Hennepin County commissioners learned Thursday that the county continues to make strides in treating adults with mental illness, but the cost has leapt significantly and the population served is more complex and diverse.

The board heard the findings and recommendations of a mental health system review it requested in January as part of its 2019 budget process. Commissioners asked about needs, service gaps and potential improvements. The review will guide how the county moves forward with its mental health strategies.

Successes included a reduction in emergency room visits and inpatient hospitalizations and fewer rebookings of jail inmates who worked with an embedded social worker.

The bad news was the rising cost of helping the growing number of people dealing with mental illness. Last year, the county spent $51 million, and that doesn't include payments covered by Medicaid. As the state contributes fewer dollars for treatment, the county relies heavily on property taxes to cover costs.

"Mental health is health, just like taking care of physical and nutritional health," said Commissioner Irene Fernando. "Hennepin County is a leader. People are paying attention."

The report stressed that the county needs to continue to accelerate efforts to develop community supports that can help people living with mental illness stabilize their symptoms and pursue recovery in the least restrictive settings.

Leah Kaiser, the county's senior department administrator for behavioral health, said clear patterns and themes appeared during the review.

The county's mental health services are fragmented and weighted toward crisis responses and hospitalization instead of early intervention, she said. Treatment of mental health and substance-use disorders is poorly integrated, and mentally ill defendants are likely to end up in institutional care, she said.

Kaiser also talked about system bottlenecks such as lack of affordable housing, strict placement requirements at regional treatment centers and long hospitalizations because of the lack of space at treatment programs.

The biggest bottleneck is the state-mandated rule that jail inmates who are court-ordered to civil commitments must be sent to the Anoka-Metro Regional Treatment Center. It costs the county $1,396 a day to house a person at the center, and the total tab for 2018 was nearly $6 million. That expense has doubled since 2013.

The county has excelled with several programs that work with people with serious mental illness and those suffering from both mental illness and substance abuse, the review said. It cited the targeted case management teams that monitor and support residents. That system has reduced emergency room visits by 56% and inpatient hospitalizations by 36% for residents under civil commitments.

The review also pointed out an innovative program at the jail to help inmates with mental illness and chemical dependency issues. A social worker embedded at the jail connects them with services when they are released. The program has resulted in a 48% reduction in jail rebookings.

The review offered a specific list of actions and several broad recommendations, including early intervention, innovative programming for diverse populations and a strong policy to advance system reform. The board will craft a strategic plan in December.

"The review is really impressive overall," said Commissioner Angela Conley. "It shows where we are at and where we have been."

David Chanen • 612-673-4465