Strategies shift for treating mental illnesses

His job was gone, his apartment wrecked in a manic rage, and the suicidal voices in his head kept insisting, "Life isn't worth living."

Then Kendall Coleman, 50, who suffers from schizophrenia and depression, met a social worker named Jolene Peterson. "I probably would be homeless or dead by now were it not for her," said Coleman, who lives in Bloomington.

Coleman is among hundreds of patients across Minnesota benefiting from a fundamental shift in the way hospitals and health plans treat people with serious mental illnesses. Facing a critical shortage of psychiatric beds, and new financial pressures to reduce costly readmissions, hospitals are increasingly turning to outside social workers for help — even deploying them inside hospitals, settings once considered off-limits to nonmedical professionals.

The goal is to arrange basic social services for psychiatric patients — including housing, transportation and job training — before they ever walk out of the hospital door. These efforts, known in social-service parlance as "in-reach," also build trust between case workers and patients who may be too stubborn to seek help and too depressed to show up for doctors' appointments and take their medications.

"This is a sea change," said Dr. Michael Trangle, associate medical director for behavioral health at HealthPartners, which owns Regions Hospital in St. Paul. "We're seeing the stirrings of [hospital] systems finally saying, 'We have to start changing our approach to help manage this population.' "

At Allina Health, which owns Abbott Northwestern and 11 other hospitals statewide, about 40 percent of patients discharged from psychiatric units never make their first doctor's appointment. Many disappear into homelessness or isolation, and cycle in and out of hospital emergency rooms.

To slow this revolving door, Allina recently began bringing in teams of outside experts — including county social workers, therapists and psychologists — to develop long-term treatment plans with patients who have a history of repeat hospital admissions.

And at Hennepin County Medical Center's psychiatric emergency room in downtown Minneapolis, visitors who request housing or other community services can meet with a social worker within 30 minutes after arrival, under a new "in-reach" effort launched last spring. HCMC's psychiatric emergency room sees 800 to 1,000 visits a month from mental health patients.

The driving force behind these initiatives is the idea that people with serious and persistent mental illnesses are less likely to rotate in and out of emergency rooms and acute care hospitals if they have stable housing, a source of income, counseling and other services that can remove the underlying sources of their anxiety.

"If they don't have the money to pay for a prescription or don't have a place to live or don't have a job, then these patients will fall through the gaps and end up being re­admitted," said Dr. Jeffrey Sawyer, medical director of psychiatry and integrative care at North Memorial. "There has to be more of a bridge to community services."

In Minnesota, the effort took on urgency in late 2013, with a new state law that put additional pressure on already-stretched psychiatric wards across the state. The law, known as the "48-hour rule," requires inmates in county jails to be transferred to state psychiatric facilities within 48 hours after being committed by a state judge. While the law has accelerated placement of mentally ill inmates at state hospitals, it has also created a growing backlog of other patients awaiting treatment.

The push to reduce hospitalizations has also been motivated by the Affordable Care Act of 2010, President Obama's health care law.

Amber Dahlman, 31, who suffers from bipolar disorder, began seeing a social worker about a year ago, after she was hospitalized with a near-fatal drug overdose. She now has weekly meetings with a case manager at Vail Place who helps her manage her medications and get social services.

The care has emboldened Dahlman to pursue one of her principal passions: art.

On a recent visit, Dahlman proudly displayed one of her paintings, "Mixed State," depicting the conflicting emotions of a person suffering a manic episode of bipolar disorder. "A year ago, I felt like I didn't want to be here," she said. "Now, I feel safe to share more of myself."

Coleman has a similar story.

For years, he suffered from bouts of manic depression, sometimes going days without sleep. Coleman said his untreated schizophrenia reached a crisis five years ago, when police took him away after he tore up his apartment in a violent rage. "I felt like the entire world was out to get me," Coleman said. "But I was always taught to keep my problems to myself."

On a recent weekday, Coleman cracked jokes as Peterson helped him through the process of re-enrolling for Medical Assistance. He still has difficult days when the voices return. But he says they are "more like whispers" and not the "loud yelling" of years past. Now, with a stable job as a janitor, Coleman plans to save enough money to attend the college graduations of his two sons in May.

"It's a good feeling to know that, no matter what, I've got someone fighting in my corner," he said. "No one should have to face a mental illness alone."

Chris Serres • 612-673-4308

Twitter: @chrisserres