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Mental health system fixes aren't simple – SC Times

When St. Cloud police arrested Solomon Roundtree after his roommate was beaten and kicked to the brink of death, it wasn’t the first time he had been jailed for actions linked to his declining mental health.
And when he was committed as mentally ill as part of the subsequent criminal prosecution, that wasn’t the first time, either. It was another in a string of incidents that has seen him committed and released back into the community, only to be re-arrested, jailed and charged with a new crime.
His story is one example of a strained mental health system that has increasingly seen jails, detox facilities and hospitals become stopgap fixes for people with serious mental health problems. Long waits for treatment programs leave many mentally ill people without options. For some, committing a crime is what it takes to get help.
That’s exactly what Roundtree’s mother, Cosetta Roundtree, says she was told as she watched her son’s health spin out of control.
Solomon, now 29, has been through a series of treatments, commitments, and jail and prison stints since he was diagnosed with mental illness. Medication and supervision stabilized his illness; when he was off his meds he sank into homelessness.
Cosetta knew her son could come across as “weird or scary.” And she feared racial stereotypes could make those situations even more dangerous for her son.
That’s why, during a community policing event in St. Cloud soon after the riots in Ferguson, Missouri, she stood up and made a chilling plea.
Offering her name and number to the officers, she begged them to call her if they were having trouble with her son. She could defuse the situation, she said.
“Don’t shoot. Call me,” she said.
The pattern is straining systems that were never intended to deal with serious mental illness.
‘We are not mental health professionals’
The log of calls for service at the St. Cloud Police Department reveals how frequently officers deal with people who are suicidal, or who have another person worried enough about their well-being to call police.
In the first four months of 2015, welfare checks are the second most frequent type of call for service for St. Cloud police, behind only traffic stops. Officers did 671 welfare checks in that time , up from the 378 during the first four months of 2005 and 449 from the first four months of 2010.
Calls reporting a suicide threat have increased at an even faster rate. In the first four months of 2015, officers went to 181 such calls. That’s up from 107 in the first four months of 2010 and 62 in the same period in 2005.
That volume has St. Cloud Police Chief Blair Anderson wondering whether his officers can continue to respond to all calls where someone is having a mental health crisis but no crime has been committed.
“Until we have a better solution, we will continue to respond,” he said. “I want to be clear about that. But, clearly, even with all of the training we have, we are not mental health professionals and so we can’t render the kind of care that is needed in these situations.”
‘We can’t find a place to put them’
Stearns County Sheriff John Sanner estimates that 30 percent of his jail inmates on any given day suffer from at least one diagnosed mental illness — a dramatic increase from the early 1990s, he said.
The St. Cloud detox facility is seeing more people under court-ordered commitment being held for weeks, rather than the few days the facility is designed for, because there are no open spots for them to get the long-term treatment they need.
And St. Cloud Hospital’s emergency trauma center is seeing a growing number of behavioral health patients who pose safety and long-term care concerns.
“It’s tough when we see somebody that’s in need of some mental health treatment and we can’t find a place to put them or we know that if we are successful getting them admitted, which we are, they’re probably going to be out in three days,” said Anderson.
“And the odds are great that we’re going to be dealing with them again. It’s like this merry-go-round that none of us can get off of,” Anderson said.
Sanner and Anderson point to the closure of state-run regional treatment facilities as a catalyst for the problem.
Shortly after those closures, largely in the 1990s, Sanner said, he started to see more jail inmates with mental health problems that his correctional officers aren’t trained to diagnose, treat or handle.
“You can’t just dump these people into the county jails and decide that that’s fixing the problem. Because it’s making things nothing but worse,” Sanner said. “We’re not a treatment facility. We don’t offer the type of extensive treatment that these people need. We can’t possibly do that.”
“Now it’s 15-20 years later, and it’s gotten nothing but worse,” Sanner said. “We’ve proven that incarcerating these individuals is not a treatment option.”
‘Who wants to call the police on their son?
The Roundtree family started to notice something different in Solomon when he got out of jail in 2010, after serving a four-year sentence for assaulting his girlfriend.
“His personality wasn’t quite right,” Cosetta said. “He seemed so strange. That didn’t make sense.”
He got kicked out of transitional housing for being too aggressive. Like many people who struggle with mental health problems, Solomon didn’t like taking his medications because of side effects.
Cosetta sought guidance from health officials on how to commit her son to inpatient care. A six-month commitment in 2013 at a Hennepin County facility showed her that when supervised in a structured environment and medicated, her son could do well.
But it didn’t last. As Cosetta sought help from county officials and health care professionals, she was told that Solomon’s case was in a gray area. He wasn’t a willing participant for commitment and there wasn’t much they could do until a crime was committed.
“Who wants to call the police on their son?” Cosetta said.
Finding housing for Solomon was difficult. She knew her son needed a place where he felt safe, where nobody could agitate him. But Cosetta’s apartment building wasn’t the answer. He wasn’t allowed to live there because of his criminal record.
“That was when he went into chronic homelessness,” she said. “…I couldn’t help him like I wanted to.”
“It’s a mother’s worst nightmare,” she said.
Solomon was at the mercy of the community.
Earlier this year , Cosetta’s youngest son called her to tell her Solomon’s name was in the local newspaper.
“My heart just sunk,” Cosetta she said.
Court documents say Solomon stomped on the head of his roommate at a north St. Cloud residence. The victim was taken to the hospital, where he initially was unconscious and on a respirator.
Solomon was charged with attempted murder.
St. Cloud Hospital and the detox facility, operated by Central Minnesota Mental Health Center, are seeing more people with mental illness than ever before.
About 9.5 percent of the emergency room’s 62,000 patients this year will have chemical dependency or mental health issues, said Paul Schoenberg, director of the emergency department.
In some cases, those patients are having to stay longer than normal in the emergency room or in other hospital beds because there are no long-term care facilities available, he said.
While the average stay for an ER patient is four to six hours, a patient with mental health or chemical dependency issues could stay two or three days, Schoenberg said.
It’s not just a problem at St. Cloud Hospital, but statewide, Schoenberg said.
“Our goal is to obviously find you the right location for the right services as soon as possible, and that’s not always easy,” he said.
As a result, the hospital is increasing from two to six the number of secure treatment rooms in the ER for patients with behavioral or substance abuse issues or both. The rooms are stripped down — with no cords or other equipment that could pose a danger for someone who is thinking about harming themself or someone else.
“We’re not looking to lock people into rooms or anything,” Schoenberg said. “We just want to provide a location that is safe and secure.”
The hospital’s two secure rooms are consistently full now, Schoenberg said. They’re also not segregated from the regular ER treatment rooms, which frequently are used by children or the elderly, which isn’t always a good mix, Schoenberg said.
Hospitals rarely turn away anyone brought there by police seeking a 72-hour mental health hold. But what happens to that person after the 72 hours has passed is up to the hospital. Often the person is simply released.
“I think it would be safe to say that we deal with the same people over and over and over again,” Anderson said.
Previously, officers had the option of taking a person in crisis who hadn’t committed a crime to a regional treatment facility. The closest and most frequently used was in Willmar, but that ended in 2008.
“Fortunately for us we don’t get turned away from the hospital often enough to matter, or ever,” Anderson said. “So we take them to the hospital and sign them in on a 72-hour hold. Sometimes it’s as simple as finding a relative that can take care of that person when there’s nowhere else to take them.”
The 15-bed detox facility in St. Cloud is almost always full, especially since detox facilities in other parts of the state have closed in recent years.
Detox facilities are paid for with county tax dollars, and more counties are choosing not to shoulder the expense. As centers close, the St. Cloud center is seeing patients from farther away. Sixty-nine of Minnesota’s 87 counties do not have detox facilities.
But there’s a new wrinkle: Increasingly, bed space in the St. Cloud detox center is being taken up by people with chronic mental illness, often under civil commitment.
Normally, a patient can stay in detox for 12-72 hours, said Nancy Rossman, program director. However, the St. Cloud detox has had patients stay weeks or even more than a month, Rossman said.
“A lot of times there’s nowhere to refer these people to, and so the counties will ask, ‘Please hold onto them until a bed can open up and they can get help beyond,’” said Danielle Brant, director of chemical dependency services with the mental health center. “Residential facilities, halfway housing — there’s a waiting list for these programs that are sometimes miles long.”
Statewide, the average length of stay at a detox facility last year was 2.6 days, said Jennifer Decubellis, assistant commissioner for community supports at the Minnesota Department of Human Services. But about 7 percent of people stayed longer than four days, she said.
Long-term stays in detox are not appropriate for people with mental illness, Rossman said.
“It is not our mission,” she said.
The state is looking at ways of changing the detox system to create a new model of treatment for people with medical or mental health issues that can’t be resolved simply by a place to dry out for a night.
Often, when mentally ill people in crisis don’t end up the emergency room or detox, they end up in jail.
The county has a contract with an outside agency to provide mental health services for inmates, but that only scratches the surface of the problem. County jail inmates with chronic mental disorders are dangerous to themselves and correctional staff, Sanner said.
“Somebody needs to own this problem,” Sanner said. “You can’t just dump these people into the county jails and decide that that’s fixing the problem. Because it’s making things nothing but worse.”
This summer, Solomon was found incompetent to stand trial. He was sent to the Minnesota Security Hospital in St. Peter for treatment.
It was there, in mid-August, Cosetta was able to reconnect with her son.
“He looks good. The medications are working,” she said.
As he celebrated his 29th birthday with two sisters, Cosetta found hope in a simple fact: Solomon recognized his daughter.
“When he was sick with schizophrenia, he did not recognize his daughters. They were complete strangers to him,” she said. “We all cried. … It was quite the reunion.”
Cosetta says she can tell Solomon is still not competent to stand trial and plans to stay in contact with staff at the state hospital
“He was telling me in his own little way he’s up and down,” she said.
“But he said, ‘I feel pretty good, Ma,’ ”
In 1867, the Minnesota Hospital for the Criminally Insane opened in St. Peter with enough space for 50 patients. It was Minnesota’s first state institution to treat people with mental illness.
For the next 100 years, institutionalizing the state’s mentally and developmentally disabled citizens was common practice, too often with inhumane results.
A 1947 report to the governor found Minnesota’s mental hospitals were overcrowded, understaffed, neglected patients’ personal hygiene and used restraints or seclusion instead of treatment.
“Many patients do not receive the care and attention which the state provides livestock on the grounds of these same institutions,” the report stated.
In 1948, Gov. Luther Youngdahl described a visit to state hospitals in a radio address. He described “herds of patients, lined up in chairs, sitting against walls, doing absolutely nothing, without even a clock or calendar to break the monotony of their existence.”
By 1960, the state of Minnesota operated 11 state hospitals, seen as places to put people who were defective or “insane.” Those included massive facilities in Willmar, Brainerd, Cambridge and Fergus Falls.
But beginning in the 1970s, the practice of warehousing Minnesota’s mentally ill residents began to change. Legal challenges and public sentiment forced it.
The state and federal governments began to move away toward providing local housing and services for people with mental illness.
With the closure of the Willmar Regional Treatment Center in 2008, just one such state institution remained open, in Anoka. It was the end of an era and a move heralded by advocates of the mentally ill, who had protested the deplorable conditions and lack of treatment at many state-run facilities.
“Over the years, we know that mental illness is a very treatable condition,” said David Hartford, behavioral health care center director for CentraCare. “People can live in the community. We don’t need those facilities anymore.”
The concept behind the changes being made was simple: People with mental disabilities and illnesses who live close to home would have the support of family and a greater ability to live and work independently.
But the change in philosophy required adequate funding for the system of community-based resources, including treatment, supportive housing and other services.
That didn’t happen.
“We never adequately funded that system,” Hartford said.
The result, experts say, has been that many people with mental illness end up in jail, hospital emergency rooms, detox centers or other places that are not equipped to treat them, placing a costly burden on the health care and law enforcement systems.
This year, the Legislature provided more than $46 million in new funding for the state’s mental health system, which Human Services Commissioner Lucinda Jesson called “fragile” with “too many gaps” during a recent interview with the Times Editorial Board.
“There are too many people who don’t have access to mental health services, and we’re not doing enough prevention and early intervention, especially for kids,” Jesson said.
Not just a bed shortage
Minnesota is frequently cited as having among the fewest treatment beds for mentally ill residents of any state in the nation. But beds are only part of the story.
“That doesn’t tell us anything, frankly,” said Sue Abderholden, Minnesota’s executive director of NAMI, the National Alliance on Mental Illness.
At intensive residential treatment facilities such as one in Annandale, a typical patient stays around 90 days. Even at an acute care hospital, the average stay is about eight days, Abderholden said.
“People are spending the majority of their lives in the community,” she said. “Instead of thinking about what are the beds we need, we need to be thinking about what are those services we need in the community to keep them there and keep them well?”
It’s too simplistic to say more treatment beds are what’s needed, she said.
“It can become a new revolving door if we don’t make sure they have the supports they need in the community,” Abderholden said.
Not everyone needs a treatment bed in a 24/7 facility. There are other community-based services that could take the pressure off residential treatment beds — and help people sooner — if there were enough of them, Hartford said.
“When there’s not enough services in the community, it means people end up in mental health crisis,” he said.
A system failure
Changes to Minnesota’s system began in earnest in 1972, when a lawsuit was filed by the families of mentally disabled patients, challenging the conditions at six state hospitals.
The lawsuit argued that mentally disabled people are constitutionally entitled to live in the least restrictive setting possible. The result was the Welch v. Noot decree of 1980, which called for hundreds of mentally disabled residents to be moved to community-based facilities.
However, there haven’t been enough community resources for treatment, housing, support and employment, experts say.
“I think we’ve really had a shortage of these services for a long period of time,” Hartford said.
In some cases, funding has been unstable or inadequate. That’s led to reduction of services or closure of some facilities, including a 16-bed community behavioral health hospital in Cold Spring. The Department of Human Services permanently closed it in 2010 as part of budget-cutting measures.
In other cases, finding qualified staff, particularly psychiatrists, has been a challenge, most critically in rural areas.
The shortage has led to increased pressure on institutions that are not designed to treat mental illness, such as jails, schools, hospital emergency rooms and detox facilities.
“Any time you have that, then those folks are taking up a bed that somebody else could use,” Hartford said.
It’s not just a Central Minnesota trend, said U.S. Sen. Al Franken, DFL-Minn., author of a bill to prevent people with mental illness from ending up in jails and prisons.
“I’m finding this all over the state, especially in rural areas,” Franken said, “where people come into emergency rooms with mental health issues or substance issues that don’t have a place to go, so they keep them there.”
Franken’s bill would divert people with mental illness to special mental health courts, where they would receive treatment. But it wouldn’t solve the shortage of mental health workers, he acknowledges.
“It just is a way of saying that … prison shouldn’t be the place where people with mental illness go in our country, and right now, it is,” Franken said.
Unequal treatment
One of the biggest factors in the crisis has been the stigma surrounding mental illness and the failure to approach treatment of mental health problems the same way as physical health issues.
Until recently, insurance companies weren’t required to cover mental health treatment the same way they cover physical health. The mental health parity act championed by the late U.S. Sen. Paul Wellstone was signed into law in 2008, requiring that all health plans offer mental health and substance abuse services by 2014.
The rules should start to result in better options for mental health treatment, experts say, but it will take time.
“It’s clearly very important to these individuals and to their families that we treat mental illness like what it is — an illness,” Franken said. “We have sort of not done that. And it’s time that we have true parity when it comes to mental health.
“It’s just like physical health. You’ve got to recognize it and treat it.”
Too little, too late
For some of the most serious mental illnesses, such as schizophrenia, there’s been a failure to get people the intensive support they need when they have their first psychotic episode — before they fall through the cracks, she said.
A doctor doesn’t tell a patient he has cancer, then tell him to come back when his cancer is stage 4, Abderholden said.
“That’s what we’ve done in the mental health system,” she said.
Although at least half of serious mental illnesses appear before age14, many schools lack mental health professionals who are able to diagnose and treat kids.
While about one in five children will experience mental illness sometime in their lives, about 70 percent of them don’t get the care they need, Franken said. He pushed a bill to provide more funding to schools for mental health services.
“Part of it is the adults in the school don’t recognize what’s happening,” he said.
Franken recalls visiting the Moundsville school district a few years ago. It has a program to train all the adult employess in the district, from the lunch lady to the school bus driver, to recognize when a child may have a mental health issue. They report it to the school counselor, who can get the child access to community mental health services.
Franken said he spoke to a mother of a 9-year-old whose behavior was out of control. Because of the training program, he got help and was diagnosed with attention deficit hyperactivity disorder and Asperger’s syndrome.
Now he’s doing well in school and recently earned his brown belt in tae kwon do, Franken said.
“She looked at me and said, ‘I was in despair before, but now I’m bulletproof. I can do anything,’ ” he said.
“Everyone wants a silver bullet to fix our mental health system. … There isn’t one.” — Sue Abderholden, NAMI Minnesota, executive director.
Not enough.
That’s what you hear when you ask about problems with mental health care. There are not enough doctors, not enough beds, not enough community support systems.
The logical answer would be get more of everything: more mental health professionals, more facilities and more community support systems. But it’s not that simple.
Experts say there’s a need to address all levels of mental health care if the system is to work effectively. That means offering a range of services efficiently and effectively, from outpatient, community-based treatment, to intensive inpatient treatment. And that requires community and legislative support and stable funding.
Dave Hartford, care center director for behavioral health at St. Cloud Hospital and CentraCare Health, says Central Minnesota has the full range of mental health services available.
“But we don’t have enough of any of them,” he said.
Experts in the mental health, law enforcement and corrections communities think they know how to fix the system.
Until that happens, professionals have come up with some short-term, focused fixes — and some tricks — for addressing the most pressing issues, from adding staff and beds to officer training and paperwork help.
Real change would come from more long-term thinking: integrating mental and physical health care, supporting outcome-based medicine and training more mental health professions.
Big ideas
Sue Abderholden, executive director of the National Alliance on Mental Illness Minnesota, suggested creating funding for a first-episode program to intervene as soon as a mental illness becomes apparent, before people become a danger to themselves or others.
“If people get the right service when they need it … it’s better for the patients and it’s better for the system,” he said.
“If you’re short on those services, it drives people to the emergency department,” Hartford said.
Experts also believe in the value of crisis care teams, which can react quickly to mental health crises. And they come to the patient, instead of waiting for the patient to come to them. Abderholden says they need to be available 24/7 across the state.
She also sees a need for mental health supportive housing to help keep people stable in the community.
Jennifer Dorholt, psychologist at CentraCare Health, sees a need for flexibility in care.
“Sometimes if my client can’t get there, maybe I should just go to their house, or meet them at the coffee shop,” Dorholt said. “I think the worst of the worst need us to come to them.”
Treating the whole person
The Affordable Care Act challenges service providers to deliver more value, efficiency and better outcomes. The demand for efficient and accountable care could drive organizations toward prevention and early intervention, which saves money in the long run.
The ACA also incentivizes care coordination, because providers and organizations will be judged on overall outcomes. Better coordination between departments, doctors and nurses can all contribute.
Mental health treatment was built outside the traditional health care system, but that’s changing.
“We have not treated mental health like other health care. We saw it as a social service and in some ways we still do,” Abderholden said.
Integration of the systems seems to make sense for many reasons. Research shows failing to address mental health can make other health conditions worse, for instance.
“One of the major reasons for poor outcomes in diabetes and congestive heart failure … is related to poor mental health condition,” Hartford said.
Hartford believes that once treatment of mental health issues is streamlined, health care costs overall will decline.
Locally, that’s exactly what they’re trying to do. One program is putting behavioral health providers into CentraCare primary care clinics. Psychologists can be present to consult at annual physicals. A patient receives the consultation right then, instead of being handed a referral to a behavioral health clinic, which might be booked out months for new patients, Dorholt said.
Full-spectrum of care
Raising awareness of the range of services available to people is another piece of the puzzle.
“Too often everything is so siloed,” said Claire Wilson, executive director of the Minnesota Association of Community Mental Health Programs. “The emergency room department doesn’t know to call a crisis team. Police officers are responding to mental health problems.”
Wilson thinks this push for integration will also encourage the synthesis of social services into health care.
“Housing is health care,” she said. “You’re not going to get better if you don’t have housing, a job and you’re cycling in and out of jail. Unless we’re treating you as a whole person, you’re not going to get better.”
Abderholden agrees that housing with supportive services is effective. While some people with mental illnesses can live on their own just fine, others need more help, she said. It’s far less costly to provide them with support than have them end up in a more acute treatment facility.
“If you have someone who’s getting the help they need, the crises are farther and farther between,” Abderholden said.
Bolstering non-professional community support can also help, Hartford said. People with mental illness need support from peers, family and friends, so a model that supported peer-support groups would be helpful.
“Adults with mental illness tend to listen to their peers … another thing I don’t think that whole part of mental illness is well understood,” Hartford said.
One benefit is that it doesn’t cost much beyond getting space to have a group. Hartford thinks there is potential for more of these groups in Central Minnesota.
Wilson believes community mental health centers are the best places to integrate care. Community mental health centers, like Central Minnesota Mental Health Center, have resources and experience dealing with the people who need coordinated care.
“Our providers have expertise in treatment models that result in a continuum of care,” she said. That goes from mobile crisis teams or EMTs for someone in a mental health crisis to targeted case management and long-term solutions.
“We’re seeing all these patients and populations simultaneously suffering from mental illness and some co-occurring diabetes,” she said. “We know how to work with the population.”
Wilson sees that expertise building with the Excellence in Health Care Act, federal legislation passed that will let community mental health clinics operate the same as federally qualified health centers, meaning they’re required to provide primary care as well as behavioral health care.
“That’s incredibly transformative,” she said. “It’s the largest investment ever in community mental health.”
People helping people
But mental health care isn’t just about beds, it’s about people — people trained to help people with mental illness. Exactly how many psychiatrists and other mental health professionals does Central Minnesota need?
Hartford couldn’t answer.
“We’ve been so short for so long nobody even asks that question. Usually it’s a question of whether to add two or one. We often don’t even conceptualize what that need is,” he said.
Abderholden agreed, saying that a general shortage of mental health professionals who want to work in this area is standing in the way.
“Part of it was a payment issue. Part of it is really a huge workforce issue,” she said.
To encourage more providers to enter the field and practice outside large metro areas, she suggests more loan forgiveness programs that draw people to rural areas.
Abderholden says the medical community could expand residency slots for primary care including psychiatry, Abderholden said.
Some mental health professions require new providers to have a certain number of hours working under licensed supervision, but the people being supervised are not paid during that time. One solution could be creating a payment mechanism for internships.
Another key is to reserve psychiatry for people with the most complex mental illness, Abderholden said. Primary care physicians are capable of treating mild depression and anxiety, especially if they are supported by behavioral health providers right in the clinic.
Digital tools
Technology is one tool being used to address the shortage of psychiatrists in Central Minnesota.
When the Central Minnesota Mental Health Center remodeled this year, it included two rooms dedicated to telepsychiatry.
The telemedicine rooms are designed to be ideal for video calls, from the camera-friendly color on the walls to ideally positioned chairs, optimized acoustics and a monitor that is at least 40 inches. Even the lighting is carefully chosen so it doesn’t produce harsh shadows.
This is all so a medical provider can see body language.
“There’s a technological aspect that you wouldn’t always think about. The room itself is created with the very best ambiance for both prescriber and recipient that’s been tried and tested, that’s not an exact science but an efficient one,” said Chad Rhoads, quality assurance coordinator, Central Minnesota Mental Health Center.
The mental health center contracts with a Pennsylvania company for the psychiatrist, who treats ages five and up.
“So in St. Cloud, you are working on a 40-inch screen with a psychiatrist that’s sitting in Pennsylvania,” said Barb Klein, clinic manager at Central Minnesota Mental Health Center.
It wasn’t an easy program to implement.
“We had a lot of red tape to go through to get it here,” she said. The telepsychiatrist had to get a Minnesota license to practice here. So, any random psychiatrist wouldn’t be able to perform the service on short notice. It takes planning.
Despite that, Klein expects to see a lot more telemedicine in coming years.
“The possibilities for that are really encouraging. … As an old-school therapist, this is something that I will say myself I really had questions about,” Klein said.
They expect some public resistance to telemedicine, even as they see potential for expansion.
“It is definitely coming in bigger form than people are using it right now,” Barb said. “It is getting the public in and our communities to understand the strength of it, to get over the stigmas and thoughts of it.”
That could be helped by legislation passed earlier this year in Minnesota that requires private insurers to cover telemedicine services as they would the equivalent in-person service, Abderholden said. Previously, Medicaid providers had been able to use telemedicine, which was especially useful in mental health because of staffing shortages.
The mental health center has another telepsychiatrist in Monticello who specializes in helping adolescent and children.
“Children take to it immediately. They are so tech-savvy. This is their world,” Klein said.
When it opened there, the wait time for psychiatry appointments for adolescents went from six months to two weeks. In St. Cloud, it dropped from six months to two. Of course, once that becomes known in the community, they receive more demand, so those wait times aren’t necessarily true anymore.
Stopgap measures
In the meantime, local agencies are coping as best they can, in a variety of ways.
The St. Cloud Police Department has critical incident teams whose members go through intensive training to help them recognize people in crisis, said Police Chief Blair Anderson.
They have officers trained in crisis intervention and negotiation.
“We use those teams for recognition and to de-escalate a situation without having to use force. But once we get to that point, we still need to take them somewhere. That’s when the quandary begins.”
After an incident, what happens to the person who had the mental health crisis?
“Clearly they can’t care for themselves. … We take them to jail and that doesn’t help the problem they’re necessarily having. And I don’t know that the hospitals are equipped to handle these people long-term. And that’s the key. These people need long-term treatment,” Anderson said.
Why not just add more mental health treatment beds around the state?
Hartford said it’s not that simple. First, we need to learn how to use the beds we have more effectively. And there’s some progress on that front.
“The one piece of good news here in Minnesota is actually we’re the only state that I’m aware of that has an up-and-running psychiatric bed tracker system, run by a hospital association,” Hartford said. “Without that, it’s much more difficult tracking where to find a bed.”
Before the tracker, there might have been empty mental health treatment beds somewhere in the state, but mental health professionals didn’t know how to find them. It required a dedicated social worker to call each location and ask. Now, it’s as simple as checking the bed tracker system.
When it’s not a crisis, even getting a first appointment for treatment can be a problem. Abderholden recommends patients call their insurance company, because they sometimes prepay for mental health appointments, essentially reserving them for their clients in advance. This temporary fix can get well-insured people into appointments soon.
“I’ve been telling people to call the back of their insurance card and really push to get help from them,” she said. “You’re paying for that insurance, and they’re supposed to ensure access to care. So you need to call them up and get them to find you someone.”
She says it works perhaps half the time.
Bureaucracy is another barrier for people to get help. Navigating social services and the mounds of paperwork they require can be daunting for even the most connected patient. A person may ask for help with a mental health issue, and pretty soon they’re booked for 20 appointments with different services, said Klein.
“All of this stuff requires a client to be healthy enough to fill out paperwork and make phone calls,” Dorholt said.
So she spends time helping them, time she considers well spent because it helps to relieve their stress, she said.
She’s also helped clients make calls to collection companies, an Adult Rehabilitative Mental Health Services worker, or the Attorney General’s Office.
“Sometimes I do a little ‘playing social worker,’ ” she said.
Solutions become reality
Some of the solutions, long- and short-term, suggested by experts became reality after the 2015 legislative session, a banner year for people working to secure more funding for the state’s mental health system.
Despite a lack of agreement on transportation, taxes and other key issues, state lawmakers overwhelmingly supported a health and human services budget bill that includes more than $46 million in new funding for mental health initiatives.
Included in the bill is $6.6 million for psychiatric residential treatment facilities for children with very serious mental illnesses, which state officials say are lacking, especially for aggressive or self-injuring patients.
The funding is expected to provide 150 new beds by July 2018 and other services for children and their families, such as individual and family therapy and medication management. There’s also $6.4 million to increase space at Anoka-Metro Regional Treatment Center from 95 to 110 beds.
There is additional money for a rate increase to promote expansion of mobile crisis services.
There’s also increased funding to expand Assertive Community Treatment, or ACT, often called a “hospital without walls” because it provides intensive service where someone lives. The team and patient meet daily and focus on solving practical problems of daily living and meeting goals.
The bill also included funding for early intervention programs for early-onset psychosis, in hopes that early treatment can prevent more serious problems later.
Federal legislation also could provide some funding for solutions. U.S. Sen. Al Franken, DFL-Minn., is pushing a bill that would extend federal support for mental health courts and crisis intervention teams, and train law enforcement officers to help keep people with mental illness out of jail and prison.
Franken also helped get $110 million over two years to expand mental health services in schools and help schools train staff and volunteers to recognize the signs of behavioral health problems so the students can get connected with services.
As Abderholden looks to the future, she knows it will be awhile for many of these measures to have a major impact.
“I do think it’s an important issue. … But it’s going to be years,” she said.
“And frankly, we need more.”
Mental illnesses are as common as silver cars and people with brown eyes. They’re more common than left-handedness.
Yet despite the fact that one in four people will be affected by mental or neurological disorders, there is still a stigma attached to mental illnesses and the people who struggle with them.
Most people will wait an average of 10 years before seeking treatment, largely due to the stigma.
To change that, CentraCare Health launched a Make It OK campaign to encourage people to talk more openly about mental illness and to ask for help.
It also calls for people without mental illness to check their own behaviors when reacting to someone with mental illness.
Marsha Hagfors, 32, of St. Cloud, has experienced this stigma firsthand.
Following a traumatic incident in college, she was diagnosed with borderline personality disorder, bipolar disorder, post-traumatic stress disorder and depression. She spent years in and out of hospitals, before finally becoming stable and healthier.
By her estimation, it helped prolong the period before she became stable by years.
Many people get their impressions of mental illness from the media, television shows where the mentally ill person is accused of murder or other horrible crimes.
But don’t apply that view to everyone, she says.
Because there’s mild and severe mental illness. And there are people that want to change and people who don’t want to change, she said.
“I think it depends on the generation but a lot of people don’t think it’s OK to talk about. I think that if you hold it in, like a lot of people do, that’s what causes more problems,” she said.
“They think ‘I already feel bad about how I’m feeling and I don’t want to feel worse,’ ” she said.
She knows that people can be scared of mental illness, both those experiencing it and those witnessing its impact.
“If you think about it, people have diabetes and cancer, it’s an illness. We can talk freely about that,” she said. But mental illness can be a conversation stopper.
She knows that the consequences of not speaking up can be severe.
“If you don’t talk about it, it comes out sideways,” she said. “For me it was cutting or trying to commit suicide.”
Now that Hagfors is in a stable place where she’s able to be assertive about what she needs, she will call out people who have a negative view or reaction to mental illness.
“I can be successful too, just like anyone else,” she said.
Working with clients at Independent Lifestyles, she tells them to speak up too.
“You’re going to probably have people that put you down about it, but you need to be that strong person and educate them,” she said.
Don’t know what to say when someone does speak up?
Don’t say anything. Just listen. Be supportive.
“(Do) anything except turning away,” she said, even if it’s handing over the phone number of a mental health hotline.
What to Say
Pretend someone you know just told you they’re struggling with an anxiety disorder or depression. What do you say? Here are a few suggestions.
•“What can I do to help?”
•“I’m here for you if you need me.”
•“Things will get better.”
•“I can’t imagine what you’re going through.”
•“We’ll make it right. It’ll be OK.”
•“Can I drive you to an appointment?”
•“We love you.”
Source: CentraCare Health.
What NOT to Say
Sometimes our words can reinforce stigma. Keep in mind, mental illnesses have a biological basis, just like diabetes, and need treatment.
Don’t say:
•“It could be worse.”
•“Snap out of it.”
•“Everyone feels that way sometimes.”
•“You may have brought this on yourself.”
•“There’s got to be something wrong upstairs.”
•“We’ve all been there.”
•Don’t use words such as crazy, psycho, nuts or insane.
Source: CentraCare Health.
1866: Minnesota Legislature passes calls for the establishment of a hospital for the insane.
Minnesota Hospital for the Criminally Insane is established in St. Peter for 50 patients.
1879: State hospital in Rochester opens for 68 mentally ill patients.
1900: State asylums for the criminally insane open in Anoka and Hastings.
1911: Asylum for the Dangerously Insane opens on state hospital campus in St. Peter; its name is later changed to Minnesota Security Hospital.
1912: Willmar Hospital Farm for Inebriates opens.
1917: Mentally ill patients also begin being admitted to Willmar.
1925: Cambridge School and Hospital for Mentally Deficient and Epileptics opens.
1938: Moose Lake State Hospital for the Insane opens.
1947: Gov. Luther W. Youngdahl appointed a Governor’s Advisory Council on Mental Health.
1949: Legislature passes the Mental Health Policy Act, which set standards of service and care for patients in state institutions.
1950: Sandstone State Hospital for the Insane is established.
1957: The number of people in the U.S. with mental illness in psychiatric hospitals or institutions peaks at about 565,000.
The Legislature passes the Community Mental Services Act, which established community mental health centers throughout Minnesota.
1958: Brainerd School and Hospital for mentally disabled people opens.
1959: Sandstone State Hospital is converted to a federal prison.
By 1960: State of Minnesota operates 11 state hospitals that housed about 16,000 people on any given day.
1963: State residential treatment center for emotionally disturbed children opens in Lino Lakes.
1968: Unit for mentally disabled people established at St. Peter Hospital.
1969: Fergus Falls State Hospital becomes one of the first multipurpose treatment campuses, serving people with developmental disabilities, chemical dependency and psychiatric illnesses.
1972: A class-action lawsuit filed against six state hospitals by parents of residents who felt that the physical conditions, care, treatment and training did not meet constitutional standards.
1978: Hastings State Hospital closes.
1980: Welsch vs. Noot Consent Decree calls for placement of hundreds of mentally disabled residents in community-based facilities.
1982: Rochester State Hospital closes.
1984: Minnesota Legislature establishes inter-agency board.
1985: Gov. Rudy Perpich officially changes the name of state hospitals to regional treatment centers to reflect the broad spectrum of services provided.
1987: The Minnesota Legislature enacts the Adult Mental Health Act, intended to increase consumer choice and expand the market for mental health services.
1990: President George H.W. Bush signed the Americans with Disabilities Act into law, extending all civil rights protections to people with disabilities.
1993: Minnesota Legislature approves a plan to convert the Moose Lake State Hospital into a state correctional facility.
1996: The federal Mental Health Parity Act of 1996 prohibits the use of different lifetime and annual dollar limits on coverage for mental and physical illnesses.
1999: Cambridge Regional Center closes.
U.S. Supreme Court ruling, Olmstead v. L.C., says undue institutionalization of people with mental disabilities is discriminatory.
2003: Minnesota Legislature adopts plan to expand community-based alternatives for people with mental illness. Eleven public/private partnerships are formed to build adult mental health treatment capacity in smaller settings, closer to patients’ communities, homes and support of family and friends.
2006-2008: Minnesota closes four regional treatment centers at St. Peter, Fergus Falls, Brainerd and Willmar.
2006: Community Behavioral Health Hospitals open in Alexandria, St. Peter, Rochester, Annandale, Wadena and Fergus Falls. They have a maximum of 16 beds with an expected average length of stay of less than 30 days.
2007: CBHHs open in Baxter, Cold Spring and Bemidji.
The Minnesota Legislature passed Gov. Pawlenty’s mental health initiative, designed to improve the accessibility, quality, and accountability of publicly funded mental health services.
2008: CBHH opens in Willmar.
Congress passes the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, which requires insurance companies to treat mental and chemical health on an equal basis with physical illness when policies cover both.
2009: CBHH in Cold Spring closes due to a lack of available staffing and duplication of services available in the St. Cloud area.
2010: The Minnesota Legislature passed and Gov. Pawlenty approved Resolution 4, House File 1680, which apologized to “all persons with mental illness and developmental and other disabilities who have been wrongfully committed to state institutions.” The resolution expressed regret for the history of institutionalization of people with disabilities in Minnesota including the practices of forced labor and involuntary sterilization.
2015: Minnesota Legislature passed health and human services budget bill that includes more than $46 million in new funding for mental health initiatives.
Sources: 1995 report by the Minnesota State Planning Agency; 2012 Minnesota Department of Human Services report to the Legislature; Minnesota Governor’s Council on Developmental Disabilities.
•National Alliance on Mental Illness, Minnesota
•CentraCare Behavioral Health
•St. Cloud Hospital Inpatient Mental Health Unit
•Central Minnesota Mental Health Center
Resources: http://cmmhc.org/?page_id=36
24-Hour Mental Health Crisis Hotline: 253-5555, 800-635-8008
24-Hour Detoxification Services, 252-6654.
Text LIFE to 61222.
•National Suicide Prevention Lifeline
•Make It OK
•City of St. Cloud Violence, Abuse, Suicide and Mental Health Info Resource Page
Non-emergency St. Cloud Police Department: 251-1200.
In case of emergency, dial 911.


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