Breakdown: In rural Minnesota, mental health safety net is in limbo

  • Article by: BRAD SCHRADE and GLENN HOWATT , Star Tribune
  • Updated: October 26, 2013 - 6:34 AM

Across Minnesota, help for the acutely mentally ill often means the ER — or jail.

– Five years after Minnesota closed its last state hospital and promised a new era of rural psychiatric care, patients like Randy May are still sitting in mental health limbo.

Last summer, the 27-year-old grad student from St. Cloud State University suffered a severe manic episode brought on by bipolar disorder. He cycled through five outstate treatment centers, landing in police custody and handcuffs more than once. Eventually, he was committed to state care by a judge. But even that, he says, didn’t help him.

“You get put in for [a fixed] amount of time,” May said in an interview. “It’s like [they’re] baking a ham. Once you are done, they’re going to move on to the next person. There’s no specific plan to get you healthy.”

Across Minnesota, hundreds of patients with the most acute mental illnesses are having the same experience — cycling through a system ill-equipped to treat their disorders, winding up in county jails or hospital emergency rooms, and often posing danger to themselves or their communities.

Few places illustrate the problem as starkly as Willmar, where a large state hospital closed in 2008, leaving nothing to adequately serve patients who are aggressive and unstable.

In this city and its surrounding counties, nearly 1,000 adults with mental illness or chemical dependency were arrested and jailed between 2007 and 2012 for offenses ranging from assault to public nuisance, according to arrest data analyzed by the Star Tribune.

Two small treatment centers in west-central Minnesota have been cited for neglect in cases where patients attempted suicide. Employees of at least three area hospitals have been injured in outbursts by psychiatric patients. Now the Kandiyohi County sheriff is considering whether to convert an unused part of his jail into a psychiatric wing.

“In my opinion, we’ve gone back to the dark ages,” said County Attorney Jenna Fischer, who has dealt with the mentally ill for two decades through the court commitment system. “It’s a tiny segment of the mentally ill, but we are failing them.”

“We’re going to have a crisis one of these times,” said Jim Pew, director of behavioral medicine at Stevens Community Medical Center in Morris, where a social worker was pushed to the ground and injured by an aggressive patient. “Somebody’s going to harm themselves or harm somebody else because we’re not able to get them placed in a facility that’s set up to deal with [them].”

‘We put people in hell’

At the north edge of Willmar — a west-central Minnesota city of about 20,000 — on a pastoral patch of land not far from the lake that bears the city’s name, sits a campus of aging, red-roofed buildings. Today it is a technology office park, but for nearly a century it operated as a state mental asylum.

What became known as the Willmar Regional Treatment Center was one in a statewide network of large institutions for the mentally ill, developmentally disabled and chemically dependent. These state hospitals evolved over the decades, but by the 1970s society had come to view them as inhumane warehouses for the vulnerable.

“We put people in hell,” said Sue Abderholden, executive director of the Minnesota chapter of the National Alliance on Mental Illness.

After decades of gradually moving patients out of the massive state hospitals and into community settings, Minnesota 10 years ago made a final push to close what remained of the costly treatment centers. Willmar’s was one of the last to shut down.

For thousands of those patients, community placement — with medication and therapy — was a welcome success. No one in the mental health field wants Minnesota to revert to the old system.

But for patients who can be volatile or unstable it has been a rough ride: In one recent 18-month period, some 4,000 Minnesotans with acute mental illness washed into the criminal justice system, ended up in jail and were committed by judges to state facilities.

Recognizing that Minnesota would need a replacement for the big hospitals, the state established a network of small, 16-bed psychiatric facilities known as Community Behavioral Health Hospitals (CBHHs). Opened between 2006 and 2008, they were designed to save money while serving patients close to home.

Problems emerged immediately. Because they lacked their own security forces, the CBHHs wound up relying on local police and sheriffs’ deputies when aggressive patients become violent.

  • related content

  • Photo gallery: Mental health care uncertain in rural areas

    Friday October 25, 2013

    Across Minnesota, help for the acutely mentally ill often means the ER — or jail.

  • Video: System can be challenging for man with bipolar disorder

    Saturday October 26, 2013

    27-year-old Randy May, who has bipolar disorder, has been frustrated by the variety of patients in treatment facilities.

  • Randy May, pictured last July at the Woodland Intensive Residential facility in Atwater, Minn., talked about his struggles with bipolar disorder and how he ended up in jail during a manic episode. “It’s like [they’re] baking a ham,” May says.

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