Cuyahoga County Council voted Tuesday to invest $7 million in new crisis center. Some worry it’s at the expense of MetroHealth.

After a contentious meeting that seemed to pit two health agencies against each other, Cuyahoga County Council voted by a slim margin to invest $7 million from its opioid settlement fund to construct a new behavioral health crisis center, filling a major funding gap in bringing the project to fruition. 

The new crisis center will be built in the Central neighborhood at the campus of the former St. Vincent Charity Hospital and is supposed to open next fall. It will act as a psychiatric emergency room, offering 24/7 in-patient and outpatient mental health and addiction services to people over 18 years old.

The council voted 6-5 in favor of funding the project.

The new center is the latest attempt by local leaders to address the interlocking challenges of mental health, addiction and criminal justice. The facility could serve up to 12,000 people a year, according to an estimate by The Centers. 

The contention around the decision largely stemmed from concerns about what shifting funding to the new center would mean for MetroHealth Medical Center, the county’s public hospital, and other behavioral health organizations.

The county’s Alcohol, Drug Addiction and Mental Health Services Board has plans to cut other services to help pay for the new crisis center. That includes $4 million for the psychiatric emergency department run by MetroHealth in Cleveland Heights, a cut that could threaten the unit’s ability to keep operating.

“One is going to live, the other one’s going to die,” said Council Member Mike Gallagher, who voted against funding the new crisis center. “As I’ve sat here for 15 plus years, I cannot turn my back on Metro.”

Council members who supported the new crisis center said they recognized the challenges ahead for both the MetroHealth facility and the new facility. But they hope they can find a way for both stay open.

“Decisions like this boil down to values. It’s about what’s really important,” said Council President Dale Miller, who voted to fund the project. “And to my mind, if we’re willing to spend $900 million dollars … on a new jail, surely we should be willing to spend $7 million dollars … for better mental health services.”

The Centers, a nonprofit behavioral healthcare provider, will own and operate the facility. With the funding in place, it can start construction, President and CEO Eric Morse said. The Centers still needs to secure $6 million in tax credits and a small philanthropic donation to fully pay for the first two floors of the center. It is confident it will receive the tax credits. If it doesn’t, leaders previously told county council members the nonprofit could secure a loan or use other investments for construction costs.

Funding choice posed threats to agencies’ plans

At Tuesday’s meeting, both MetroHealth and The Centers described how their operations face threats due to funding challenges.

MetroHealth opened a 10-bed psychiatric emergency department in Cleveland Heights last year. Cuyahoga County invested $5 million in the facility. In a comment to county council, Dr. Christine Alexander-Rager, the health system president and CEO, said it would be forced to close the department if the ADAMHS Board approves the funding cut. She also worried that the two facilities would provide the same services.

“My reason for being here tonight is not to weigh in on whether or not a crisis center is needed,” Alexander told county council. “It is to recommend thoughtful planning for the full continuum of services and to recommend against cuts from the ADAMHS Board to our currently standing psychiatric ED.”

The Centers, meanwhile, said it must complete construction of the new crisis center by September 2026 because of strict federal funding rules. A chunk of the construction costs – $6.8 million – is being paid for with federal dollars. About $2 million of that has already been spent, according to Miller.

“If we don’t move forward, then the ADAMHS Board is going to have to repay the $2 million that has already been spent,” Miller said.

Several council members questioned why there was not more communication among MetroHealth, The Centers and the ADAMHS Board before Tuesday. Members encouraged the board and health care providers to improve their working relationships going forward.

Morse said he’s committed to that process.

“Whatever fragmentation happened during this process … I want to do whatever I can to rebuild it,” Morse said. “I want to work closely with Metro and all of our community partners. I think there’s a way that both of our systems can stay operating. I do not think it’s duplicative.”

In an emailed comment provided after the meeting, Alexander stressed that her testimony was not intended to oppose the crisis center but was a call for more thoughtful planning.

“Duplicating services without adequate resources isn’t just inefficient, it’s unsustainable,” she wrote.

MetroHealth isn’t the only behavioral health facility facing cuts from the ADAMHS Board. So is FrontLine Service Inc., which operates a crisis stabilization facility on the West Side. A staff member from FrontLine asked county officials Tuesday to delay the vote and gather more information about whether the new crisis center will be more efficient and effective.

Patient overlap for new and existing facilities

The new crisis center and the psychiatric emergency department in Cleveland Heights have some similarities.

For one, both centers can accept patients who volunteer to be assessed or admitted and those held involuntarily, many of whom may be brought by police officers. 

There are also differences.

“I think the biggest difference is that Metro will have the capacity to handle much more medically complex people than we can,” Morse said.

The new crisis center will be much larger than the Cleveland Heights psychiatric emergency department, which currently has 10 adult beds. The crisis center is expected to have 16 psychiatric residential beds — where patients can sleep and stay for seven to 10 days — as well as 10 beds for people detoxing from alcohol or drugs. It will also have 40 “chairs,” where people can stay for up to 23 hours.

Crisis center will need additional county investment

The Centers will ask Cuyahoga County to chip in more opioid settlement money to help pay to operate the crisis center in its first three years: $4 million in 2027, 2028 and 2029.

Council members have not yet voted on this operational funding. A spokesperson for Cuyahoga County Council said it is not yet known when that funding request will be made.

The opioid settlement dollars are onetime funds. Several members who voted against the crisis center funding Tuesday said they worry Cuyahoga County will be stuck supporting the new crisis center past three years.

Gallagher called that prospect “daunting.”

Morse, with The Centers, said it’s cheaper to admit patients into the crisis center than to treat them at a hospital’s emergency room. He’s hoping the center can show that it saves hospitals money in its first three years of operation, leading insurance companies or hospital systems to fund the program after that.

This story was updated to include a response from a spokesperson for Cuyahoga County Council on the timing of the $4 million vote.