On a Wednesday afternoon, three children in Scott and Carver counties had two things in common: They were considered a risk to themselves or others, and they had to wait in a hospital without psychiatric care until a place could be found for them.

"They've all been sitting there anywhere from six to 20 hours," said Melanie Warm, Carver and Scott County Crisis Program supervisor.

The Crisis Program is a state initiative that operates 24/7, dispatching a team of licensed mental health professionals to intervene in mental-health crises and figure out the level of care that's needed. It also coordinates a variety of follow-up and community-based services.

In extreme cases, the team finds a bed for someone who needs inpatient hospitalization — not an easy task, considering that neither Scott nor Carver has a single psychiatric bed. As a result, patients have to wait hours or days for care, at times traveling hours away to reach it.

Warm said wait times typically are at least three hours. In her recollection, the longest wait was eight days.

"Scott County has grown so fast," said Kim Churchill, chair of Scott County's Mental Health Local Advisory Council. "Our psychiatric infrastructure has not grown fast enough to keep up."

Pushing for prevention

When mental health professionals talk about what's needed in Scott County, they don't point to a single solution.

In addition to the much-needed crisis services, there are also community-based intervention services that can act as preventive measures.

"There's definitely a need for more community-based intervention services to keep people out of the hospital," Warm said.

These community services range from in-home therapy or in-school therapy to urgent care for mental health, allowing patients to see a doctor without having to stay in a hospital overnight.

"[The lack of beds] is a huge problem," Warm said. "But really, that's not the solution. It's a much bigger picture."

Scott County has seen success result from preventive measures taken in other areas.

After implementing a program called "Signs of Safety," which works with families to prevent child protection issues before they happen, human services experienced a drop in the number of children being placed outside of their homes. After hovering around an average of 60 per month between 2006 and 2012, the number of placements dropped to 39 per month in 2013.

Scott County social services is working on a program to prevent people from ending up in the criminal justice system because of their mental illness, said Scott County Health and Human Services Director Judith Brumfield. But implementing it will require more county tax levy dollars, and it's not yet clear if that will be available.

"In some ways, it really comes back to citizens," Brumfield said. "How important is it that we do these kinds of things where you don't see the immediate payoff — it's a future payoff?"

Low spending overall

In 2014, Scott County's mental health revenue budget was nearly $3.9 million. Nearly 40 percent of that came from the county levy.

The bigger human services picture shows that Scott County works with a lot less money than most of its counterparts across the state. According to the most recent Minnesota County Human Service Cost Report, in 2013 Scott County had Minnesota's third lowest per capita human services cost, and the lowest per capita county contribution. For social services, which includes mental health, the county had both the lowest per capita cost and the lowest county portion in the state.

When those numbers were presented at a Feb. 17 County Board meeting, commissioners applauded the low county spending. Commissioner Mike Beard said he's concerned, however, about increased state and federal contributions.

"At the end of the day, this is not sustainable," he said. "This state and federal number frightens some of us."

For the Crisis Program, having sufficient funds means piecing together a smattering of grants and negotiating reimbursement from private insurances companies.

"It's a big job," Warm said.