BE IT RESOLVED, that the Hennepin County Board of Commissioners hereby authorizes up to $20,000,000 of its federal funding from the Coronavirus Local Fiscal Recovery Fund available under section 603 of the Social Security Act, as added by section 9901 of the American Rescue Plan Act (“Federal Pandemic Funds”), to be utilized for eligible costs, staffing, operations, and services to advance equitable behavioral health strategies; and

 
BE IT FURTHER RESOLVED, in order to implement the above resolving clause, the County Administrator is authorized to negotiate agreements with organizations to advance equitable behavioral health strategies from June 1, 2021 through December 31, 2024 in a total not to exceed amount of $20,000,000; this includes but is not limited to negotiating amendments and increasing the not to exceed amounts for existing agreements with providers or negotiating new agreements with organizations; that following review and approval by the County Attorney’s Office, the Chair of the board be authorized to sign the agreements; and the Controller be authorized to transfer or disburse funds as directed; and

BE IT FURTHER RESOLVED, that the above referenced authorization of Federal Pandemic Funds by the Hennepin County Board of Commissioners does not imply a continued funding commitment by the county for these costs, operations, or services when Federal Pandemic Funds are no longer available; and

BE IT FURTHER RESOLVED, that the County Administrator is directed to seek alternative funding sources for these purposes; and that to the extent other state or federal funding is received for the expenditures by this Resolution, the County Administrator is delegated authority to reduce the above authorization of Federal Pandemic Funds if necessary to ensure there is no duplication of assistance; and

BE IT FURTHER RESOLVED, in order to implement the above resolving clauses and pursuant to Minn. Stat. §§ 383B.101 et seq., the County Administrator is authorized to effectuate the goals of this resolution, including but not limited to directing and coordinating county personnel and resources as needed to implement operations and services to advance equitable behavioral health strategies; and 

BE IT FURTHER RESOLVED, that the Hennepin County Board of Commissioners hereby approves the addition of 36 full time equivalent positions to the 2021 Human Services department budget, which may be funded with Federal Pandemic Funds to the extent eligible and as directed by the County Administrator.

On March 11, 2021, the American Rescue Plan Act of 2021 was signed into law, including the appropriation of more than $130 billion to the Coronavirus Local Fiscal Recovery Fund, for making payments to metropolitan cities, counties, and other units of local government to mitigate the fiscal effects stemming from the public health emergency. Hennepin County expects to receive direct payments from the U.S. Treasury totaling more than $220 million and received the first half payment of $122.9 million in May of 2021.

The American Rescue Plan Act provides that money from the Coronavirus Local Fiscal Recovery Fund may only be used to cover certain costs incurred between March 3, 2021 and December 31, 2024, and expended by December 31, 2024, including costs to respond to the public health emergency or its negative economic impacts. Under the available guidance from the U.S. Treasury, this category of eligible costs can include supports for vulnerable populations to access medical or public health services; new or enhanced government services needed to meet behavioral health needs exacerbated by the pandemic, such as mental health treatment, substance misuse treatment, other behavioral health services, hotlines or warmlines, crisis intervention, overdose prevention, infectious disease prevention, and services or outreach to promote access to physical or behavioral health primary care and preventative medicine; as well as payroll and covered benefits expenses for public safety, public health, health care, human services, and similar employees, to the extent that their services are devoted to mitigating or responding to the COVID-19 public health emergency. This category of eligible costs can also include a broader range of services and programs when provided in a Qualified Census Tract (QCT), or to families living in QCTs, or to other populations, households, or geographic areas that are disproportionately impacted by the pandemic. Such services may include funding community health workers to help community members access health services and services to address social determinants of health; funding public benefits navigators to assist community members with applying for available public benefits or services; addressing educational disparities through evidence-based educational services and practices to address the academic needs and the social, emotional and mental health needs of students; and promoting healthy childhood environments by providing home visiting programs with structured visits from health, parent educators, and social service professionals, and enhanced services for child welfare-involved families and foster youth; among other eligible uses.

The American Rescue Plan Act also provides that money may be used for the provision of government services to the extent of the reduction in revenue due to the pandemic. Under the available guidance from the U.S. Treasury, this category of eligible costs can include maintenance of infrastructure or pay-go spending for building new infrastructure, including roads; modernization of cybersecurity, including hardware, software, and protection of critical infrastructure; health services; environmental remediation; school or educational services; and the provision of police, fire, and other public safety services.

History: Pre-pandemic data estimates that about 200,000 adults and 33,000 children in Hennepin County will be diagnosed with a mental illness. During the pandemic, 4 times more individuals are reporting symptoms of anxiety or depressive disorders. Sadly, according to the CDC, the proportion of emergency visits for mental health issues for youth ages 12-17 increased by 31% during the pandemic. In 2020, suicide was the second leading cause of death of people in Minnesota between the ages of 18-34. The impact of COVID-19 on mental wellbeing have been most heavily felt by people with low incomes, and those who identify as BIPOC. Black Americans are 1.2x more likely to report symptoms of anxiety or depressive disorder and Hispanic Americans 1.3x more likely compared to white Americans. Positive COVID cases and deaths have been disproportionately higher in communities with larger Black populations and other communities experiencing poverty. For low-income communities of color, the economic stress created by the pandemic, along with isolation and increased risk of serious health conditions and death from contracting COVID-19, have all contributed to increasing mental illness in our communities.

The impact of COVID-19 has compounded already existing disparity in mental health across other life domains, like housing and education. For example pre-pandemic, youth with mental illness are 2x more likely to drop out of school and 21% of people experiencing homelessness have serious mental illness. One of the most notable areas of disparity is seen in the justice domain. People with mental illness are 4x more likely to be arrested for low level crimes. Close to 70% of youth involved in the juvenile justice system have diagnosable mental health condition and youth of color are disproportionately represented an out-of-home placement (81%). In Hennepin County, admissions to the state hospital from jail increased by 114% over the past 5 years and by 567% since 2013.

The requested funds will support cross-sector collaborations aimed to serve communities disproportionately impacted by COVID-19. The programs outlined here serve a population that is more than 50% people of color and are heavily focused on qualified census tracts. Ensuring that there is sufficient, high quality, culturally responsive and low barrier access to mental health support is necessary to protect individual and community health and safety.

In response to direction from the County Commissioners to invest in early interventions, prevent overreliance on deep end services, and reduce disparities, staff recommend the use of Federal Pandemic Funds in the following areas: 

• Expand School Based Mental Health to improve access to evidenced based mental health services for youth. These services increase access to mental health supports from 13% to 85% for all youth. Data shows BIPOC youth are 2.7x more likely to access school based mental health than their white counterparts.
• Develop and expand network culturally specific mental health services in alignment with enterprise-wide priorities for ARP funding and disparity reduction goals. 
• Expand Family Home Visiting for outreach and services of universal short term evidence-based family home visiting to Hennepin County families. Through these services, home visitors support families in promoting healthy child development, increasing their connections to community resources, and support caregiver mental health (reduction in postpartum depression or anxiety).
• Expand Caring Connections 4Kids partnership between public health nurses and child protection to conduct mental health screening, health assessments, and connect children to services (birth to six years)
• Reform 911 by building upon a pilot program that creates an alternative behavioral health response to 911 calls that are mental health related.
• Expand hours at 1800 Chicago to 24 hours to fully carry out the disparity reduction aspects of this program and increase access to an alternative for law enforcement and residents needing walk-in care who would otherwise not receive support or be redirected to more traumatic, intrusive, deep end services such as emergency rooms and jail.
• Expand the Embedded Police Social Workers across all cities in Hennepin County to direct people away from law enforcement contact and builds healthier communities by helping people access needed social services and community supports.
• Launch a Juvenile Behavioral Health Initiative to create a county-wide strategy to improve the quality of life and outcomes for families and youth via connection to appropriate resources and decreased involvement with the justice system.
• Expand Family Response and Stabilization Services to reduce the need for out of home placement of children by supporting the entire family when a youth is experiencing behavioral or mental health issues. The intervention provides immediate support at the time of the crisis and stabilization services following the initial contact. 
• Pilot a Family-Based Recovery program to create an in-home treatment and recovery option for families experiencing substance use disorder rather than disrupting the family system through child placement during parental treatment and recovery.
• Launch a mental health awareness campaign funding a multi-faceted campaign of a direct connection between community and trusted influencers to raise awareness of mental illness, especially suicide, and to reduce stigma associated with mental illness through tactics including television, radio, print, social, outdoor and digital media particularly in BIPOC, suburban and rural communities in the county.

Current Request: Authorize up to $20,000,000 of Federal Pandemic Funds to advance equitable strategies to support residents with mental health and substance use disorder needs; negotiate agreements for services 08/01/21–12/31/24. This would allow for Federal Pandemic Funds to support the above interventions in the following estimated year-by-year amounts with an additional allocation of 36 FTEs in the Behavioral Health area.

Impact/Outcomes: The measures supported through this Board Action Request will provide more than 11,000 people with low barrier, upstream, whole-person and family supports designed to meet the complex needs of diverse communities. They will leverage multiple funding sources and expand the reach of Hennepin’s current investment.

We anticipate similar outcomes to what was presented in the “Mental health” and “Mental health and public safety” board briefings earlier in 2021 with an increased impact to 11,000 additional residents. These outcomes include 97% children current with well-child exams and 92% current with recommended vaccinations, reduced hospital admissions (29%) and emergency room visits (56%), reduced unnecessary days at the state hospital (40%), reduced jail bookings (35-48%), reduced jail bed days (37%), reduced school suspensions for Black and African American youth (53%), reduced child protection involvement (50%) and increased access to community mental health supports (40%).

Additional outcomes associated with these initiatives

• Increased positive mental health outcomes for BIPOC residents
• Increased number of young children who remain with their parents and out of Child Protection
• Reduced caregiver positive toxicology screens
• Reduced recidivism for adults and youth
• Increased housing
• Increased physical and mental health care accessed
• Increased family stability
• Increased trust between community and Hennepin County