'Support for people in crisis': Henrico planning $14M detox and recovery center

With drug overdoses in Henrico County skyrocketing – already, Henrico Police have responded to more than 41% more overdoses this year than during all of last year, according to county data – Henrico County Manager John Vithoulkas is making what he has termed a “bold proposal” to address the issue.

Vithoulkas is proposing the county-funded creation and construction of a $14-million detox and recovery center in Eastern Henrico, to be managed by Henrico Area Mental Health and Developmental Services but ultimately operated in partnership with one or more non-governmental entities.

Henrico officials late last month posted a request for proposal to solicit bids for consulting services for the project, which are due by Dec. 1. Pending approval from the Henrico Board of Supervisors, they intend to allocate about $3 million during the current fiscal year to begin the planning and design process, then fund the remaining $11 million in the Fiscal Year 2021-22 budget, which begins July 1.

The center, which would be located near the county’s new Mental Health East facility and Eastern Henrico government center on Nine Mile Road, would be “a 24-hour, in-patient, medically supervised detoxification and recovery center” with an initial capacity of 12 to 16 beds, according to the RFP. It would be licensed by the Virginia Department of Behavioral Health and Developmental Services.

“The guts of the thing is support for people in crisis,” Vithoulkas told the Citizen Monday. “That could include people coming out of jail, it could include your neighbor. It’s trying to do as much as it can using the resources that we have in the community without creating something like a county hospital.”

Vithoulkas and county officials envision the facility as a touch-point through which those dealing with immediate needs can get the help they seek – regardless of which form that might take. Only one other Virginia locality (Fairfax County) has a similar facility, Vithoulkas said.

Vithoulkas anticipates that it will take about two years from start to finish to plan, design, build, staff and open the facility, once the county has signed a contract with a consultant in January or February. It’s seeking a partner who would provide consulting services through the first year of the facility’s operation, with the possibility of a second year of those services, as well, according to the RFP.

Ultimately, though, Vithoulkas expects it to become another in a growing list of public-private partnership projects in the county, akin to those in place with First Tee of Greater Richmond at Belmont Golf Course; the YMCA of Greater Richmond at the Frank J. Thornton YMCA Aquatic Center on Laburnum Avenue; NOVA Aquatics of Virginia and Thalhimer at a planned aquatics center at Regency Square; and The Rebkee Company for the county’s planned indoor arena and convocation center at Virginia Center Commons.

In each case, the county has funded the construction or renovation work and retained ownership of the properties but the partners are tasked with operating the facilities on a day-to-day basis (while also keeping profits), thereby eliminating ongoing financial obligations for the county.

“The more partners we have [for the recovery center], the better,” Vithoulkas said.

Idea stemmed from 'Recovery Roundtable' task force

The idea for a county-owned recovery center resulted from the work of Henrico’s Recovery Roundtable, a task force composed of various public and private officials from a variety of related fields (including prevention, recovery, substance abuse and criminal justice) that formed about 18 months ago and met about nine times.

It offered eight final recommendations in a 196-page report issued in February, including the creation of such a short-term detox facility.

“Henrico County could more effectively ensure public health and safety by implementing a comprehensive, cohesive, and sustainable strategy to prevent and treat SUDs [substance abuse disorders],” its members wrote.

In addition to recommending a detox and recovery center, the task force also suggested:

• more investments in evidence-based prevention programs;
• more comprehensive outpatient substance-use treatment programs with access to related services;
• expansion of risk-based community outreach programs;
• the establishment of contracts with recovery residences and financial help for people who seek admission to them;
• outsourcing of drug-testing services
• efforts to reduce “failure to appeal” cases in the court system;
• expanded substance-use diversion and treatment programs within the jails;

Several of those recommendations already have taken shape; the latter may be the most significant shift in the county’s efforts to treat substance-abuse to date.

The task force concluded that the county’s criminal justice system was struggling to keep up with criminal activity and recidivism that resulted from untreated substance abuse disorders. That was not a surprise to county officials, who for years had been concerned about Henrico’s two jails nearing functional capacity.

Former Sheriff Mike Wade, who years ago implemented a highly successful recovery program in the jails known as RISE (Recovery In a Secure Environment), had suggested that a third jail might be necessary just to house inmates with substance-use issues.

But the cost – perhaps approaching $100 million – was a major roadblock. Officials then began to contemplate related ways to service those with such issues, which in turn helped lead to the creation of the task force, which was chaired by Three Chopt District Supervisor Tommy Branin and Varina District Supervisor Tyrone Nelson.

“The group agreed that this is probably the best option,” Nelson said of the recovery center. “A lot of people committing crimes are committing crimes because of their habits. If you begin to focus on the person instead of just the discipline, we can help the person and then help the community.”

Since taking office earlier this year, new Henrico Sheriff Alisa Gregory has diverted about 1,000 inmates with drug dependency or mental health issues from the county’s two jails to rehabilitation programs, reducing what had been a crowded jail to its lowest level in about 15 years earlier this year (just more than 1,100 at the time).

Only non-violent inmates with abuse issues are eligible, and in addition to their approval, such diversion efforts also require approval from a group of county agencies – including a judge, Commonwealth’s Attorney’s Office, Sheriff’s Office, and Mental Health officials.

County agencies also have begun working on ways to increase outreach through schools and other community groups in an attempt to prevent substance-abuse in youngsters before it starts.

Challenges of treating those in need

Henrico Police this year have responded to more than 410 overdoses – already one more than they did in all of 2017, 59 more than in 2018 and about 120 more than last year, according to county data.

And those numbers, Vithoulkas reported in an Oct. 29 letter to Henrico’s Board of Supervisors, “understate the full problem because many overdoses are not reported,” he wrote. “In recent years there have been more deaths in Henrico from overdoses than from car accidents, homicides, or suicides – and this trend will be true again in 2020.”

The Office of the Chief Medical Examiner of Virginia reports that 36 people died of drug overdoses in Henrico during the first six months of 2020, seven more than during the first half of last year (which concluded with 74 such deaths).

Opioids continue to be responsible for more fatal incidents in Henrico than any other drugs, but alcohol and cocaine also are creating significant issues in the county, Henrico Area Mental Health Clinical and Prevention Division Manager Daniel Rigsby told the Citizen. Of those who come to the county for help, about an equal number have abuse issues with opioids as with alcohol, he said. Cocaine and marijuana disorders register at the next rung down on the list.

The county’s overdose numbers this year present a particular challenge for county officials, according to Rigsby.

“One of the things we’re concerned about is that even though we recognize overdoses have gone up since the beginning of the pandemic, our requests for services have not,” he said. “So there’s some gap that we’re aware of between the need and our ability to meet the need.”

Some of those in need likely are connecting with private recovery groups, he said, but others may not be. The nature of substance-abuse disorders is that a desire for recovery can be fleeting, Rigsby said.

“The concern that we have is that for people with substance abuse disorder, when they’re ready for treatment, they’re ready for treatment. But that can change kind of quickly,” he said. “So, ‘Tonight I feel really bad and I’m ready to do something about how I’m feeling, and I want to get better,’ [but] if you tell the person, ‘Great, but you’re going to have to wait til Tuesday to start the process,’ chances are they’re not going to be able to make it to Tuesday.”

A major roadblock for those who need immediate help – and for the agencies that want to help them – is availability of services and associated costs.

“It is very hard to get someone into detox immediately, especially if you don’t have insurance,” Rigsby said.

Several local private detox centers that treat people with alcohol-abuse issues charge between $2,000 and $5,000 for their services, he said. And there are only a few detox beds available through the Richmond Behavioral Health Authority, which serves the metro Richmond region.

Earlier this year, the county received about $54,000 in funding through Virginia’s State Opioid Response Grant, which it’s using to fund short-term stays at recovery or detox facilities for citizens who couldn’t afford them otherwise. That funding expires next September but additional funding is possible in the coming fiscal year.

But the proposed county detox and recovery facility would treat people regardless of their insurance situation, Rigsby said. The intent would be to accept primarily, or only, Henrico citizens, but officials haven’t discussed exact details yet, he said.

During the pandemic, Rigsby’s office has adjusted some of its efforts; it now trains people virtually and by telephone about how to respond to opioid overdoses. And Henrico Police officers are referring citizens who may need services to the agency, which also send officials out on calls with police sometimes, Rigsby said.

Both data and anecdotal evidence points to the fact that – particularly as the pandemic continues – the substance-abuse problem in Henrico is deepening, Brookland District Supervisor Dan Schmitt told the Citizen.

“There’s folks who may not realize there’s an issue [with substance abuse],” he said, “but let’s face it. . . it’s something that’s prevalent in our society. It’s not going away.”