Behavioral health hospital could open in summer 2025

Oct. 26—The new behavioral health hospital to be started through a partnership between Medical Center and Midland Memorial Hospitals Discussions could potentially open July 1, 2025.

At a meeting of the Permian Basin Behavioral Health Center board Tuesday at Mission Fitness, they talked about where to put the hospital in closed session, but no decision was made.

Board President Russell Meyers, who also is President/CEO of Midland Memorial, said he's not sure the site isn't set, but it's not done yet.

"It has taken a long time to get the details together, so it's not completely set. We hope it will be soon," Meyers said.

He added that they don't have a building design or contractor, so it's hard to have a firm schedule.

"But the schedule we have from the programming consultant, the people that do the ... pre-architecture work — how many rooms and what size are they and that sort of thing, they laid out a schedule for us that would have us opening July 1 of '25. That's probably not far off. We've got to get it down a little tighter, but that's in the ballpark," Meyers said.

The firm that is doing the pre-architecture work is Broaddus Companies.

Meyers said the way the money was appropriated from the state to get the project started was to engage the Texas Facilities Commission.

"The legislature required the Facilities Commission to take the lead on design and development of the property, so it's the Facilities Commission that hires the architect and the project manager and those folks. We've worked with them, they've taken our input, but at the end of the day it's their call" on who gets hired," Meyers said.

He added that it will not be a state facility, which is strange for them because they are used to constructing buildings that the state will own and operate.

Senate Bill 8 from the third special session last year says their job is to design and build it and then give it to the consortium of the two hospitals to operate it.

"They're not accustomed to doing deals like that. They're having to learn like us ... They're great people. I've enjoyed working with them. They're smart," Meyers said.

He said they have arguably been working on this project since 2015. Midland Memorial hired Meadows Mental Health Policy Institute to do a comprehensive behavioral health assessment of Midland County.

"They did this huge report for us," Meyers said. "... They published it in '16; huge assessment; what services are here; what's the need; how short are we to meeting the need, which is really short. What can we do differently What strengths do we have and we had quite a few. We have really good providers just without enough capacity to do anywhere near enough work."

"That got the ball rolling. We had the Healthy Minds initiative for several years where we raised some money locally. We did a bunch of education; stigma reduction stuff to get people convinced that it's just another health issue. It's not any different from diabetes, or whatever other medical concerns you might have. I think we made some good progress there," he said.

In early 2021, MMH hired another consultant to do a business plan for a behavioral health center to help us walk through what kind of volume they could do, what would it would take in terms of what it would cost to build, what it would cost to operate it, whether they could make "cashflow."

"Is there any chance that it wouldn't lose a ton of money because that's one of the reasons you don't have enough behavioral health is money. It's very poorly reimbursed in a lot of ways. A lot of the people that have severe needs can't work. They've lost their jobs. They've lost their third-party insurance because their mental health condition has prevented them from being productive citizens. It's a really difficult business to do, but they were able to show us a business plan that looked like it was potentially viable. So we started looking at how we can pursue it ...," Meyers said.

The big catalyst was the American Rescue Plan Act.

"When the federal government allocated all that money to the states and the counties and the cities; didn't give any of it to hospitals, but they assigned it for things like improving the behavioral health status of communities that have been damaged by COVID. Texas got over $16 billion of federal money under ARPA. The legislature in the last session kept it on the back burner until the third special session. We were watching this and it occurred to me finally that it specifically says behavioral health ... This is money we could go after and make this thing happen that we've been hoping for and envisioning for five or six years. So we got with (Rep.) Tom Craddick (R-Midland). Tom got with (Rep.) Brooks Landgraf (R-Odessa). They worked together to get the legislature to give us some of that money and they gave us $40 million," Meyers said.

The money came with two major strings, he said.

One was they had to create a partnership entity called a local government corporation between Midland County Hospital District and Ector County Hospital District.

"They told us we'll only do this if it's a combined effort intended to serve the whole region. We said OK, we can do that. We're friends. We'll get that together and we created the corporation which is the Permian Basin Behavioral Health Center ... The second string was the money is going to the Facilities Commission. ... We asked for $86.5 million. We got $40 (million), so clearly we had to raise more money privately. We said we'd do that. They put the Facilities Commission in charge of design and development and managing the state component of the funding. We said yes, we'll do that. That's enough to get us going. We think we can raise the money ... There are people in our communities that care about this that will actually give money for it. And here we are," Meyers said.

The two hospitals went to the Secretary of State's Office and chartered a new corporation, which we're empowered to do and that's what the PBHC is. It's a corporation that we jointly sponsor, but it doesn't affect the sovereignty of either of the individual hospital districts. It's something they are doing together.

Both hospitals have people with behavioral health concerns in and out of their emergency rooms.

"Neither of us has any services we can provide for those people, so we're constantly looking for a place to send them. It's Oceans. It's Springboard in Midland or Turning Point, if they have a drug and alcohol problem. Way too often, it's somewhere out of town where we can find a bed and when that happens those hospitals don't have to take our patients just because recall them. We have contracted to pay them to take our patients, so each of us spends our local funds buying psychiatric services from providers who may or may not do a good job. So we'd be better off building something and programming it such that we can serve our communities and our region's needs and keeping our own money devoted to our own facility instead of sending it off ...," Meyers said.

MCH President/CEO Russell Tippin said they know behavioral health is a huge need that gets bigger every day.

"You don't have to look much further than what's happened in the schools and in hospitals with violence. We know that behavioral health is a big issue, that especially in the Permian Basin, is something that we're treating in our emergency rooms right now. We shift people to (centers) outside of San Angelo or somewhere else. That need needs to be met here and it'll just be better for the overall health of the Permian Basin," Tippin said.

This would be a separate entity operated by the Ector and Midland County hospital districts, he said.

It is operated by a separate board. There are three people from MCH and three from Midland Memorial.

As to what services the facility will provide, Meyers said the 100-bed hospital is intended to serve children to seniors. There will be offices, outpatient functions, therapy rooms and all the things that go to support those 100 beds. Outpatient services will pay for that as well, he said.

Satellite clinics would be a logical item to grow out of this, but they are focusing on the main part right now.

One of the things they've heard a lot is that there's probably a bigger need for children's services than anything else. There are hardly any inpatient beds for children, he said.

"Children don't need that many inpatient psych beds, but it's greater than zero and there really isn't anything anywhere nearby that can hospitalize a child with an acute need. ... There's people who are so sick that they're non-functional. They're psychotic. They've attempted suicide. They've threatened suicide. They've had some kind of breakdown that requires them to have an acute level of care for what we think will be seven to nine days on average in the inpatient facility. Then we hope to create a network of places where those people go after they've been hospitalized. An intensive outpatient program where they come every day for a while and get a course of therapy that moves them toward functioning in the world," he said.

"Maybe over time, not initially, but maybe a residential place where someone who's trying to figure out a way back into society can live for six months while they're rebuilding their life and still get some therapy on site," Meyers added.

They hope there will be a lot of outpatient services that will be more likely to prevent people from getting into that crisis position.

"That's one of the challenges we have now is there's not enough counseling and outpatient psychiatry available to people and people don't know how to get to it. So their conditions have to get terrible before they get any help. If we could convince people to get their anxiety treated when it's early; get their depression treated when they first realize they're feeling it versus waiting until their suicidal everybody wins. That's a cheaper way to do it; it's a more effective way to do it and people don't have to go through a crisis to get the help they need. We hope to build that whole continuum centered around this. Texas Tech psychiatry is going to be really crucial to it. They've got a growing program and they're going to be vital. They're going to be the medical leaders of this thing," Meyers said.

He added that PermiaCare is also involved.

"They're vital as kind of a front end of all of this. They're active in the community. To the extent that we're able to care for these people who are acutely ill and keep them out of the hospital, PermiaCare is doing that. They don't have enough capacity to do everything needed, but we hope we can work together to grow that. They're a ... really important partner for us."

Staffing will be a huge concern. Meyers said they are fortunate in that they have a couple of years to work on that.

Texas Tech is training psychiatrists. Meyers said they have a lot of confidence to get psychiatrists through the pipeline.

Tippin said he talked to Texas Tech University Health Sciences Center Regional Dean Dr. Timothy Benton about psychiatric care and training and offering fellowships in psychiatric care for doctors so they can train their own.

"Because we know when we grow our own in the Permian Basin they tend to stay here longer, so I think that's just another partnership that something like this creates," he said.

Tippin said behavioral health requires a different type of verification.

"You're really going to have to zoom in on the right kind of people to work at that kind of faculty to give care that's appropriate to those patients," Tippin said.

He added that the behavioral health needs of the Permian Basin are being addressed by local emergency rooms throughout the region in Rankin, Andrews, Seminole, Odessa and Midland.

"People go to the ER for their psychiatric and behavioral health. That needs to go to a place that specializes in that kind of care," Tippin said.

"We train a lot of nurses the region. Nurses are the largest component of the workforce, even in a psych hospital, but we'll have to train them to be psychiatry nurses. That's not something many of us are doing right now. UTPB has a social work program. They've got a licensed counseling program. We're going to support them; try to help them grow that and encourage people to choose those professions. ... Just like all of our other staffing concerns it's going to be an ongoing challenge, but I'm hopeful that with a couple of years' advance notice we can get most of the people we need by the time we're ready to open. ...," Meyers said.