Head of Park Center Discusses Challenges, Opportunities to Improve Mental Health Space
Amanda Bracht, the CEO of Park Center, a licensed nonprofit agency serving people with severe and persistent mental illness, substance use disorders, and homelessness, is known as an innovative leader in the mental health community in Nashville.
As a graduate student, she was unsure whether to focus on social work or become an attorney. After an internship with the Public Defender’s Office, Bracht credits social workers advocating for their clients and a special mentor the late Jeff Blum, whom she described as, “a fierce advocate for those who were often unhoused and ending up in the criminal justice system,” for ending up on her current career path.
“Seeing people who were fighting in those early days to give people a voice and to advocate for better care for folks who had mental illness, who are ending up in the criminal justice system just energized me and I was grateful to have those early mentors,” said Bracht, who started out with the Mental Health Cooperative (MHC) where she worked in total for more than 25 years prior to taking the helm at Park Center. She said she also had a three-year stint working for the Public Defender’s Office.
How do you define mental health and mental illness?
I look at mental health much like I look at physical health. Physical health refers to our physical body, fitness, nutrition and how well we take care of our physical presence. Mental health is our emotional, psychological and social well-being. It’s important to take care of both of those because I firmly believe that mental health impacts our physical health and vice versa.
And then I look at mental illness much like I look at physical illnesses. Mental illness is something that could be brought on by genetics; it could be brought on by trauma; it is something that is significantly impairing our brain function. It could be something as severe as an illness like schizophrenia or bipolar disorder where you need ongoing medication and ongoing treatment for that throughout your lifetime — much like somebody who is diagnosed with diabetes on the physical health side may need that ongoing treatment. Or it could be an illness that is an episodic illness that you’re suffering from depression because you’ve had an acute trauma or significant loss in your life and you go through counseling or medication, or a combination of those two, and your system has an opportunity to recover. You’re able to get the support you need, and then you no longer need that level of treatment. So, mental illness can have differing ranges of severity as well as different treatment throughout a person’s life.
What are some of the most significant changes you have seen over the years?
When I first started the thought of having mental health clinicians or agencies working hand in hand with people in the criminal justice community or in the public health sector was not really happening, it was just starting to happen. I remember doing trainings for attorneys and police officers, and we would talk about mental health, and they would look at me like, “I don’t have a clue what you’re talking about.” Now when I’ve had the pleasure of being in meetings or doing those trainings, they’re like, “I know what you’re talking about, and here’s my experience.”
Some of the biggest changes is this willingness to do innovative programs [like] mental health court. Nashville’s was one of the first ones in the country in the early 2000s. And so much has evolved from that — treatment courts and recovery courts have happened.
Looking at the outpatient world of mental health, the thinking now is not only about getting people medication who have a serious mental illness but also thinking about those other things that impact their care like housing and making sure they have good transportation. There’s much more willingness to look at the impact of those things on people who are in our mental health system.
Some of the innovations you were part of establishing the Behavioral Care Center at the Davidson County Sheriff’s Office; the Community Mental Health Systems Improvement (CMHSI) efforts led by the Metro Public Health Department; and the co-responder programs with Metro’s Police and Fire departments – Partners in Care and REACH.
Let’s go one by one to talk about how each program came about and what some of the biggest impacts are you have seen:
The Behavioral Care Center
What makes the BCC really innovative is that while it is under the Sheriff’s Office umbrella, it is a treatment program; and [Sheriff Daron Hall] was adamant that it is a licensed residential treatment center … designed by a team of mental health clinicians. While the behavioral health technicians are part of the Sheriff’s Office, they are seen as a member of the treatment team. They are not correctional officers. There is very robust programming, and the person is called a participant in the Behavioral Care Center. They’re no longer an inmate.
The thing that I’ve also seen with the BCC is true teamwork from the District Attorney to the treatment team to the defense attorneys. When they meet every week on staff cases, they’re all looking at it from the aspect of what’s best for this individual, and how can we safely get this individual the treatment they need so they can be productive citizens. They’re talking about things like housing, employment, how to get that person connected – those things do not happen in a traditional criminal justice program. But they do happen in residential programs, but there you don’t have the expertise of an attorney.
So having a true multidisciplinary approach is so innovative, and being able to give people care, get them transitioned back into the community without having to go back to court, and without having them to build up a lengthy criminal record that’s going to create more barriers from in the community, is something that I think that program has done exceptionally well.
CMHSI – Community Mental Health Systems Improvement
The Community Mental Health Systems Improvement (CMHSI) grew out of a meeting that started in 2016/17 when the [Metro Public] Health Department convened a group of leaders in the behavioral health and first responder communities in our city and asked them to identify their biggest pain point. All of those people came together, and we identified that our biggest pain point is that when a person is in crisis, it takes too long to get them the care they need, and it’s tying up all of these responders who don’t have expertise to be involved in it. So, the question was, what can we do collectively to improve that?
That group then decided to formalize into the Community Mental Health Systems Improvement [effort], and we started looking at data. That led us to seek funding for the Mental Health Co-op’s crisis treatment center [which was established out of that effort.] That’s a 24/7 place where officers can bring people and not have to wait with them while they’re getting a mental health assessment. Officers can bring individuals, hand them over to mental health professionals, and then get back on the street. It solved the problem of police manpower. It also solved the problem of people ending up in the wrong place to get treatment. And it got the individuals to the actual treatment teams who could do a rapid assessment and get them care.
o that was one of the first biggest wins for the Community Mental Health Systems Improvement. As a result of that, we decided to focus on other things. One issue that we’re currently focusing on is housing and the difficulty in funding supportive, affordable housing for folks with mental illness and/or substance use issues. We have another group that’s focused on early intervention for children and youth who have acute behavioral health needs, and how to get them treatment without extensive wait times in our emergency rooms or in juvenile detention.
So, CMHSI really started looking at how we can bring people together, identify a problem and then find solutions to that problem.
Partners in Care, which we have covered in our Jan-1 issue:
In Partners in Care, as illustrated in the earlier story [in The Contributor], a counselor, a mental health clinician, is paired with a Metro Police officer. They are riding together and go out to calls related to mental health that come through dispatch. That program is near and dear to my heart because we had to advocate for it at a time when it was not necessarily popular for mental health clinicians to pair with police officers. It was the summer of 2021 when we started the program.
But the issue as I had experienced it in my career. Law enforcement officers were getting these calls, and they were asking for help. “How can we do this better? Because we don’t want to use force. How can we get the person to treatment, but we don’t know because we’re not mental health clinicians.”
Thankfully we were able to get the support of Chief [John] Drake and his administration who agreed to pilot it in two precincts and see what happens. So, we have great partnerships between the Metro Police Department, the Health Department, and Mental Health Co-op.
The data piece was compelling from day one. It showed that there was a significant need. We were able to get people connected to care very quickly, had very few arrests as a result, and very few uses of force. It was so successful that officers in other precincts were asking for expansion. I believe wholeheartedly that that pilot demonstrated how this could work, and it’s now a citywide program.
REACH stands for Responders Engaged and Committed to Helping:
After the success of Partners in Care, the Fire Department was like, “Wait a minute. We also have mental health calls.” They started collecting data, too, on the number of times ambulances were responding to calls related to someone expressing suicidality. They were taking those calls and taking people to the ER in ambulances.
So, it is the same concept [as with Partners in Care]. If you pair a clinician with a paramedic, you don’t have to take a full ambulance, you can respond in an SUV or a van. Again, it started as a pilot to prove that there is a need first of all, then let’s look at the types of cases, and make sure we’re responding to the right cases and are providing the right level of care at the right time.
What role do you see yourself and Park Center play in these opportunities?
Park Center has been around for 40 years. And they’ve been the leading nonprofit organization that’s been providing that supportive housing, that I’ve just been speaking about, and employment services and dedicated homeless outreach for people with mental illness and substance use issues.
When I think about the housing piece that we do. We have over 132 housing units across our city. We need to grow that, and thankfully, we have plans to break ground on another permanent supportive housing project later this year. That will be in the Madison area. We call it Park Center North, and we’re excited that that will offer affordable, supportive housing for individuals and maybe couples who want to have an independent housing unit. We’re also looking at opportunities for families who need supportive services to break the cycle of homelessness by getting access to the proper mental health treatment, the proper physical health treatment, and those other supportive services that keep them engaged in their community.
One of the other things we do is specialize in supported employment. We have an individual placement and support team. That supported employment team is going to be critical as we look at keeping people in housing and having that source of income so that they can pay for their rent and other basic necessities that they have. And we continue to look at how to identify those people who qualify for Social Security benefits and get them connected with that.
Those supportive services that really look at integrating individuals into their community, being successful in their community, and thriving in their community, is the role that I see Park Center doing.
Anything else?
I would say one opportunity for our city is finding ways that the nonprofit community can collaborate more effectively with local government as well as state government. We all want to do things to improve our community, and I think we need to focus more on collaboration and not necessarily recreating something when there may be a service provider in our community that’s really good at that.