A little over a year ago, the mental health community came together at a news conference to raise concerns about the quality of care and treatment being provided at the Minnesota Security Hospital (MSH) in St. Peter. Since then, changes have been made: Staff received training on how to avoid and safely use seclusion and restraints in an emergency; a family council has formed; additional staffing was funded, and plans are underway to remodel in order to provide an environment more therapeutic for patients and safer for employees.
These changes, and the efforts of the administration and staff who have embraced these changes, have not produced the results we expected.
Despite licensing correction orders, trainings and increased funding for the MSH, we continue to see seclusion and restraints used, often repeatedly on the same patients. They are not banned, as some media stories would suggest. The per-diem funding at the MSH is $628, compared with $1,309 at the Anoka Metro Regional Treatment Center, leading to low levels of treatment and programming. Patients committed at the MSH still have long stays — often five years or more. Many feel hopeless, making recovery difficult.
The MSH cannot operate in a vacuum. We speak up as organizations that fundamentally know that mental illnesses are treatable and that recovery happens every day for Minnesotans. People at the MSH have the most serious mental illnesses, but they are treatable if we provide the best treatment, demonstrate to patients that a return to the community is possible and, most important, provide them with hope and a chance for recovery. They can get better.
We believe that the time has come for action — not just by the Minnesota Department of Human Services, but also by the entire community. To achieve this, we ask the state to commit to the following changes:
• Increase the per diem, and differentiate it according to the different levels of treatment of each unit in order to increase the amount of treatment and programming being provided. Without this, we will continue to see the tragic cycle of untreated illnesses, conflict, and injuries to both staff and patients.
• Hire more mental health professionals and practitioners, not just security counselors, in order to increase the ability to provide a therapeutic environment. We need to make sure there are enough psychopharmacologists, psychiatrists, psychologists and other mental health professionals on staff to provide active treatment and to develop effective treatment plans.
• Examine more closely when seclusion and restraints are used and what could have been done to prevent their use — what was happening at the time, whether there other interventions that could have been used earlier, etc.
• Engage community providers to provide “in-reach” where they can collaborate on treatment options and transition people back to the community. This should include building greater capacity in our community mental health providers to make sure that people can be discharged from the MSH when they are ready.
What is particularly disheartening is that many of these people are in the MSH because they could not access timely, appropriate treatment and care in the community when they most needed it. Now they cannot access timely, appropriate treatment and care at the MSH. Our state must make it a priority to treat each person committed to the MHS with dignity and respect, to ensure that they have their basic needs met, and to provide therapeutic treatment.
We have an obligation to provide appropriate levels of care, a safe setting for patients’ recovery and a road map for how they can return to the community as their conditions improve.
Claire Wilson is executive director of the Minnesota Association of Community Mental Health Programs; Shannah Mulvihill is executive director of Mental Health Minnesota; Grace Tangjerd Schmitt is president of Guild Incorporated, and Sue Abderholden is executive director of NAMI Minnesota. This article was also submitted on behalf of Wellness in the Woods; the Minnesota Psychological Association; the Emily Program Foundation; Rise; People Incorporated; Lutheran Social Service of Minnesota and the Minnesota Society for Clinical Social Work.