An influx of inmates from county jails has created a public safety crisis at Anoka-Metro Regional Treatment Center, prompting the state to take the controversial step of limiting new admissions at Minnesota’s second-largest psychiatric hospital.

After a surge in workplace injuries and assaults, state Human Services Commissioner Lucinda Jesson notified law enforcement officials that Anoka-Metro is restricting admissions from county jails under the so-called 48-hour rule, which requires certain inmates to be transferred to a state psychiatric facility within 48 hours after being committed by a state judge.

The emergency measure, disclosed in an April 24 memo obtained by the Star Tribune, pits the state’s largest agency against the Minnesota Sheriffs’ Association, which lobbied for the 48-hour rule so that mentally ill inmates could move quickly out of jails and has argued that any effort to impede admissions likely would violate state law.

The suspension is also the latest signal of deeper flaws in Minnesota’s mental health system, which has suffered from a chronic, severe shortage of psychiatric beds.

The conditions at Anoka-Metro, a 175-bed facility that treats people with complex psychiatric conditions, have become so dire that at least one state legislator has suggested bringing in the National Guard to protect patients and staff. The idea is supported by the public sector employees’ union local that represents workers at Anoka-Metro.

“We absolutely need to restore order,” said state Sen. Chris Eaton, DFL-Brooklyn Center, a former employee at the facility. “Right now, [Anoka-Metro] doesn’t have the training or the staffing to deal with the violent people coming through its doors.”

‘We are under stress’

Though safety has long been a concern at Anoka-Metro, state officials and hospital staff say the situation worsened considerably after the Legislature passed the 48-hour mandate in 2013. The mandate, while heralded by law enforcement officials, required facilities like Anoka-Metro to admit jail inmates ahead of hospital patients with psychiatric illnesses. Staff at Anoka-Metro say the rule has turned the hospital into a dumping ground for violent criminals.

“We are under stress,” said Deputy Human Services Commissioner Anne Barry. “And that stress is the product of the sheer level of seriousness and level of need of the people who are coming to us.”

In 2014, the first full year after the 48-hour mandate went into effect, the number of injuries resulting from aggressive incidents nearly doubled to 45 from 24 in 2013, according to state data.

In a February incident, a housekeeper at Anoka-Metro was cleaning a room when a male patient grabbed her arms, threw her against the wall and started kissing and licking her face. The housekeeper attempted to scream but she could not because the assailant had forced his tongue into her mouth, according to an Anoka Police Department report.

The attacker, Mohamed Hussein Hassan, had a history of criminal and sexual behaviors. Less than a month earlier, he grabbed a breast of another female staff member; and on many occasions he had exposed himself, while masturbating, to other staff. When police arrived, Hassan was still pacing the hallway, the police report said.

‘Nothing to lose’

But leaders of AFSCME Local 1307, which represents more than 300 workers at the hospital, say the reported injuries understate the scope of the problem because much of the violence goes unreported.

“Most of the people coming in [under the 48-hour] rule have nothing to lose,” said Jackie Spanjers, president of AFSCME Local 1307. “So if they don’t like the way things are going, they start busting things up and hurting staff.”

The move to limit admissions, however, already has aroused concern from the Sheriffs’ Association. The group strongly supported the 48-hour rule because of long-standing concerns that jails had become de facto holding pens for people with mental illnesses. With their mental disorders untreated, jail inmates sometimes would lash out violently.

Jim Franklin, executive director of the Sheriffs’ Association, said any effort by the state to limit admissions under the 48-hour rule would “certainly appear to be a violation” of state law, and he suggested the Department of Human Services could face legal action. At the same time, the association has supported provisions in the health and human services budget that would create more beds and community treatment options for people with mental illnesses.

“Our concern is that before the 48-hour rule, we had people sitting in jail waiting for placement for days and, in some cases, up to a month,” Franklin said. “We don’t want to go back to that type of situation.”

Apart from limiting admissions, the Human Services Department is exploring other steps, such as creating a separate unit at Anoka-Metro that would separate newly admitted patients who might be violent from the rest of the population, Barry said. A similar unit already has been created at the Minnesota Security Hospital in St. Peter and has helped to reduce assaults.

Even so, Barry acknowledged that limiting admissions under the 48-hour rule could result in legal action. “We’re not intentionally breaking the law,” she said. “But we’re making sure that everyone understands that … in some cases, we may not make the 48-hour mark.”

 

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