by CHRIS ROGERS
It is National Alliance on Mental Illness (NAMI) Minnesota President Sue Abderholden’s mantra: Minnesota’s mental health system isn’t broken; it was never built. In Winona County and across Minnesota, there has been a growing recognition about how counterproductive responses to mental illness and lack of access to real mental health care hurts people and burdens local institutions, from law enforcement to social services. So in 2018, what is Minnesota going to do to build its mental health care system?
Last week, the Winona County Board endorsed one potential answer to this question: a proposal from the Association of Minnesota Counties (AMC) for a mental health bonding bill in this spring’s legislative session. The Minnesota Legislature will convene later next month, and many lawmakers expect to pass some kind of bonding bill — a big loan the state will take out to fund investments in buildings and equipment across the state. AMC, a lobbying group that represents all of Minnesota’s 87 counties, has proposed that the state include funding for mental health facilities in its 2018 borrowing package.
AMC proposed funding for two types of facilities: first, funding for supportive housing for people with mental health issues and second, funding for “regional triage centers.” Hiawatha Valley Mental Health Center’s Hiawatha Bluffs Living is one example of supportive housing. The Winona apartment building has in-house mental health care professionals that help residents with daily living skills. That facility serves a permanent or long-term housing option for people with serious mental illness. The AMC proposal is aimed more at providing half-way houses for people coming out of intensive in-patient care at one of the state’s major mental health hospitals in Anoka. Counties from across the state send patients there, but a lack of options for helping discharged patients transition back to community life limits the hospital's ability to discharge patients in a timely way, which in turn exacerbates the hospital’s shortage of space for accepting new, incoming patients, according to county officials. That inability to discharge patients quickly affects counties' bottom line because they have to pay for a higher level of care for longer. AMC says that more supportive housing options would help relieve that pressure, resulting in better outcomes for patients and taxpayers.
AMC’s definition of what it means by “regional triage centers” is admittedly open-ended. “The vision for what those are is still being developed,” AMC Executive Director Anne Kilzer said. There are a variety of ideas for how they could work, she explained. It likely involves in-patient care and serving as a treatment center for mental health crises, Kilzer added. “The triage center approach would reduce the number of people in mental health crisis that are brought to the jail as a last resort,” AMC’s policy white paper states.
Officially, NAMI has a neutral position on AMC’s proposal. Abderholden’s organization represents mental health patients, people with mental illness, and their families. She explained, “We strongly support supportive housing. We think that’s really important. We have been — traditionally NAMI has been opposed to triage centers, central receiving centers, et cetera.” That kind of treatment model might make it easy for law enforcement, emergency rooms, and social services to have somewhere to send people who are having a mental health crisis, but it is not a very good model for patients, she stated. When designing a mental health system, Minnesotans should think about what the patients need, not just what government needs, and Minnesotans ought to incorporate mental health care into the health care system, not create a separate system, she stated.
Earlier this month, Governor Mark Dayton proposed a $1.5-billion bonding bill. It included one mental-health item: $5.8 million for renovations at Anoka Metro Regional Treatment Center. Asked for NAMI’s stance on that proposal, Abderholden said, “It’s not anything huge. It’s nothing that’s really going to help build our mental health system.”
Both Dayton and AMC’s proposals focus on infrastructure. By definition bonding bills provide funding for capital investments — buildings and equipment — while state budget bills provide funding for programs, services, and staff. Is infrastructure the mental health system’s main need? It is a need, Kilzer said. Obviously, there needs to be more funding for services, staff, programs, and better reimbursements for care providers. However, she said, “This is a bonding bill year.” Typically, the state government passes budgets in odd-numbered years and bonding bills in even-numbered years, though it is possible for the legislature to pass supplemental budgets during even-numbered years. “We identified bed space as a primary critical need because we just simply do not have places for people to go,” Kilzer explained. Right now, Kilzer said counties have the resources to staff the sort of projects AMC is hoping would be funded in this bonding package, but in the long run there needs to be more funding for staff, too. “Both are needed. A building without services is not going to get us anywhere,” she stated.
Asked if infrastructure funding is the mental health care system’s main need, Abderholden said, “Oh, God, no.” NAMI has a laundry list of priorities for the 2018 legislative session, including limiting the use of solitary confinement, expanding school-linked mental health programs such as the one Winona has launched, and making sure teachers get suicide prevention training. One of the biggest platforms for NAMI is ensuring that mental health parity is a reality. Legally, theoretically, U.S. health insurance companies are supposed to cover mental health care treatment like they would any other treatment, but national studies and NAMI Minnesota surveys have shown that for many people, it is still an empty promise. They can’t get coverage for mental health care needs. “If you want to talk about making sure people have access to mental health care, we need to make sure we are enforcing mental health parity,” Abderholden said. “We think that’s critical.”
Winona State University (WSU) professor Diane Forsyth sat with Abderholden on a state task force charged with developing recommendations for improving the state’s mental health care system. Among the many recommendations were calls for developing a bigger, better workforce of mental health care professionals from aides to pyschiatrists. Forsyth and WSU recently announced some good news on this issue: WSU launched a new program offering post-graduate certificates in psychiatric care for nurse practitioners. The program, offered through WSU’s Rochester campus and based largely on clinical experience and online classes, allows nurse practitioners to get a post-graduate certification as a psychiatric-mental-health nurse practitioner, which allows them to provide more specialized mental health care treatment, including prescribing medication and facilitating short-term talk therapy, with patients. The program’s first cohort started last fall. Forsyth said that while some may work in mental health care full-time, many of the students are primary care nurses who will simply add mental health treatment to their skill set.