MARYVILLE, Mo. — The Northwest Missouri Cooperative Mental Health Board of Trustees met for the first time last week, beginning the work of the four-county body that aims to increase access to mental health resources across the region.
Once underway in earnest, the board intends to primarily use targeted grant funding to address particular areas of need — either by expanding existing programs and initiatives that are working well, or by creating new ones to fill gaps.
The effort initially grew out of a leadership team in the 4th Circuit Court created by former Judge Roger Prokes. More than two years ago, that team, led by Associate Circuit Judge Robert Rice, tackled issues related to mental health and the court system, including expanding programs like the Drug and DWI Courts and a 24/7 hotline for law enforcement to speak with a trained counselor when dealing with a person in crisis. But, Rice said at last week’s meeting, that effort quickly grew larger in scope after pulling on thread after thread that reached well beyond the courts.
Over the next two years, Rice and the leadership team brought together stakeholders from the justice system, health care, education and other disciplines to discuss common challenges that stem from what is a crisis-level lack of resources for people with mental and behavioral health problems. From the court’s perspective, for example, a lack of care for a child who needs it could — and often does — culminate in repeated visits to jail and prison later in life.
Those discussions eventually led to a summit last year in which Rice, the leadership team and representatives from local schools, health care providers and the justice system made their pitch to the five county commissions within the 4th Circuit — Atchison, Gentry, Holt, Nodaway and Worth — to create the cooperative mental health board.
Such boards may be created specifically to address mental health issues in a region, and the process for creating them is outlined explicitly in state statutes.
The Atchison County Commission opted not to participate, but the other four counties signed agreements in July officially creating the board.
On Nov. 17, in the Nodaway County Courthouse, Rice led the board members through their first steps in getting the board on its feet.
“What you guys are here for is really a culmination of two years of hard work to put together a sustaining program where our community works together to put forth a plan and then get some funding for that plan to create more mental health resources for our communities,” Rice told board members. “And we thought, when there’s more people working together, we can do more good.”
Now in an unofficial capacity, Rice indicated he will continue to act as an adviser to the board through at least early next year.
Once funds are secured, one of the board’s first priorities will be to hire an executive director who can perform the day-to-day work needed to carry out the board’s goals.
However, before beginning to meet its ultimate goal of helping to grow more local resources for mental health care, the board will need some funding of its own.
The state statute that outlines the board’s creation and operations also provides a potential funding mechanism: a property tax of up to 40 cents per $100 valuation that could be passed in any participating county. First, though, it would need to be placed on the ballot by a county commission. Then, a majority of voters would have to approve it.
Each county could pass a different tax, or no tax at all. But some sort of permanent funding, Rice said, will be needed for the board to have its intended impact.
Still, Rice cautioned that passing any such tax would require a monumental, coordinated effort, and will require a coherent plan of action to show the public both the dire need and that the tax money would result in tangible help.
Even without a dedicated funding source, the board will pursue some grant opportunities that could be used down the line to demonstrate effective programs that could be expanded further with more funding.
In the meantime, Rice said he intends to meet with each participating county commission before the end of the year to ask for any available funds that could assist with the costs of operating the board, like attorney’s fees and travel.
Until then, the most important immediate work facing the board is creating an inventory of existing resources across the four-county region and identifying where they fall short.
In February, that process will kick off in earnest with a Sequential Intercept Model mapping workshop to be held in Nodaway County — one of the ways the mental health board will work to properly inventory the resources currently available and start to identify needs.
The SIM model has participants map out all possible points of contact with the justice system when someone may be diverted to get the help they need. For example, a typical map may start with community services, including options like a crisis line; progress to law enforcement contact, like being arrested; and on to court hearings, prison time and reentry into society at large.
At each point along the map, participants in a SIM workshop aim to detail resources available to individuals that could help keep them from progressing to the next level. For example, someone who has been arrested but is in need of mental or behavioral health resources could be connected with those resources by law enforcement. Those kinds of connections among agencies could help people get resources they need and keep them out of the justice system.
February’s SIM workshop aims to create a detailed map of those resources with a wide range of participants with the goal of making sure each agency and organization involved at each step is aware of how to help individuals they come in contact with and to strengthen the connections among those stakeholders to ensure the process is as smooth and successful as possible.
First in rural area
The new cooperative mental health board appears to be the first based solely in rural Missouri, with other boards centered in more populated areas like Kansas City, St. Louis and Columbia.
Rice said part of the reason for that is likely the complicated web of requirements for how the board must be composed.
For example, at least one member of the board must be a licensed physician, but at least half of the members can’t be involved in health care at all. One-third of the members must represent consumers of psychiatric services or the families of such consumers. And in multicounty boards like this one, the board members must be appointed according to the population of the different counties, in addition to meeting the other representation requirements.
In areas with sparse populations like northwest Missouri, checking all of those boxes can be challenging, likely contributing to why the northwest Missouri board is the first of its kind in a rural part of the state.
One hot topic of discussion during last week’s four-hour inaugural meeting was the decision by the Atchison County Commission to opt out of participating in the board.
Over the several months leading up to the signing of the agreements among the four participating counties, Rice and Tarkio attorney Beverly Jones, who drew up the board’s bylaws, worked closely with all five county commissions in the 4th Circuit to craft an agreement that was acceptable to all of them.
Every commission’s chief concern was over funding: How much would they need to contribute, and where would it come from?
In multiple meetings earlier this year, Atchison County officials expressed concerns over the breakdown of the board — particularly a previous proposed makeup that had a majority of members coming from Nodaway County — and especially over funding.
Atchison County officials said at the time that without a dedicated funding source, they feared that they may be pressured into using their own county funds to help support the board’s projects if other counties outvoted them — for example, if the board agreed to fund a proposed project, and the other county commissions agreed to fund it, then the Atchison County Commission would similarly be expected to get on board even if the commissioners felt they could not afford to.
Commissioners there also expressed skepticism that Atchison County voters would ever approve an additional tax, and one commissioner, James Quimby, said in March that he would not support one either, even though he recognized the need the board was trying to address.
Rice and Jones attempted to assuage some of those concerns by working on new drafts of the bylaws and offered to rewrite them further, but the commission ultimately decided against participating.
During last week’s meeting, board members who had not known about the commission’s decision said they were surprised and hoped that the county commission would reconsider in the future after seeing the board operate.