by CHRIS ROGERS
Minnesota’s mental health care system is not broken. It was never built. That is how the president of Minnesota’s chapter of the National Alliance on Mental Illness (NAMI), Sue Abderholden, describes mental health care in the North Star State. Winona area criminal justice leaders, mental health care professionals, social service providers, and elected officials also described Minnesota’s mental health care system as overloaded. Winona County citizens often wait for weeks or months to get mental health care treatment and wind up in local jails and emergency rooms in the meantime, exacerbating citizens’ illnesses and draining local budgets, they said. The good news: these problems are not being ignored.
This summer, Minnesota Governor Mark Dayton appointed a task force on mental health to diagnose the problems with the state’s mental health care system and recommend solutions. The diverse group recently released a draft set of recommendations; the final version is due next month. Its recommendations run the full gambit from prevention and improved emergency mental health care to recruiting more psychiatrists and providing stable housing for people with mental illness. It will be largely up to the governor and the legislature to decide whether and how to implement the recommendations.
“This task force, I think, was very needed,” Winona County Board Chair Marie Kovecsi said. “The state of the mental health care system — most people say there is no system. It just kind of happens if you’re in the right spot at the right time.” Kovecsi attended a task force meeting in Rochester last week. She has spent the last year working with Winona County’s Criminal Justice Coordinating Council (CJCC) on its efforts to steer citizens away from unnecessary incarceration as a result of mental illness and toward actual treatment and works with the county’s community services department on its efforts to respond to mental health care needs in Winona County. “We’re trying to do the best we can with very, very inadequate resources,” she stated.
The task force’s long list of recommendations includes calls to ensure that there is a “continuum of care” in Minnesota’s health care system — that a full spectrum of services is available to treat the full range of types, severities, and stages of mental illness. At a recent meeting, Winona County Community Services Director Beth Wilms spoke about one current gap. When the county can manage to get a citizen a spot at one of the state’s psychiatric hospitals that is prepared to treat severe mental illness and aggressive behavior, getting those citizens out of those hospitals can be hard because even when the citizens are ready, there often are not any spaces available at less-intensive, step-down facilities, she said. As result, the county winds up paying thousands of dollars to keep citizens at a high-intensity treatment center they do not want or need to be in, she stated.
Another major problem CJCC members and local mental health care providers have focused on: the lack of psychiatrists who can prescribe medication to treat mental illness. At a meeting last year, former Winona-area public defender, now judge Carmaine Sturino talked about a young man she represented who committed suicide while waiting to see a psychiatrist. The task force urged state leaders to act on a set of recommendations in the 2015 “Mental Health Workforce Plan for Minnesota.” It lays out plans for growing the pool of mental health care professionals by expanding education programs, offering loan forgiveness to mental health care workers in high-need areas, and providing better compensation for mental health care work, among other recommendations.
Homelessness is another major problem the task force and CJCC members pointed to. It is hard for people to recover from mental illness amid the stress of being homeless, task force members wrote. They called on state leaders to act on the Interagency Council on Homelessness’ existing set of recommendations and to support a variety of programs to help house people across a spectrum of less-severe to more-severe mental illnesses. One such program, called “permanent supportive housing,” pairs affordable housing with in-home mental health programs. The task force also recommended expanding the number of Intensive Residential Treatment Services (IRTS) facilities for people with more severe mental illness.
When it sought input from professionals and citizens, the task force received more comments on the lack of beds at inpatient psychiatric hospitals than any other issue. The task force’s draft recommendations do not go so far as to say that the state needs more hospital beds for severe mental illness. They recommend expanding IRTS facilities and other housing programs as alternatives to hospitalization and establishing a group that would study further whether more beds are needed. “It’s looking at both how to decrease that bottleneck by building up the continuum of care outside that [hospital] setting … and the recommendations do touch on, potentially, increasing the inpatient bed capacity,” said Minnesota Assistant Commissioner of Human Services Claire Wilson.
Better mental illness prevention and public health campaigns to promote mental health and reduce stigma and shame are a big part of the task force’s recommendations. “The stigma is huge,” said the head of Winona’s NAMI chapter, Helen Newell. “If someone is diagnosed with diabetes, their friends are right there helping them with treatment, but if someone has mental illness … people tend to not know what to say, and so they say nothing.”
The task force group also recommended efforts to better serve communities that disproportionately suffer from mental illness — including lesbian-gay-bisexual-transexual-queer people, Native Americans, and refugees — and to better understand why the current mental health care system may be failing them.
Many of the recommendations would cost money. The task force did not get into specifics on funding, but it spent a lot of time talking about enforcing requirements for health insurance to cover mental health care in the same way it covers physical health care — also known as mental health parity — and ensuring that health insurance covers programs such as IRTS. If health insurance programs start paying more for these programs, will it drive up private health insurance premiums and the cost of government-run insurance? Wilson said that many of these programs are already covered by government insurance programs, but that she could not comment beyond that. Newell said that by proactively addressing mental illness and helping people recover instead of sending them to emergency rooms that do not solve their problems, a functional mental health system would save society money. “If those needs are met with community services, often it keeps people out of the hospital,” she said. “Go to the emergency rooms; you don’t get out of there for less than $1,000.” In addition to being the law, enforcing mental health parity is the right thing to do, she added. “It’s a physical illness. It just happens to be the illness in our brain instead of in our digestive system or any other type of physical disability, and yes, it needs to be covered by insurance,” she stated.
Will these recommendations be implemented? “That’s a great question,” Wilson said. “These discussions are going to continue at the task force level. It will become a conversation with the governor and the legislature about how these move forward,” she added.
“I think there’s enough public will to not let it completely drop,” Kovecsi said. She was encouraged by the fact that care providers, state agencies, local officials, and mental health advocates all seemed to be on board, but she and Abderholden had some concerns about where the responsibility lies for following through on the recommendations. “If there’s no follow-up to this set of recommendations, I don’t want it to be just another investigation or analysis that sits on the shelf,” Kovecsi stated.
Abderholden said NAMI would be working hard with lawmakers to enact the recommendations and that legislators have already taken many important steps. “There is no one thing we have to do to build our system,” she said. “We have to do multiple things.”