ST. PAUL-If you are a Minnesotan experiencing a mental health crisis, there's a strong chance that the police officers or paramedics who respond to your call for help will take you to jail or a hospital emergency room because there aren't enough other treatment options available around the state.
Or you may be taken hundreds of miles to another state where a psychiatric bed is available, making it hard for your family to visit.
When you're released, you may end up homeless because you didn't get the care you needed and there are few other housing options available.
"Too often people with serious mental health issues end up in our jails, our hospitals or on the street homeless," Ramsey County Board Chairman Jim McDonough said at a recent Minnesota House committee hearing. "This is the outcome of not planning, building, providing or maintaining a continuum of care.
"Our residents who have a mental health condition are left without support, their conditions deteriorate, and they end up in bad and worsening situations. They lose their jobs, their housing and whatever stability they've achieved."
But a proposal moving quietly through the Legislature would take a step toward closing gaps in mental health facilities.
The bill would provide $80 million for state grant programs to construct six mental health crisis centers around the state that cities, counties, hospitals and other public entities would operate to serve mentally ill and chemically dependent people. The plan also would grant funds to build three long-term housing facilities to support mental health services.
Numerous studies have reported huge gaps in Minnesota's mental health services.
The crisis center proposal "would be a start in closing those gaps," said Sen. David Senjem, the Rochester Republican who introduced the bill and chairs the Capital Investment Committee that will decide whether to fund it.
Bricks and mortar
Senjem's legislative package and a companion House bill sponsored by Rep. Tony Albright, R-Prior Lake, would provide money in the Legislature's public works bonding bill this year for grants to local governments to pay for constructing or renovating facilities to house a wide range of services that treat people with mental illness or chemical-dependency disorders.
The state funds could be used only for bricks and mortar. Although details remain to be worked out, costs for operating the centers would come from fees for services, private health insurance, Medicaid (called Medical Assistance in Minnesota), state grants and local property taxes. The services would be provided by public agencies or other organizations.
"Each community could design a center and a program that fits their region as best they see fit," Albright said. He envisions mental health, social work and medical professionals working together at the centers with law enforcement personnel, local faith communities and other mental health advocates.
Local entities would apply for grants to the state commissioner of human services, who would evaluate project proposals and set criteria for the grants.
Ramsey County model
Ramsey County's Urgent Care for Adult Mental Health center at 402 E. University Ave. in St. Paul "offers a glimpse of what this bill envisions," McDonough said in recent interview.
Opened in 2011 by an alliance of Ramsey, Washington and Dakota counties, area hospitals, health insurance plans and several advocacy groups, the center provides 24/7 crisis phone support, mental health crisis assessments, chemical health screening, crisis stabilization services, family education, referrals to psychiatrists and other community services. It also employs "peer recovery specialists" who have overcome mental health or substance abuse issues and know how to navigate mental health systems and "build up hope," said Alyssa Conducy, manager of chemical and adult mental health services for Ramsey County's Community Human Services Department.
The urgent care facility also houses a detox center and the county's civil commitment court. It's located near Regions Hospital, the Ramsey County jail and the Union Gospel Mission, where many of its clients come from.
When people drop into the center, they enter a "living room" reception area that provides a "safe and welcoming environment," Conducy said. The center's crisis assessment staff typically see visitors first, try to stabilize them and build coping skills with daily, weekly or monthly counseling sessions. Last year, they did about 700 face-to-face assessments.
The staff try to connect clients with services in or near their homes. "Eighty percent of them can get the services they need in the community, not in hospitals," Conducy said.
"We also go into the community with police," she said. Last year, St. Paul officers requested the center's assistance 142 times. The center, in turn, asks police to transport "people who are dangerous to themselves or others" to more-secure facilities.
Other counties want in
The Association of Minnesota Counties is all in for the crisis centers.
Eighty-six of the state's 87 county boards of commissioners have passed resolutions calling on lawmakers to fund the program. AMC executive director Julie Ring said last week that she expects the remaining county to submit its request soon.
Senjem has big-time Senate muscle behind his bill.
It is co-sponsored by Senate GOP Majority Leader Paul Gazelka, Senate DFL Minority Leader Tom Bakk, Senate Finance Committee Chair Julie Rosen and Sen. Sandy Pappas, the lead DFLer on the Capital Investment Committee.
Albright's companion bill in the House also has broad bipartisan support. At two recent House committee hearings, long parades of advocates and lawmakers testified in favor of the bill, and no one opposed it.
Senjem and Albright both said there's a growing recognition across the state of a need for more facilities to assess, treat and house people with serious mental health issues but who don't need hospitals.
Identifying the need
Senjem said he started hearing about problems at Mayo Clinic's St. Mary's hospital in Rochester, where patients waiting for mental health admissions were being boarded in the emergency department "because there was nowhere else to put them." Mayo reported averaging seven such patients a day for a total boarding time of 1,963 days in 2016, the latest data available.
About the same time, the senator said, he also was hearing about the need for mental health centers from county commissioners, sheriffs, county attorneys, business leaders, college and school officials and organizations that provide mental health services.
"The main complaint was there was no place to take people who need help," he said.
More emergency room beds aren't the answer, said Dr. Bruce Sutor, clinical practice chair at Mayo's department of psychology and psychiatry.
While some more beds are needed, he said, just adding ER slots would be like adding more intensive-care hospital rooms for heart attack patients but doing nothing to prevent smoking, improve diets and exercise or provide more cardiovascular and blood pressure screening.
For mental health care, Sutor said, the state needs more outpatient services that better identify and treat mental illnesses earlier and address addictions that often overlap with mental diseases.
The benefits of early intervention
Early interventions can help "decrease hospitalizations and increase employment, thereby generating benefits to participants and the state," according to a 2016 cost-benefit analysis by the Minnesota Management and Budget department. Of seven mental health services analyzed, it found that six provided benefits that exceeded costs.
For instance, every dollar spent on sending a team of mental health professionals to meet and help an individual at a crisis scene saves an estimated $3.90, the study said.
Duluth-area officials recognized the problem early on. In 2015, they commissioned a study that found St. Louis County spent about $52 million a year to house and treat the top 200 users of the county's mental health services, said St. Louis County Commissioner Patrick Doyle.
Most of those people were caught in a "revolving door," bouncing from jail or hospital emergency rooms to the streets, Doyle said. "We didn't have a warm hand-off, follow-up care and ways to make sure they got to their appointments or their medical and social needs were met."
He said Arrowhead region officials are ready to apply for state crisis center grants if they become available.
Ten southeast Minnesota counties also are prepared to seek a grant, said Paul Fleissner, Olmsted County's deputy administrator for health, housing and human services. Senjem credited Fleissner for crafting the crisis center proposal.
Senjem had a personal reason to act. "My mother suffered from mental illness all her life. My dad was bewitched with the demons and committed suicide when I was 12 years old," he said.
"I probably know this subject just about as well as anybody."
Albright, a long-time advocate for mental health care, also has a family connection to the issue. His daughter is a paramedic who "transports these patients 200 or 300 miles day in and day out," he said. "When I asked her why, she said, 'Dad, that's where the bed was available.'"
Still faces uphill battle
Gov. Mark Dayton didn't include the mental health centers in his $1.5 billion bonding request to the Legislature earlier this year.
When asked if he supports the legislative proposal, his press secretary, Sam Fettig, said in a statement: "Gov. Dayton thinks Sen. Senjem has an excellent idea to address this critical need in Minnesota. He looks forward to working with the senator to include it in this year's bonding bill."
The project still faces a steep climb. Republican legislative leaders have said they plan to approve about $800 million for bonding projects this session, or roughly one-third of what state and local government agencies have requested.