Minnesota’s state-operated mental health facilities, plagued by care breakdowns and staffing problems, have a new leader for the second time in less than a year.

Marshall Smith, a longtime private hospital executive and health care consultant, has been named chief executive of direct care and treatment at the Minnesota Department of Human Services, considered one of the most difficult assignments in state government.

Smith, who took over last month, will oversee two of the state’s largest mental hospitals, a network of seven smaller, short-term psychiatric hospitals, and state-operated treatment programs for people with drug or alcohol addictions. Together, these facilities employ about 1,800 staff and serve about 3,800 people. He will report to Nancy Johnston, deputy commissioner of direct care and treatment.

The appointment comes amid persistent outbreaks of violence at the Minnesota Security Hospital in St. Peter and the Anoka-Metro Regional Treatment Center, as well as severe bottlenecks in patient flow that prevent timely and adequate care for people with serious mental illnesses. In March, the Legislative Auditor raised fresh alarms about the statewide shortage of psychiatric beds, and called on the state and counties to create a more comprehensive set of community-based mental health services.

The agency suffered a major setback this spring when lawmakers failed to approve new funding for the Security Hospital, the state’s largest psychiatric facility. Gov. Mark Dayton recommended a $90 million overhaul of the hospital designed to create safer and more therapeutic living units; and to bring the hospital’s staff-to-patient ratio more in line with hospitals providing mental health care in other states.

The Security Hospital’s license was placed on conditional status in 2014 after a 41-year-old patient was stomped to death in his room, a killing that investigators later blamed on poor supervision.

Smith has served in a number of executive roles in private hospitals. From 2007 to 2013, he was chief executive of a 25-bed hospital in Monticello operated by CentraCare Health, a private hospital-clinic system. More recently, he was chief executive of Regency Hospital in Golden Valley.

His appointment marks the second time since last fall that the department has gone outside its ranks and picked a private hospital administrator to oversee its mental health operations. Smith fills a position left vacant last November by Daniel Anderson, who had spent more than 30 years as an executive for Minneapolis-based Fairview Health Services. Anderson left the position less than two months after his appointment, citing differences with his previous work in the private sector and budgetary limitations.

“It’s a tough, tough job,” said Roberta Opheim, state ombudsman for mental health and developmental disabilities. “Some of the reforms that need to happen require statutory changes, and that can be very frustrating for someone coming in from the outside who is used to quick decisionmaking.”


Twitter: @chrisserres