a lack of staff, the facility has been operating at limited capacity, serving no more than 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 the additional $7 million to build another residential treatment facility — modeled after the Mary Hill Center — in Chillicothe, a town about 55 miles west of Nelsonville. This facility will have a capacity of 30 beds, but will start with a limit of 15. Construction should begin in January.

Services at the Chillicothe residential facility will primarily be reimbursed under a new Medicaid program called OhioRISE, which will pay for behavioral health treatment in psychiatric facilities for young people. But the facility will also treat children who are not enrolled in Medicaid.

Before Ohio’s rural projects were approved for ARPA funding, each one was reviewed by Randy Leite, executive director of the Appalachian Children Coalition, a nonprofit that advocates for children’s health. He decided which proposals for ARPA-funded projects from the Appalachian region would be presented 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 a lot of it wasn’t 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 has to do with reimbursable services,” he said.

Leite and the coalition presented Ohio officials with about $30 million in ARPA investment recommendations, 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 and Hopewell Health Centers, a federally qualified health center that received about $1.5 million. The money will pay for renovations to the 16-bed Children’s Crisis Stabilization Unit in Gallia County, south of Nelsonville; expansion of the daily treatment program; and improving its school 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 needed so that children can make good use of their educational opportunities.”

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