Moving mentally ill Minnesotans out of jails, into treatment is goal of state spending boost

Under pressure from jail officials and mental health advocates, Minnesota lawmakers will spend $75 million over the next two years to get individuals suffering from mental illnesses out of jails and into psychiatric treatment.

Lawmakers last week authorized a $700 million infrastructure package to fund roads and bridges, clean up drinking water and invest in universities. Among the largest projects is a plan to add bed space at a state-owned psychiatric hospital to help more quickly transfer people languishing in detention who have been committed to state psychiatric care.

More than a decade ago, Minnesota lawmakers mandated that detained individuals with mental illnesses who are committed by a court to psychiatric care need to be transferred within 48 hours. But limited space in inpatient psychiatric hospitals means there aren’t enough beds for the state to quickly take in those who are stuck in jails or emergency rooms waiting.

That has put a strain on county jail staff, who sheriffs argue are not equipped to offer the proper care. In Ramsey County, one individual waited more than three years to access a psychiatric hospital.

“You’re not coming out better after three years at our jail,” said Ramsey County Sheriff Bob Fletcher.

Clay County Chief Deputy Chris Martin said an individual who waited in custody for 15 months for a mental health bed became violent toward staff members. He tried to take officers’ keys and taser. Deputies were regularly calling the state, Martin said, trying to get the individual placed in a psychiatric facility.

“We talk about a 48-hour rule – he spent over 10,870 hours with us after he was committed,“ Martin said. ”He suffered for that, and our correctional officers suffered for that. We, as citizens of Minnesota, have to do better for them. We have to stop criminalizing mental health.”

Hennepin County Sheriff Dawanna Witt said there are typically about 20 people in her jail at any given time awaiting psychiatric care.

With $55 million from the state’s infrastructure package and another $20 million in a human services budget bill, the state is expanding the Anoka-Metro Regional Treatment Center, a state-owned psychiatric hospital, in the hopes of getting people more quickly into appropriate care.

The expansion, which will add 50 beds to the facility’s existing 96, will help, sheriffs, attorneys and mental health advocates say. But it’s not a cure-all.

“It won’t solve it,” said Sue Abderholden of NAMI Minnesota, “but it’ll make a big dent.”

The Minnesota Department of Human Services said the increase will allow the state to admit another 150 to 200 patients each year.

“It won’t solve the treatment capacity problem,” the department said, “but many more people with serious mental illness will get care in the right treatment setting.”

As of last week, the Minnesota Department of Human Services reported there were 61 people on the waiting list for psychiatric beds who have been committed to state care.

“It’s a significant increase,” said House Human Services Finance and Policy Co-Chair Mohamud Noor, DFL-Minneapolis.

A state task force has been looking into the issue for a couple years, and Noor said, “they told us clearly that we need to increase capacity.”

The backlog, advocates warn, makes the state susceptible to lawsuits from individuals who have waited more than 48 hours for a psychiatric bed. Dan Gustafson, an attorney, is representing plaintiffs in a class-action lawsuit challenging the state’s failures to transfer individuals from jail to psychiatric hospitals within 48 hours.

Gustafson said the lack of capacity was a choice made by state lawmakers.

“The 48-hour rule doesn’t mean anything if you don’t have space,” Gustafson said, “but ... the question is why don’t we have space? And the answer is because they didn’t put the resources into getting the space that they need.”

Legislators passed other measures this session to try to address mental health needs, Noor noted, including an increase in reimbursement rates. Minnesota has seen some mental health providers close in recent years despite high demand, and those in the field have stressed that Medicaid reimbursement rates are part of the problem. They said too-low payments don’t cover the cost of doing the work and contribute to staffing challenges.

Rate increases could help more people get help earlier on, Noor said, “so that they don’t have to wait until things become a crisis.”

Part of the shortage, Dr. Eduardo Colón-Navarro said, is because individuals who have been taken to Anoka and stabilized end up staying longer than necessary because there aren’t enough resources to help them return to their communities and continue treatment.

There’s “no doubt in my mind,” said Colón-Navarro, chief of psychiatry at Hennepin County Medical Center, that Minnesota needs more in-patient psychiatric beds, but the problem will persist if the state fails to add other resources for after patients are discharged.

“The beds will fill up and then we’ll be stuck in a cycle again,” he said.

Abderholden said bringing mentally ill people to jails and then psychiatric hospitals is not the solution. The state needs resources to keep people from entering the criminal justice system.

“We can’t build our way out of this,” she said. “We have to do some of that earlier intervention. What I like to say is our mental health system isn’t broken; it was never built.”

Jessie Van Berkel of the Minnesota Star Tribune contributed to this story.