The future of a new behavioral health crisis center in Cleveland’s Central neighborhood is uncertain after a key funder raised the possibility of pulling the plug on the project this week.
The center is currently being renovated and is set to open in September.
Leaders hoped the new facility would offer round-the-clock mental health crisis services as an alternative to the emergency department or jail. The state of Ohio, Cuyahoga County and the local mental health and addiction board committed millions to getting the space built and running.
The largest investment was from the county’s board of Alcohol, Drug Addiction and Mental Health Services (ADAMHS), which decided last year to cut funding to other agencies in order to put $10 million annually into the new center’s operations.
But the board’s new CEO now says keeping that commitment would mean it has to cut millions more from other mental health providers, many of which already took a hit to their budget this year.
CEO Jason Joyce, who began the job in November, told the board Wednesday that it needed to make a decision on how to proceed. Keep its plan to fund the crisis center and cut other programs to afford it? Or drop its commitment in order to maintain some funding stability for others? The board will reconvene March 11 to vote on the issue.
“Given our current financial constraints, this decision requires us to prioritize one over the other,” Joyce said at the meeting.
It’s a precarious choice, and several social justice advocates rejected it outright. John Lentz, a former president of Greater Cleveland Congregations, a group of religious organizations that has championed better mental health crisis services for years, said that leaders had to “break out of the habit” of pitting vital social programs against each other when there are sufficient resources in town.
“There seems to be plenty of money to move the Browns from downtown,” Lentz said. “Elected leaders figure out ways to support the Cavs and the Guardians, and there’s excitement about a new lakefront development. But here we are.”
ADAMHS board members urged Joyce Wednesday to pursue funding from local hospital systems or philanthropic sources. Joyce said he would try but had doubts that it would work. Another board member said they felt “irresponsible” for not having critical conversations about the project until recent weeks.
Leaders of The Centers, the nonprofit health organization selected to run the new crisis center, said Wednesday that they reworked their budget to scale back its reliance on ADAMHS board dollars. Eric Morse, the organization’s CEO, said he recognized the difficult decision at hand. But he discouraged the ADAMHS board from entirely cutting the crisis center’s operational funding. Doing so would waste $30 million raised to build the center, he said.
“I really believe that if the ADAMHS board, the county and The Centers partnered in good faith, we could work together to get this thing done and not cause harm” to the existing behavioral health system, Morse said in an interview after the meeting.
A larger question seems to be seeping into the debate, too. How vital is a new crisis center to the community? At a meeting Wednesday night, Joyce said he didn’t want to “fool ourselves” into thinking the new center would reduce the need for many of the other ADAMHS-funded services. While it might streamline the mental health system, the center isn’t a panacea, he said.
Some of Joyce’s statements drew audible laughs and cries of frustration from staff at The Centers, many of whom had spoken earlier about their belief that the center is a necessity for people in mental health crises.
Where the crisis center came from
The plans for a new crisis center sprang from an investment from the state. Post-COVID, Ohio had federal money to spend, and it wanted to put those dollars toward improving mental health services. It gave the Cuyahoga County ADAMHS board $6.8 million dollars to build a new crisis center.
Throughout 2023, the board worked to find a location for the facility and an agency that could take it on. After initially working with MetroHealth, the hospital system pulled out. ADAMHS then approached The Centers.
The partnership was fortuitous. The Centers had recently bought buildings on the former St. Vincent’s campus, including one that would be the site of the new crisis center. On the first floor, it would have 40 chairs to accept patients in an emergency mental health crisis, with behavioral health professionals on-site to treat them. A second floor would have 16 beds for people who needed to stay longer-term.
The goal, Morse said previously, is to reduce the number of patients in jails or emergency rooms with mental health crises. These patients are often expensive for hospitals, since they are time- and staff-intensive. Morse said in a presentation last September that 10,000 people with behavioral health crises show up annually at emergency rooms at the Cleveland’s Clinic’s Lutheran Hospital and the main campus of University Hospitals.
In fall 2024, the ADAMHS board awarded the Centers the money from the state, as well as some of its own, to construct the facility. No board member voted against it.
Money for center meant cuts for other services
Questions about the new crisis center’s long-term funding began to bubble up last summer, after the Cuyahoga County Council was asked to pitch in money for construction and operational funding.
In response, the ADAMHS board laid out a commitment in writing to provide $10 million a year to the center’s operations starting in 2027. The board also laid out a plan for how to get there: At least some of that money would be pulled from existing providers, including a psychiatric emergency room run by MetroHealth in Cleveland Heights and a smaller crisis stabilization unit on the West Side run by FrontLine Services Inc.
The decision, perhaps inadvertently, pitted MetroHealth against the Centers. County Council barely passed a vote to invest $7 million in the construction of the new center, angering several council members who felt that doing so disadvantaged MetroHealth. Afterwards, MetroHealth announced it would close its psychiatric emergency department by the end of 2025.
Morse said he was not aware of the plan to pull money from MetroHealth or FrontLine before the ADAMHS board presented it last summer. He had believed money to run the new crisis center would come, at least partially, from reserves.
The new crisis center would also essentially replace the county’s diversion center, which had been funded by millions of the county’s opioid settlement dollars. Brandy Carney, the county’s director of public safety and justice services, told the county council last year that the diversion center would shut down after the new crisis center opened.
The Centers also has asked the county to invest $12 million of its remaining opioid settlement money into the first three years of the new crisis center’s operations. The council has not yet voted on that.
Board faces larger budget uncertainty
The ADAMHS board is facing larger budget challenges and relied on cash reserves to balance this year’s budget.
Budget projections Joyce shared Wednesday show that the ADAMHS board faces an $8 million to $12 million budget deficit in 2027, depending on how much it funds the crisis center.
Cuyahoga County also scaled back its health and human services budget this year — including the amount it gave the ADAMHS board, which in turn cut mental health agencies it funds by 20% across the board.
FrontLine Services had to lay off staff as a result, Signal Cleveland reported last year. That meant fewer residents could be served.
The $10 million commitment to the new crisis center, which kicks in starting in 2027, exacerbates those challenges, Joyce said.
Providers, ADAMHS board members, community: What comes next?
At Wednesday’s meeting, three nonprofit mental health and addiction agencies — the Hitchcock Center for Women, Stella Maris and EDEN, which provides low-income housing — said that further cuts could make it more difficult to serve clients.
But the majority of public speakers pushed the ADAMHS board to find a way forward for the crisis center. Many were affiliated with The Centers, though others were community advocates who say they see a need for more accessible mental health care. Larry Heller is a crisis outreach worker at the Northern Ohio Recovery Association. He said he works on the streets to help people get people access to mental health care and addiction services. The crisis center would make it easier, he said.
“It can be the foundation and the universal access point, guaranteeing the access to care for so many people who have been denied access for so long,” Heller said. “It can be the universal point to our entire system of care.”
One major pitch Morse has made for the new crisis center is that it wouldn’t turn anyone away: It would accept residents walking in or coming from police, hospitals or community agencies. Existing facilities, like the diversion center, have set up stricter rules about who they can and cannot accept.
Joyce acknowledged the many benefits of bringing on a new crisis center, like rerouting residents in mental health crises away from emergency rooms and connecting them with longer-term social services. And he said that the status quo for treating mental health in Cuyahoga County is not sufficient. He plans a system-wide evaluation of agencies and services in the future.
“We need more money, to be honest with you,” Joyce said. “I mean we continue to take cuts, and we continue to have to lose programs.”
But, he said, the board and community need to make a choice based off of the budget and information available right now.