In South Dakota, a mental health triage center takes pressure off jails and ERs. Could it work in Lafayette?

A glass door emblazoned with the logo of The Link.
The Link mental health triage center is located inside a city-owned property in downtown Sioux Falls, SD, July 16, 2023.

Halfway through former tech entrepreneur Paul TenHaken’s first term as mayor of Sioux Falls, South Dakota, the coronavirus pandemic hit, and with it came a slew of challenges the young mayor hadn’t anticipated.

One was the lingering mental health effects. “The pandemic changed people,” TenHaken said. Suicides began to increase, he noted. Alcohol abuse, long a problem for the Great Plains town, was visibly tearing at the community’s fringes. “There’s a lot of people who cope with mental health issues through substances,” TenHaken observed.

With partners from the medical field, law enforcement and social services, the city, under TenHaken’s leadership, convened a working group that came up with a plan for helping people cope differently and break the cycles of addiction and mental health struggles.

“They were presenting to our ERs or they were detoxed and sobering up in our jail,” he said, taking up spaces that could be used more effectively. That system wasn’t serving its subjects well either, he added. “Just putting them in the jail, sobering them up and putting them back on the street was not doing anything.”

In 2021, after more than a year of convening, planning and negotiating, The Link, a mental health triage center opened on a city-owned campus in downtown Sioux Falls.

There were plenty of hurdles that had to be cleared to get there — and plenty that remain — but recently the center celebrated 10,000 service encounters.

“It was a bit of a sales job,” TenHaken admits.

Getting the region’s two major hospital systems, which operate as competitors, to collaborate was part of that difficult pitch. In the end, both agreed to contribute an equal amount of funds — $400,000 each per year — to get the project going.

Finding a location that wouldn’t prompt public outcry was another challenge. “Everyone knows we need it, nobody wants it next to them,” said Tenhaken, describing a sentiment all too familiar to many who have tried to open facilities for homeless or mental health services in cities and towns across the country.

Eventually, the group settled on a city-owned plot in downtown Sioux Falls, close to existing services, such as homeless shelters and a soup kitchen.

Nearly three years and 10,000 client visits later, some of the concept’s limitations have become apparent. While initially envisioned as a mental health triage center, The Link has functioned much more as a sobering and detox facility.

In Sioux Falls, much of the community’s substance abuse issues stem from alcohol. Diverting publicly intoxicated people from the jail to the new center has allowed more opportunities to connect them to services and has freed up space and time in the correctional system.

“It’s not very therapeutic to go to jail,” said Lt. Jason Leach, who has been representing the Sioux Falls Police Department throughout this process, attending conferences and visiting mental health triage centers across the country to learn about best practices.

Data suggests that the opening of the triage center has shown results. In 2020, the year before The Link opened, there were 221 bookings for 48-hour protective custody, involuntary commitments for alcohol or drugs and five-day emergency commitments at the local jail, all bookings relevant to the services the center provides, local publication Sioux Falls Live reported. In 2022, there were 13.

As for the mental health portion of things, however, “it never really took off,” Leach said.

A woman stands inside a room with a large frosted window and a single bed.
Kat Cedeño Torres, nurse manager of the The Link at the time, is pictured in one of the facility’s individual treatment rooms on July 16, 2023.

This might be, in part, because there are other resources available in the community that are better suited to deal with the broad spectrum of mental health issues beyond substance abuse, noted Phyllis Arends. Arends served as the executive director for National Alliance on Mental Illness’s Sioux Falls chapter during the visioning process for The Link and now runs her own mental health service in town.

“The triage center is a huge, huge thing in our community,” Arends said. “That took a lot of people who all had pieces of the mental health pie to come together and say: You know what, we’re going to put our little turf wars aside and make this work.”

A collaboration between the city, the county and the two largest hospital systems, The Link is just one patch in a quilt of mental health resources in and around Sioux Falls.

There is a mobile crisis response team those in crisis or their loved ones can call on to get help.

This concept is one the state of Louisiana has been trying to deploy since early last year, with limited results. The provider selected for Acadiana ceased operations in the fall and the Louisiana Department of Health has yet to announce a successor. Plans to develop a local system have led to roundtable discussions among providers, but have not produced a coordinated response yet.

Then there’s Sioux Falls’ community mental health center, which is operated by a nonprofit and offers a variety of mental health services, including counseling, to residents of all age groups. The community mental health center system was established by the Community Mental Health Act of 1963 to establish a system of community-based care instead of institutional care.

In Acadiana, the Acadiana Area Human Services District serves as the operator of the local community mental health center. The district recently became the first organization ever to be accredited as a Certified Community Behavioral Health Clinic by CARF International, which surveys and certifies the quality and availability of mental health services provided by the organizations it accredits.

CCBHCs are required to serve anyone who requests care for mental health or substance use – regardless of their ability to pay, place of residence, or age – and to deliver crisis services that are available 24 hours a day, 7 days a week.

The district has been running its “Same Day Access” program since receiving accreditation in December and has placed 600 patients in care since then, according to AAHSD Executive Director Brad Farmer.

The Sioux Falls Police Department has also experimented with a co-response program for mental health-related calls, a concept that has gained traction in Lafayette as well.

In Sioux Falls, a dedicated unit consisting of a police officer and a mental health professional respond to those calls during the summer, when more officers are available while school isn’t in session.

“We really found value in that project,” Leach said. The department is hoping to run the program year-round as soon as funding and staffing allows. In the meantime, specially-trained officers make mental rounds once a week to check in on repeat callers and connect or re-connect them to services if necessary, taking some pressure off regular patrol officers.

“The officers on the street really appreciate that,” Leach said.

A sign for The Link hangs on a brick facade.
The facade of The Link in downtown Sioux Falls on July 13, 2023.

In Lafayette, both the sheriff’s office and the police department have recently launched similar efforts.

While The Link might not have fulfilled its entire mandate as of yet, it has added another resource to the community that can help curb the downstream effects of mental health issues and substance abuse.

“As a community, you have to say: I know this is not going to fix the problem, but it’s one other thing we can do,” TenHaken said. “Everybody wants to hit home runs on these issues and there’s no home runs to be hit. It’s just a series of small wins.”

Now, the challenge is to keep the center going. As with many efforts of this kind, funding and staffing have been challenges. In total, the partners pooled more than $4.9 million in cash and $534,616 in-kind support for The Link to fund the pilot project through its first two years.

To maintain services will take continued public and private investment, TenHaken said. “It’s going to cost money moving forward, it’s never going to pay for itself,” he noted. “But it’s a service the community needs.”