Public care for the mentally ill in Minnesota is deeply flawed, with patients cycling in and out of county jails and hospital ERs because of a severe shortage of psychiatric beds and community treatment, according to a stark new review by the state agency in charge of those services.
In a report prepared for the Legislature and released quietly last week, the Department of Human Services found major gaps in the treatment of severe mental disorders, often resulting in people having to live in a “frustrating limbo” until proper care becomes available.
These gaps have created a crisis at the state’s second-largest psychiatric institution, Anoka-Metro Regional Treatment Center, where 30 to 40 percent of the hospital’s 175 beds are occupied by people who no longer need to be there but have nowhere else to go.
The bottlenecks at Anoka-Metro are so severe that the state may forced to consider building more psychiatric hospital beds, according to Human Services Commissioner Lucinda Jesson. Such a move would reverse a five-decade trend toward moving psychiatric patients out of institutions.
“This is a serious issue,” Jesson said in an interview Friday. “People are sitting in emergency rooms waiting to get into [Anoka-Metro]. They’re not getting the care they need, and that exacerbates their mental illness.”
Though focused on Anoka-Metro, the 110-page report provides a penetrating look at statewide gaps in Minnesota’s psychiatric services. The report paints a bleak portrait of a system that suffers from an acute shortage of beds and often fails to provide patients with adequate support once they are discharged.
Rural areas face particularly limited services. The report finds that people in all but 13 of Minnesota’s 87 counties live in federally designated Mental Health Professional Shortage Areas. In 2011, there were 643 licensed psychiatrists in the state, or about 1 for every 8,200 people.
“Community hospitals in Minnesota have complained bitterly about the lack of state facilities that forces them to board people in psychiatric crisis,” the report said.
The bottlenecks at Anoka-Metro are both a cause and a symptom of these failings. As the state closed public mental hospitals in recent decades, Anoka-Metro became the safety net for patients with the most complex issues, including people determined by a court to be a threat to the public’s safety or their own.
Ideally, the report says, patients at Anoka-Metro should be able to transition directly to a community setting as soon as their treatment is complete. Instead, they face administrative delays and resistance from group homes or other facilities that may be reluctant to accept a psychologically complex patient.
The result is that alarming numbers of patients are “stuck” at Anoka-Metro for weeks and months after they no longer need care.
In 2013, the report found, people discharged from Anoka-Metro received a total of 13,800 days, or 38 years, of unnecessary treatment — at a cost of $1,000 per day to taxpayers. The state found one patient who spent 205 days at the facility after he no longer met the criteria for hospital-level care.
And because so many beds are occupied by people who don’t need them, many patients in need of psychiatric care are not getting treatment. DHS estimates that 140 people who could have been treated at Anoka-Metro did not get that care because of patient flow bottlenecks.
In addition, many people are cycling in and out of Anoka-Metro multiple times because they are not getting appropriate care after discharge. About 80 people had three or more episodes of care at the facility over a four-year period, DHS found.
The problems at Anoka-Metro, which serves the entire state and received $34.2 million from the state this year, cascade throughout the mental health system, as patients waiting for entry cycle through hospitals, jails and other local facilities that are not equipped to treat them. A report last September in the Star Tribune found that hundreds of people with psychiatric illnesses languish in Minnesota jails, often for weeks or months before receiving proper care.
Anoka-Metro “is a bottleneck to the whole system,” Jesson said.
To ease the backlogs, DHS is pursuing several “immediate solutions,” including the opening of a 16-bed transitional unit at the Anoka-Metro campus, as well as collaborating to open two new intensive treatment centers targeted at patients being discharged from the facility.
Opening new centers will be a challenge given the stigma still associated with mental illness and fierce resistance by many communities. Even seemingly innocuous programs can face stiff resistance from neighborhood groups. Last month, the Golden Valley City Council initially rejected a day treatment program for children with mental illnesses as common as depression and hyperactivity, after parents expressed fear of home invasions. The City Council reversed its decision after an outcry from advocates for the mentally ill.
“These things take time,” said Sue Abderholden, executive director of the Minnesota chapter of the National Alliance on Mental Illness. “If mental illness was a lesion on your skin that you could see … then we would have invested the necessary dollars a long time ago. It’s an invisible illness, which makes it easier to ignore.”