Violent incidents rose dramatically last year at the Department of Human Services’ state-run facilities, according to a scathing auditor’s report that detailed chronic management and safety failures across the agency’s division that serves some of Minnesota’s most vulnerable and difficult residents.
These problems, along with others plaguing DHS’ state-run facilities, were outlined by Legislative Auditor Jim Nobles in a report presented Wednesday to lawmakers. The nearly $300 million State Operated Services division that runs 130 residential facilities to serve those with mental illness, developmental disabilities and chemical dependency needs to be more open and accountable to the public, the auditor’s office said.
Nobles called for a re-examination of the division’s mission and whether some of its clients can be better served by private providers.
“It’s a very critical report,” said Nobles, who delivered his office’s findings to a legislative committee. “It’s kind of unrelentingly critical of every aspect that we looked at. I think everybody [at the committee hearing] expressed what we feel. We’re tired of the problems because they didn’t just occur recently. They’ve persisted over a long period of time and it’s really time to solve them.”
The number of assaults involving either staff or residents at DHS state-run facilities almost doubled in 2012 with a projected total of nearly 2,000 incidents. The report also projected a rise in reported sexual incidents, self-injuries and threats.
“We’re seeing some large increases in physical assaults; that’s very troubling,” said Joel Alter, the lead auditor.
The civil commitment process for residents, particularly those committed to the state security hospital in St. Peter, was also criticized. Nobles’ office said the state could be wasting money and facing possible lawsuits by keeping people in treatment facilities longer than may be needed. Unlike many states, Minnesota does not have a regular judicial review process to evaluate residents committed to state facilities as mentally ill and dangerous or developmentally disabled, and the state needs to fix this hole, the report said.
Auditors also identified continuing concerns about the use of restraints and seclusion techniques in state facilities. The report noted that the security hospital, which houses 400 of the state’s most dangerous and mentally ill, has been “critically understaffed” with licensed psychiatrists for more than a year. At the close of last year, there were only two full-time psychiatrists on staff; a year before there had been eight.
“Every single recommendation in that report we agree with and we’re already headed down that road,” said DHS Commissioner Lucinda Jesson. “I think we’ve made amazing progress, particularly over the past year, to get this on a much more stable, better path.”
In the past year and a half, Jesson hired a new CEO to head the entire division and has installed some of her most capable DHS managers to specifically turn around the troubled security hospital. Auditors noted it’s too early to evaluate whether those changes are working. The facility has been on a two-year probation after a series of licensing violations were identified in 2011, including the seclusion and restraint of residents.
Jesson said the rise in physical assaults is partly attributable to a better reporting system and an abrupt, but necessary policy change made at the security hospital to address concerns about the seclusions and restraints issue. That has led to more assault reports, she said.
“We had to make changes quickly to keep the hospital open and with those changes came more uncertainty than we would have liked,” Jesson said. “We are doing that training now. We’re trying to put in clear standards, and when we find things that aren’t working, we change them.”
The report found that the division — which employs more than 3,000 state workers, or roughly half of all of DHS employees — had high leadership turnover and until recently has not received the attention it needed from top DHS officials.
Several lawmakers on the Senate Health and Human Services Finance Committee, where Nobles delivered his report, expressed frustration and concerns about continued problems with the division “that has been troubling to us for a very long time,” said Sen. Tony Lourey, DFL-Kerrick.
“We look forward to embracing the recommendations here and bringing more openness, accountability, transparency to our public process,” Lourey said.
The state’s ombudsman for mental health and developmental disabilities, Roberta Opheim, said the report laid bare problems that her office and others have been trying to get DHS to address for years. She says State Operated Services needs a culture transformation so it can better serve a vulnerable population.