Minnesota taxpayers have shelled out more than $92 million over the past six years to house patients who no longer require mental health treatment at a state hospital but have nowhere else to go.
The cost per patient, according to Department of Human Services records, now tops $1,300 a day — enough to rent an apartment in Minneapolis for a month.
The rising toll is a largely hidden but stark sign of gaps in the state’s mental health safety net, particularly for Minnesotans accused of a crime but deemed mentally unfit to face the charges.
Courts now send these patients primarily to a state hospital in Anoka. But once doctors there say the treatment is complete, there’s often no place for them to transition back to society. They usually require more treatment or supervision after intensive inpatient care is finished, but places like adult foster care, residential treatment programs or group homes are often too full to let them in right away.
As a result, the patients sit at state hospitals for weeks, months or even years longer than they are supposed to.
One patient has been in Anoka for more than four years since being cleared for release.
And those extended stays mean there are fewer beds available for vulnerable patients who do need the hospital-level care.
The cost of housing residents who no longer require treatment mounts quickly. Hennepin and Ramsey counties, for example, were billed a combined $15 million-plus for the past two years for unnecessary services, according to DHS records requested by the Star Tribune.
In light of these high costs, mental health advocates and lawmakers say it’s time to rethink the system and create more community-based treatment that would cut down on bed shortages.
Beyond that, the state needs to find ways to intervene earlier and reduce how many people come to the criminal justice system already in the throes of a mental health crisis, said Sen. Tony Lourey, DFL-Kerrick.
“We can’t just simply wait for the crisis and respond any longer,” said Lourey. “That’s never going to work for us.”
Delays from jail to hospital
It usually begins with an arrest.
Every year, thousands of people with mental illnesses come to county jails in Minnesota. If they are deemed mentally unfit to face their charges — for example, if someone doesn’t understand the fundamentals of the court process — they are committed to treatment in a state hospital, usually Anoka Metro Regional Treatment Center.
This is frequently where the bottleneck begins. If beds in Anoka are full, the patients might wait in jails that are not properly equipped to treat mental illness.
To speed up the process, the state Legislature passed a law in 2013 mandating that DHS transfer patients out of jails and into treatment within 48 hours of a judge’s order.
However, since the law went into effect, the state has consistently failed to meet that deadline. In more than 100 instances — or about a quarter of the total cases — DHS did not admit the patient within the 48-hour mandate, according to DHS data.
In many cases, DHS cites law enforcement not transporting the patients on time. But another common reason is that there is simply no room in the hospitals.
In June, for example, Anoka was over its bed capacity. When a judge ordered three people to Anoka from the Hennepin County jail, mental health staff at the hospital said they couldn’t take them. But the jail deputies ignored the hospital staff and tried to drop them off anyway.
“It’s a judge’s order,” Sheriff Rich Stanek said in an interview at the time. “It’s my job as a county sheriff to enforce the orders of the court. Not deny them. Not work around them. Not ignore them. Which is why I did not.”
When hospital staff turned the patients away, Hennepin County Judge Elizabeth Cutter ordered DHS Commissioner Emily Piper into court to explain why.
Piper testified that the problem wasn’t lack of trying on the state’s part. A significant reason for overcrowding was that county officials were failing to find placement for patients who have been cleared for release.
Once hospital staff deem them ready to go, the patients become the responsibility of the counties where they were first arrested. So when people are arrested in Minneapolis, Hennepin County must find a place for them after state hospital treatment is complete.
But if the counties don’t move them, those beds never open up.
At the time of the hearing, the Anoka facility was dedicating 27 out of 99 beds to patients who had been cleared for release, according to DHS court data. A state hospital in St. Peter, also for treating patients who come in through the jails, was using 16 of its 26 beds to house patients who no longer needed to be there, according to DHS court filings.
In an interview, Piper said she understands it’s difficult for counties to find new housing, especially with scarce funding, but it’s their obligation to find a way to place the patients. “So I don’t really think that that’s a necessarily justifiable excuse to continue to warehouse people in our hospitals,” she said.
Regarding the patient who’s been in Anoka for four years, Piper wouldn’t speak to specifics, citing medical privacy laws.
However, she said, “I by no means think that that’s acceptable.”
Counties out of resources
The explanation for the delays from the counties vary, but it usually comes down to lack of money.
Each case is different, but counties usually place these patients into facilities like adult foster care or Intensive Residential Treatment Services, known as IRTS. These beds are at times hard to come by in Minnesota, and the facilities often have long waiting lists to get in.
Then there are cases in which the patients have serious criminal histories, such as violent or sexual-based offenses, and most facilities can’t — or won’t — take them, said Linda Curran, adult mental health supervisor for St. Louis County.
“We’re talking about really, really hard-to-place people,” said Curran. “People are calling 50 or 60 places trying to get them placed, and it doesn’t always happen.”
In some cases, red tape between state and county government slows the process to a halt. Anoka doctors can clear patients for release, but the courts may have a backlog on their mental health evaluations, which are necessary for a patient’s release. While everyone waits, the daily fees start kicking in.
“I can’t move those people,” said Deputy Hennepin County Administrator Jennifer DeCubellis. “You could call this out from the sheriff’s office all the way through the system. There are bottlenecks.”
In 2016, in an effort to put pressure on the counties to move these patients quicker, DHS started billing the counties for 100 percent of services after the patient has been cleared for release.
But the delays have not gone away. And at $1,375 per day, the costs add up.
Over the past two years, Minnesota counties have collectively paid more than $37 million on the unnecessary treatment costs.
And that money doesn’t go directly toward mental health funding. Instead, it’s funneled into the state’s general fund, a budget that funds a wide array of government services in Minnesota.
“I’m really kind of dumbfounded by that,” said attorney Doug McGuire, who coordinates a defense board for mentally ill people petitioned for commitment in Hennepin County. “It sounds like there’s money there. And why it’s going into the general fund — it doesn’t make sense to me.”
‘We have to do better’
Many in the mental health field agree. If one of the primary hurdles in building more resources is funding, it doesn’t make sense that the state wouldn’t direct that money toward a solution to the problem, said Sue Abderholden, executive director of the National Alliance on Mental Illness.
“I’m a pretty hopeful person, but this is just really frustrating to me,” she said.
Legislators have pushed for diverting some of this money toward mental health services. A pared-down version of the bill succeeded this year, which will send a small portion — $1 million — collected through Anoka toward an “innovation” mental health fund beginning in 2018.
Some county governments have also been working on creating more beds to get patients out of Anoka more quickly. In the past year and a half, Hennepin County opened up 32 new mental health intensive treatment beds and 16 crisis beds. It’s in the process of opening 48 more beds, said DeCubellis.
But there is still more work to be done, particularly with the patients who have serious criminal offenses in their past, said DeCubellis. “There’s no one solution that’s going to solve this. And there’s no one entity responsible. We all need to be accountable for moving the line.”
Lourey, who served on a state mental health task force convened by Dayton, said the real solution may be more complicated than just creating new beds. Right now, patients often don’t come into the state’s mental health orbit until they’re going through a crisis that brings them to jail. To truly address the problem means creating more services for people in the community to stop that crisis from happening in the first place.
“We all have to own it,” said Lourey. “And we have to do better.”
The fact that so many in the system are placing the blame on others is indicative of how much work needs to be done, said Rep. Nick Zerwas, R-Elk River.
“We need to look at everyone involved blaming someone else as the problem,” said Zerwas. “It shows complete and utter dysfunction, and that the system really has broken down.”