Inebriate Center An Outreach Point

August 9, 2002
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GRAND RAPIDS — With the dedication of its Public Inebriate Center on Aug. 21, Mel Trotter Ministries goes back to its roots.

The new center will minister to the “hardest cases” — the intoxicated individuals that pass out on the street and are typically taken to a hospital emergency room for tests and observation.

“The issue is there are those who get so drunk that they essentially fall down and can’t get back up,” said Rev. Thomas Laymon, executive director of Mel Trotter Ministries.

What they need is just a safe place to sleep it off.

The whole idea is to look out for their safety, said Sandra Enders, development assistant for Mel Trotter. The police have already started bringing a few people into the center.

“Because we have medical staff here, they’re not in danger. We watch over them until they become stable again.

“Once they get coherent, we like to help them with recovery because that’s what we do; we’re a licensed substance abuse treatment center.”

It’s set up as a non-judgmental program in that treatment isn’t forced on individuals, but they are made aware of treatment that’s available for the asking.

A public inebriate center provides humane treatment for individuals who don’t belong in a hospital, or who don’t belong in a detox facility because they don’t want treatment, explained Ross Buitendorp, Kent County Community Mental Health’s contract manager for the Inebriate Center.

Start up of the new inebriate center at the mission, located at 225 Commerce SW, is being funded with $60,000 from Kent County Community Mental Health’s budget, a collective $95,000 from Saint Mary’s Mercy Medical Center, Spectrum Health and Metropolitan Hospital, and $15,000 from the Downtown Improvement District.

Those contributions will cover most of the first year of operation and community fund raising is expected to cover the center’s continuing operations. Laymon estimated the annual cost of running the center at $200,000 a year.

Saint Mary’s has already expressed willingness to help beyond the first year, he said.

Mel Trotter has to have at least one staffer — a registered nurse, a paramedic or emergency medical technician — on duty around-the-clock in order to maintain the center, which can receive anywhere from five to 50 people at any time.

For liability reasons, ambulance services dispatched to “man downs” can only drop off a person at a medical site where there is a doctor or an emergency medical technician, which — up until now — meant a hospital.

Laymon believes the program will affect the downtown area in a couple of ways.

“An impact will certainly be made on those individuals out on the street at night in danger of dying, particularly in the colder weather,” he said.

It’s going to impact hospital emergency rooms as well.

Public drunkenness was decriminalized years ago, and the protocol became that when a “man down” was reported, the person was picked up by police or ambulance attendants and taken to a hospital emergency room where they stayed until they were sober enough to walk out, Laymon observed.

“That’s been the case, so those individuals have not been coming to us for a good long time now.”

Dr. Jeffrey Jones, staff physician with Spectrum Health Butterworth’s emergency department, said those individuals take up beds, nursing time and physician time that can be spent treating other people.

“Sometimes they’re abusive,” he said. “Instead of just keeping them here until they sober up again, Mel Trotter has a chance to try to get them into alcohol rehab and treatment centers.”

Laymon said ambulance services also will be affected in that they will be able to deal more quickly with the issue of whether to take a person to a hospital or the center.

Ambulance attendants and police officers are going to be able to pick them up, drop them off quickly and be on their way, he added.

“This is important to the community on a number of levels. These individuals oftentimes do die from exposure,” Laymon said. “These are the toughest individuals to turn around. If we can take a more concerted, focused approach like we’re taking here, then we can possibly turn around a few more of them.

“The other side of it is that we’re a growing community and this is going to be a growing problem like it is in most larger cities. So it’s important for the city to put in place efforts to solve the problem now.”

On any given night, three to six individuals are taken to local hospitals in that condition, while many times that number of individuals are publicly intoxicated but still mobile, said Lody Zwarensteyn, president of the Alliance for Health.

He said as it is now, the system “medicalizes” the problem by taking the person to the most expensive place possible and making a patient out of him.

For liability reasons, emergency room staff must examine and run tests on those individuals, and the hospitals usually have to absorb those costs because most often the individuals don’t have insurance.

Zwarensteyn estimates the hospital ends up absorbing — at cost — about $200 per person.

A study done in 1992 showed that Butterworth Hospital (now Spectrum Health) alone racked up $128,500 that year in emergency room charges for public inebriates, of which $92,700 had to be written off, Jones said.

At the time, the average charge per inebriate was $344, with charges ranging from $31 to $900.

Because of the lack-of-insurance issue, the ambulance services, too, typically end up writing off about 90 percent of the costs associated with that, Zwarensteyn said.

The whole system works against the best interests of the patients and the public, he said, and the purpose of the center is to move away from that.

“This is a community problem. Neither mental health, nor public health, nor the hospitals or substance abuse agencies or anybody — solely — can take this on. It’s not a single agency problem. And the problem does not stop with the inebriate.”

According to Zwarensteyn, the real target is to look at ways of finding and referring into care people with dual substance abuse and mental problems, the most difficult to reach individuals of all.

In that respect, the Public Inebriate Center is a first step in a longer game plan, he said.

The Public Inebriate Center has been a long time coming, so people like Laymon, Zwarensteyn, Buitendorp and Jones, among others, are pretty excited about it.

In late 1994, the Kent County Health Department and Kent County Community Mental Health (CMH) Services separately approached the Alliance for Health to undertake a community-wide study of the problems faced by public inebriates, as well as by those diagnosed with mental illness and substance abuse problems.

A study completed by the Alliance in June 1997 identified gaps in services and looked at how those individuals, as well as the hospital system, could be helped with substitute detoxification facilities.

Once it was decided how an inebriate center could be structured, Mel Trotter Ministries volunteered to take it on, Zwarensteyn recalled. Then it was a matter of finding the resources.

Kent Emergency Medical Services developed a protocol that ambulance and public safety personnel would follow to determine when a person would be eligible to be dropped off at a “non-medical” site, such as Mel Trotter.

“The next step we’re working on right now is the means to allow the state to help with Medicaid and reimburse the ambulances,” Zwarensteyn said.

If Medicaid can help pay for runs to a non-medical site, that would remove what little financial incentive ambulance attendants have now to deliver the inebriate to the ER in hopes that he might have some insurance.

The Medicaid program has indicated willingness to help in that regard, Zwarensteyn said.

As evidenced by the money raised thus far, he believes the community will continue to show its support with ongoing funding.

“With evaluation and experience, we’re pretty confident the program is going to prove itself in future years,” he remarked. “This is a win-win situation all around. We’re very grateful to Mel Trotter.”

Other shelters around the country aren’t doing this, he pointed out, so Mel Trotter Ministries could serve as a model for other communities.  

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