Springfield City Council — November 18, 2024

0:05 I'm going to call the uh Springfield City Council work session to order with roll call Mayor Van Gordon here councelor Weber here councelor Mo here councelor rodley here councelor Blackwell here councelor Doyle here and councelor pisher here thank you we have one item tonight which is the Lane County behavioral health update and Council rodley I would like to declare potential conflict of interest as an employee of the counties more specifically of Health and Human Services thank you Corey all right Neil I think you're introducing the item and then we're going to have yes um so I'd like to introduce um and invite up Eve gray Lane County's director of Health and Human Services and Alicia Beamer um she's the chief administrative officer for peace health

0:51 also in the audience is Steve moer HEI um the County Administrator and staff um tonight you're the council will receive an overview of the public private uh partnership and collaboration that's uh working towards a vision for Lane County's work on Behavioral Health um we have you received a PowerPoint in your packet and we'll put that up right now for you if that works and I will turn it over to Alicia and Eve thank you the microphone's not on that is that on now perfect you passed the first test okay thank you welcome and thank you guys for coming thank you good evening I'm Alicia Beamer as he

1:39 shared I'm the chief administrator administrative officer at peace health srart River Bend I've been with peace health for 17 years uh prior to that I worked uh at Lane Council of government where I did Adult Protective Services investigating abuse and Ne neglect for seniors and people with disabilities here in Lane County for that entire time and I'm Eve gray director of Health and Human Services for Lane County I've been in this role for three years um but have worked in healthcare in Lane County since 2011 great well thank you well we look forward to talking to you tonight about a really exciting opportunity that we are really looking forward to Bringing

2:25 to our community and our neighbors and and our loved ones and so if we can go to the next slide oh it's me sorry I failed the next test that'll give me a chance to ask ask the question before you get started do you want us to hold our questions until you get through or do you want us to uh pepper you with them throughout the throughout the presentation we're comfortable with both okay fantastic thank you feel free to ask questions as we go along thank you so thank you so just to start out a bit that uh as you all know when we closed University District we made a commitment to this community to ensure that we had an impatient psychiatric uh

3:13 unit that stayed that we would preserve that service until we could identify another solution and so as we looked at what is that solution we looked at what are the needs in the community and we know that there's a need for uh adolescent psych uh adolescent psychiatric impatient psychiatric hospitalization and Care in this community at Riverbend for example we board up to four patients a week that are under the age of 18 four up to a week at a time until they can get care up in Portland for into an adolescent psychiatric facility we also know that there is a need for additional adult care P impatient care for adults uh we

4:00 are sending patients up to Portland for that level of care currently and today and uh and so there's there's truly a need for both our youth and our adolescents to receive inpatient psychiatric care here in this County and with that that looks at really what is uh what can we do that's beyond just those 35 beds that we have in our current unit that's at University District uh that we were able to preserve and keep there at University District when we closed univers when we closed the hospital and so we really are looking at okay what is the the longer term plan and strategy for that and uh

4:45 and looking at from a peace health perspective our vision is to have an impatient psychiatric hospital that we announced would be a 96 bed impatient Psychiatric Hospital in this community to fill that void for the Youth and Adolescent as well as our adults in need um and that would be a 96 bed hosp hospital that would have 24 adult or 24 youth beds as well and so we announced and we were very excited to announce that we would be pursuing a certificate of need for an impatient psychiatric hospital for 96 beds and we also looked at what are the needs for the community beyond that and what we evaluated I'm I

5:31 have the pleasure and honor also to sit on the steering committee for the crisis stabilization center for the Lane County Crisis stabilization Center and we looked at that we really looked at what are the crisis services in our community we know that one in five adults uh experience a mental illness in their lifetime and one in six adults uh or one in six children do so we know there's that impact as well and we also know that about on average individuals go for 11 years before they receive treatment for that their uh mental illness and so what what can we look at from the community from a broader Network and

6:16 service and as I've had the opportunity to serve on the crisis stabilization Center steering committee and learning more about that we've been looking at crisis Services we know that they need to work together and uh in larger systems to meet that need and that's evidence-based from the nation National evidence-based information as well as uh when we're looking at are is our current community meeting that need and some of those the test to determine is the need being met uh psychiatric boarding one of the ways that you know and to Mayor van Gordon's test like not passing the test would be psychiatric boarding in the

7:01 emergency department and just as I shared with you we're seeing quite a bit of that in our emergency department at Riverbend and what that does is it impacts the care for the community as a whole because individuals are coming they're sitting for up as I shared up to a week at a time which takes an emergency department bed away from other folks who are coming to our emergency department for care and for um and most importantly it means that those individuals are not receiving the right level of care in the right amount of time and they're not getting the treatment that they need in that moment there's also an over representation of people with mental illness and substance use disorders in our justice system

7:46 justice system and we hear a lot about that from a number of different Outlets but but we definitely see that and we see that even in our emergency department where individuals are being brought in to our emergency department from law enforcement because they are interacting with law enforcement because there's no other outlet for them to be served and then we have folks walking out of our emergency department and I can say even my own family have come to the emergency department for psychiatric care and because of the chaotic environment and distress of that environment have walked out because they don't feel that that's a healing environment for them to receive that care and so that those all of those three

8:32 items would say that we're not passing that test and that we can do better and as we from peace health looked at that really how could we have a model of care that would include both our 96 bed impatient psychiatric hospital as well as the crisis stabilization Center colocated to ensure that people have seamless transitions of care where they can go to the crisis stabilization Center rather than an emergency a emergency department and receive that care there and then if appropriate be on the same campus and go right over to our impatient psychiatric hospital and and so that's really where the vision came

9:18 from I will say that uh I I had I've had the honor and pleasure a number of years ago of serving on the junction city transportation system TR task force and the Planning Commission and I can only imagine like the the the work that you all do as far as what are you looking at looking out many many years ahead and uh so you know even with the transportation system task force it's very complex and detail oriented and we're looking out 30 years in advance on what what can can we plan for the community and from a peace health perspective that's really also what we're looking at is is what what can this service provide for the community in the years ahead I will say

10:05 from a person standpoint it is getting ahead of that um giving or really providing an opportunity for Youth and adolescen and adults to come to the crisis stabilization Center for and the first time receive the treatment they need instead of 11 years down the road when maybe things have fallen apart where it's too late and they can't get that service or they are interacting multiple times with law enforcement or other um uh devastating events may occur because we didn't get ahead of that so as we look at at the planning for the lives that we serve that is what this uh plan really will help help support and start to work on them as it gets

10:52 developed but also from a health care perspective as we look at it what is the vision for healthc care uh from a a peace health and an Enterprise perspective we look at from a a behavioral health and impatient Behavioral Health Care and it does not need to be part of an acute care hospital we do not currently provide that at University District it's uh across the river 7even miles away from Riverbend it's very successful in in running as a standalone uh hospital and that's really what it will be licensed as as a standalone Hospital uh operating on its own as a hospital without needing to be attached to riverband and then

11:39 with the the collocation of the crisis stabilization Center again it will help with that that throughput and and um support and sustainability of care for these individuals we also see that uh Behavioral Health although I know I've I've been asked a number of questions about the viability of Behavioral Health Services right now especially for impatient we've been running our impatient Behavioral Health Unit since 1969 we opened it I may be familiar with it being called the Johnson unit yep so and it was very Innovative at the time when we opened it uh The Sisters of St Joseph opened it really because it was filling a void and a need during that

12:26 time and again uh you know we have been able to sustain it very well over the years and uh develop really um be very we we have have transformed our services as the Acuity and the need has increased we are and and so this model of care really will help us as we continue to transform and Mental Health Services change hopefully for the better over the course of the next 30 40 years as we move forward uh and that's really that model as well so that that's our vision a long story I apologize for that but I'll turn over to Eve to talk really about the impatient uh or the the crisis

13:12 stabilization Center we may have one slide oh thank you I think we may have one slide on the rehab hospital did you speak to that as well so this is also uh as you all are familiar we did uh we received certificate of need and also Zoning for uh approval for an impatient rehab facility hospital that's going to be breaking ground here in early next year in 2025 and this the the facility that you see that's that's photographed in this slide is very similar to what you will see for the impatient psychiatric hospital that we're uh planning on building where it will again be a

13:59 standalone hospital that does not need to be attached to RiverBend um but it does uh provide and we're really excited that it will be providing Innovative uh state-of-the-art care for uh individuals who have experienced a traumatic brain injury a stroke or or um a cardiac event where they require significant uh Rehab Therapy and physical therapy and it will be one of the first trauma brain injury units in the state and we're really excited to be um moving ahead breaking ground and providing this service in our community here in Springfield so just wanted to um share that and also just how it also aligns with our impatient

14:45 Behavioral Health Hospital model thank you okay on to the stabilization Center um and I'll describe this model in a little more detail because it is a model that is becoming National best practice but it's newer and not as many folks are familiar with the model for a stabilization Center so the um the levels of care that are within a stabilization Center are all levels of care from the person who ran out of their anti-depressant and just needs a medication refill and it's after hours they can drop in to an individual who is

15:31 in Behavioral Health crisis this will have secure portions of the facility and be capable of handling um every single level of Acuity so uh the initial intake area for individuals who are walking in and much like um the the hospital system the people who walk in are not going to be as sick as the people who are transported in so um the front entrance will be utilized by common everyday all of us who sometimes have a day that we're having difficulty getting through or our kids are having a day where they're having trouble getting out of

16:16 bed because they just they have been depressed and they just can't take that next step or the the person the mother who just found out that her son was in a severe car accident and is now in the Intensive Care Unit down the road at Riverbend and doesn't know what that next step is to take you know those are the stories of the types of individuals who will utilize the walk-in services that are available within the Urgent Care setting it'll be everyone now just as the emergency department has an assessment when people walk in the door we will have an assessment when people walk in the door and identify if there does happen to be someone who is significantly sicker than the normal

17:02 person that we would expect to walk into uh a facility like this they can be very rapidly um treated and moved back to the secure area so that we are uh getting them treatment and uh and assuring that we have discharge planning for them uh this is unique compared to the emergency or crisis services that we have today today if an individual is in a Behavioral Health crisis their um their option really their only option voluntarily is to go to the emergency department where often they are not able to receive definitive care no fault of the emergency department it's just if you don't reach a certain level of sickness they can't keep you and there's

17:49 nowhere there there's no inpatient unit that will take you and so you get discharged without a psychiatric a full psychiatric evaluation necessary necessarily without treatment um without connection strong connection to resources that's what the stabilization Center will do for us and for our community is give that opportunity so that individuals come in and they're immediately treated by someone who is trained to treat the condition that they are presenting with we've got yes please sorry to interrupt you but it's a I think it's a good segue um you spoke of what you spoke of when there is contact with law enforcement and those

18:34 folks are showing up fre more frequently but I'm also interested in what you just said your secure area um you have plans I assume or your plans for people coming in on a PO or the um ones that are pre-trial like the old lcph and then you have how's that you're going to be working with the courts or the the Sheriff's Office who holds detainees on where's that integration because you know the capacity of the jail is not like it used to be either they have one housing unit's got nine cells for people with significantly mentally ill that's right so this going to expand on that or so this is this is a health care facility um though we will

19:22 be accepting law enforcement drop offs um so if law enforcement encounters someone out in the community and they believe that they have encountered this person primarily because they of a mental health or substance abuse disorder uh they will have the option of taking the individual to the stabilization Center and we will have a secure sally port there so that they'll go into a locked area they will um make the transition of the individual from law enforcement custody to the stabilization center staff and then they will drive away and um in other stabilization centers around the country that are operated by our contractor connections this drop off happens in about 5 minutes so that law enforcement

20:08 is back on the road right away and the individuals are getting treatment instead of going to jail for individuals who need to be charged they will still be going to jail so are you saying that they won't need a PO a po police officer hold uh they they can have be on a psychiatric hold at the stabilization Center so if someone meets the criteria for a um psychiatric hold we will be able to do that but just like any health care facility we will only be able to hold individuals who meet the definition for a hold under the civil commitment rules enter to s for others that's correct okay but but I I do appreciate where you're going with this counselor because the this model will reduce the

20:56 need for for police off officers holds is in theory right I mean one it will as you're having individuals who are coming into to the stabilization Center who may need may be interfacing with law enforcement multiple different times the opportunity with the stabilization Center that we don't have in our emergency department right now is that there they can stay they can get they can get stabilized and then they can get connected to services that are outside of of you know that setting whether that's housing or connections to to L County behavioral health or other services that we really cannot do in an emergency department so likely that

21:41 should reduce the number of interfaces with most dangerous to the public yeah on for Poes so that's my that's my biggest concern the other great thing about the model um that connections runs and one of the major reasons that we selected them as our provider is that other communities where they're operating they're identifying that about 60% of individuals who are brought in involuntarily are converting to voluntary care uh pretty rapidly when they come in and today those individuals are either being delivered to the emergency department and refusing care and then being discharged if they don't meet the criteria for a hold or they're going to jail um but this is a very

22:26 human- centered model it's a model where you're brought in and immediately a peer greets you um the in other communities the peers have the Handcuff keys and will actually say you know you're released you're safe here it's incredibly de-escalating for people one second yes hey thanks and if you if you're gonna get to this later please just tell me that but one of the biggest concerns I see in this type of model is um Staffing um you know we have a staffing and issues um and recruitment Across the Nation especially in the health care field and so you're talking about these people that are going to be needed there to help with that so how do we face that challenge and um and see

23:13 that that's staffed appropriately that is a huge challenge um and what I would say is that we are we are starting well we've been in task forces but we're starting more task forces on this some great things uh in our community uh we are increasing have increased access to the training of peers and in the stabilization Center model um peers are a big part of the Staffing model um uh the state of Oregon just approved for qhas qualified Mental Health Associates to be trained at community colleges and Lane Community College has agreed to be one of the pilot sites for doing that so we'll be able to increase the pipeline there for

23:59 qualified mental health professionals or the Master's level clinicians Lane County is getting ready to partner with United We heel um which is an apprenticeship program that uh is starting a qmhp apprenticeship so that there may be a pathway to become a qualified mental health professional that doesn't involve the Master's Degree route uh and we're looking at possibilities for accelerating Pathways there uh we are also looking very strongly ATS iatric residency programs there are a lot of barriers to starting residency programs but we have some active work happening in our community really peace health is a huge leader in that space so at all levels we have work that's happening and in nursing um there

24:44 is work to increase capacity and uh representative Nathanson uh Alicia and I just came from a meeting with her she just uh increased access to provisional lure for nurses to be able to come in from out of state and start working right away so there's lots of efforts happening all over the place we don't have a solid answer to your question um but I didn't want to make it seem like we're sitting on it um anything what no I thank you so much it's a really great question well and also just being able to take care of their mental health right I mean because I can imagine the burnout in that profession has got to be significant so we yes and and appreciate both of those comments we so peace is partnering we partner with LCC and

25:31 Bushnell really they they have been great Partners in building our nursing Workforce and we're graduating a 100 nurses a year out of LCC already and looking at an opportunity to expand that and then again through Partnerships with Bushnell graduating um I think a 20 SC it's more than that 24 nurses a year and then they're adding and and really making that more robust there so I think as Eve alluded we're on a number of task task force and with the three-year trajectory for when we open it really is looking at currently what is the workforce need down here in Lane County for this and then what what do we

26:16 need to do to to help grow and develop to be able to be ready to to open these facilities and to your point I really appreciate the sustaining ensuring that we're retaining IND individuals and recruiting so uh housing is always something that we're looking at and how we recruit into the area uh and and so that's certainly something as we we look at that that is one of our barriers that we're we're considering as well and then again Workforce the the burnout and and uh looking at how how do we help support our our our providers and caregivers nurses and everybody who provides care to these patients so thank you for for raising that and just so that everyone has a sense of the scale these two

27:01 facilities we're anticipating will employ between 300 and 400 people uh combined or separately combined yes um so how should I think about the stabilization Center um so it sounds like it sounds like it is it's count it's a County facility right is it more like an urgent care or is it more like an emergency room or some combination in between it's all of it so every every level of care that you would need for Behavioral Health will be um available and for all ages so we we at this point do not have a lower age limit for the stabilization Center the state might tell us that we need one so we are

27:48 holding that as a possibility um but all ages all levels of Acuity and the goal with a stabilization Center um this mod again other places in the nation has shown that 70% of people who would have needed inpatient care can be stabilized in a stabilization Center and we can keep folks first we will keep folks in an observation status that's for um 23 hours and 59 minutes if they can't stabilize within that period of time we will have beds for adults to go to kids will be in beds all the time whether they're an observation status or whether we're keep keeping them for a longer period of time and that's to accommodate the family and the privacy and the

28:33 support that a family needs because when you're caring for youth you're caring for their whole family um so we really wanted to be thoughtful about that uh so there will be uh the the observation unit there will be 16 beds in the adult uh unit for individuals who need to stay longer 16 is because there is a federal rule that says we can't have more than 16 it's not just because um that is all we necessarily could fill but having the inpatient unit right there is going to be so important because if we start to get overwhelmed we'll be able to transfer some folks over to the inpatient side uh who will be caring for folks at similar levels of Acuity and that Synergy um it will be really

29:18 important that's one of the really unique things it was hard for us to figure out how to get these facilities together because we needed 11 acres in the Metro area that was close to the acute care hospital and was um and had uh accessibility within 30 minutes for 90% of Lane County residents those were our criteria and so finding 11 acres in the metro area is really hard but um that's we are so fortunate that um that we're looking at the possibility of collocation here because of how those services will all work together um so any other questions about the services I've some pictures of stabilization centers too um that I can walk you through but would am happy to

30:03 answer any other service related questions I think we're ready for pictures okay let's do it so this is um our our contractor's newest facility connections opened the stabilization Center in Kirkland Washington and uh it is in a corporate office Park it's a former corporate office office for one of the big box stores I can't recall which one is the Big Box store but they still well um I think it may be a hardware anyway I I'll I'll get them here to tell you at some point but um the the corporate offices they kept actually a portion of their office space they leased the rest of it to

30:48 connections uh and there are multiple businesses that are all operating in the same office Park you'll notice from the outside you wouldn't know what it was if you didn't know what connections was and that is something they take pride in in all of their facilities uh and Alicia can certainly speak to when she toured the Tucson facility uh you wouldn't know from the outside what type of facility this was uh it's kept very quiet and very welcoming because we want for everyone in the community to feel like they want to feel safe going there uh here is just kind of the aerial mapping view of where that facility is in in Kirkland uh you can see a monasi school very in very close proximity and

31:33 actually closer than the monasi school is a daycare that is immediately adjacent to the facility um again really really important to maintain uh the the calm around the facility because these facilities are operating in Metro areas in very close proximity to schools and dayc carees and and other places where you really want to make sure that uh the environment is safe and welcoming here is a a picture of the Kirkland entry way this is the entry into their urgent care facility um so our uh architecture would likely be pretty similar to this there's a lot of thought that goes into um what what colors do we use that are

32:18 therapeutic that are calming what does the artwork look like that is therapeutic and calming um so there are there's tons of attention to detail because the environment that you bring someone into when they're in a Behavioral Health crisis is hugely important in that initial deescalation and opening up their um the possibilities for treatment um here is just a picture of the waiting area and the reception area in uh in the urgent care it's all connected to the remainder of the facility um but for anyone who doesn't require that higher level of care they'll just stay in the typical waiting room exam room type areas uh that you would expect in any Urgent Care

33:03 environment this is the 23-hour observation unit this unit is secure and you might think gosh for people who need a secure setting it's pretty wide open and it is but the cool thing is that they found that folks who are very highly escalated in Behavioral Health crisis when they're brought into an environment with other people who are experiencing similar things it is therapeutic for them to talk and to share stories and to learn about each other's coping mechanisms um there are rooms that they can take people off to if they need quiet time or they need time away um so all of that is built into the structure but this is how folks spend uh the majority of folks who come into the stabilization Center and need

33:49 to stay for longer than an Urgent Care visit will stay and receive definitive treatment in this unit this observation unit um so here's an example of of their Cal room uh I mean those blue that blue wall there it's a special textile wall That's intended for someone who just needs to ground themselves with texture on a wall you know that again this is the level of detail that um that they go into thinking about how do we create the most therapeutic environment possible for our community um and they also like to brag about how well they take care of their staff you know we will be employing almost 100 people in the stabilization Center itself and uh and so we have areas that are separate for staff that

34:35 have just as much attention to detail put into them uh in terms of really honoring the incredible work that the staff in these facilities do here is another one of the connections facilities in Harrisburg Pennsylvania um again another place where you just wouldn't know what what it is uh from the outside and another facility that is very close to parks and schools uh and is right in the middle of a metropolitan area as is true for the the Arizona facilities that connections operates so what are our next steps we've got uh we've got work to do all kinds of places I mean we've got to get these facilities built uh we need some

35:22 regulatory uh assistance from the Oregon Health Authority we're working very closely with them on that and there are funding conversations that we'll be having but um the really cool thing is that when we came out with an announcement of this partnership public private partnership and one of the largest Behavioral Health campuses in the state so much energy started to develop around this project to think about how do we get this done and how do we make it sustainable so we're really also excited about the size of this project has brought so much energy and momentum that we might not have gotten to if we were just trying to do this as a standalone Center and that um that's another part of our excitement so with that we can entertain any other

36:18 questions well you must have covered all all all of our questions so um yeah it so when I think about it as a campus one of the things you keep coming back to is that it's you know um wherever the provider is it's located in the essentially in the middle of everything right so is it a closed campus or is it or is there a lot of just foot traffic around um there is not there's foot traffic in that folks will be driving in or they might be walking in from the emx for Urgent Care Services or you know taking a lift or an Uber or something but um it is not a facility where people are going to be loitering and that is really important to us in terms of

37:03 creating a welcoming environment and also for our staff who are walking out to their cars and making sure that they feel safe because it's a 24-hour facility it is really really important that we maintain calm and quiet and that that folks move on to their next destination which was one point that I didn't make is that every person who leaves connections facilities is connected to that's why they call it connections that is um they're connected to that next level of care they're provided with Transportation also in order to get to their next destination um so and that is true for the impatient unit as well no one is discharged to the street everyone has a plan they have transportation they get to where that next destination is so we're not just

37:49 sending people out the door to find their way yeah and to add some context to that we're we see about 15 patients a day in our Riverbend emergency department that ideally would be better served in a crisis stabilization Center and approximately 50% of those individuals are brought in by mobile crisis or by law enforcement the remainder are primarily coming in through self Transportation so I think you said two interesting pieces to it so when I think about the broader sort of healthc care environment here um when this achieves total buildout we should think of it as sort of freeing up emergency room very much capacity so like some of the concerns that we've

38:34 heard broadly across our community about emergency room weight times this in theory would help relieve that yes this in theory will definitely help relieve that because we will one those 15 or even more individuals potentially could be going to the stabilization Center for that first encounter and visit so they won't be coming to the emergency department and we also will will not be boarding Youth and adolescents in our emergency department for days or weeks on end and so that opens up those beds for that throughput as well as adults that are boarding in our emergency department waiting for that care and I think my last question is um when you think about this is sort of a a down payment on the work that needs to

39:20 be done around Behavioral Health in this in in this community how far do you think we're off off the mark this isn't this is going to solve all our need but how much of our need is it a third is it a half let's get through the first stage and figure out where we're at we can answer probably some of that the um the state just did a study looking at the different types of um Behavioral Health beds that we need available to us this inpatient facility would fulfill is it 60 to 70% of the inpatient beds in the county that the state says they needed it's complex but yes it will it will uh serve a large portion of that for sure and in terms of residential

40:07 facilities we're a lot farther behind there so we will get the 16 secure residential beds that will put a dent in the need uh but the greater need for us is actually in the non-secure residential facilities particularly substance abuse uh treatment facilities and we are very far behind there uh it will actually probably be easier for us to come up with transition plans for individuals who come in with just a mental health condition those who need substance abuse treatment it is still going to be challenging to find that definitive care if they need a residential facility it's much easier if all they need is Outpatient Care well and I I would just add it I mean I I appreciate your your question mayor I

40:52 and it is such a complex question but I also think as we look at the VIS we don't know what the impacts of the pandemic were yet right especially on our kids that um were home during that pandemic and not in school and missing out on those things and then the adults as well and so as we look at yes currently right now there's a significant need in this community and in this state for residential beds but what this provides is immediate access to care which we do not have and that ability to get in front of an individual and get them the services they need right in that moment and to take advantage of that moment when they're there in a healing compassionate and Trauma informed way so that they do get

41:39 those services and resources and we're not continuing to grow this issue and epidemic instead so maybe to plant that seed and and look at it from that way as well and then the other pieces of the system that uh we have been starting that we have already started started mobile crisis um expansion for um for the count we are serving countywide now mobile crisis Services uh that meet the state requirements um and it's not 24 hours our County Services quite yet uh that is Staffing related so thank you for that question it's really really important um but we are expanding that capacity to go to where people are and

42:24 treat them so that they don't have to come to any facility um again getting further Upstream can we treat people before the biggest crisis of their life hits um that's the goal of mobile crisis it's the goal of the stabilization Center and the Urgent Care um because when people go and they're not treated and they're not treated and they're not treated that's when we see The Crisis happen on the street uh and then of course the deflection program which has started for individuals who uh are encountering law enforcement because of their possession of uh elic substances uh there is now an option to to divert folks in it's actually to deflect folks into a system without being arrested uh so law enforcement has

43:09 access to that resource now for um for folks who have primarily a substance abuse Challenge and would benefit from uh immediate access to treatment so these are it's all pieces of the puzzle that we're trying to put together to expand our capacity but you're right mayor Van Gordon none of these things in and of themselves are going to solve the problem we're in pretty deep uh after many many decades of disinvestment and Behavioral Health Victoria I'm just so grateful that we're having this conversation um that this is something that's finally being discussed and that we're finally looking at the potential for solutions for some of these people

43:54 um anyway I'm just I'm just really grateful that here and that you're telling us about this and that I really appreciate your vision thank you counselor all right well when when we came in I thought we were going to need 90 minutes but you guys got us from point A to point B very effectively really great to see you come over and just chat about things that are going on and share some more information I think it's really helpful the countyy is a great partner of Springfield and obviously peace health is somebody that's really important to this community as well so thank you so much for your time yes thank you very much you have a good evening with that we are adjourned thank you