The past few weeks, we’ve shared the problems and challenges facing mental health care providers in Greater Minnesota. Today, we look at the solutions and recommendations laid out by the Center for Rural Policy and Development. Catch up on part one and part two.

Mental health services in Greater Minnesota

Limited resources are putting growing pressure on rural communities

By Marnie Werner, Research Director, Center for Rural Policy and Development

Working on solutions

To paint the whole picture of our mental health system is beyond the scope of this article, but it’s clear that it is a large, complicated issue, and it cannot be put right with quick fixes here and there.

However, there are many examples from around the state of how local providers are working to improve access to community services.

Yellow Line Project

Blue Earth County Human Services is working with the sheriff’s department and other law enforcement agencies to develop the Yellow Line Project, a jail diversion program that places a social worker “at the front door of the jail,” says Blue Earth County’s Youngerberg.

When a person with a mental illness is picked up by law enforcement, officers have few options, says Youngerberg, basically the emergency room, detox or jail. From the human services perspective, though, “there are lots of options. It’s a different way of looking at things.”

The social worker can contribute options on what would help and what’s available. Ultimately, it is the law enforcement officer’s decision to decide whether or not to divert from a criminal charge, but the discussion between the two disciplines makes for a more informed decision.

“With police and human services, the goal shouldn’t be to make one the same as the other,” she says. “They should work together.”

Interactive video

Interactive video technology is one of the most promising strategies for rural areas, where distance is a major consumer of time and money.

“It’s hard to have professionals on the road” visiting clients, says Dave Lee, Director of Public Health and Human Services for Carlton County. Those hours spent in the car could be used seeing more clients.

Carlton County is part of Adult Mental Health Initiative Region 3, comprising six counties and three tribes in northeastern Minnesota. The region covers 23% of the state’s land and only 6% of its population, so distance is the issue. The region is experimenting with the State of Minnesota’s internet-based telemental health system, Vidyo, to connect people with mental health providers.

For example, county jails sometimes have difficulty safely transporting inmates with severe mental health symptoms to a psychiatrist for diagnosis. The telehealth equipment installed in the jail allows the inmate to meet remotely with the psychiatrist, who can make a diagnosis and prescribe medication.

Schools in the region are also using the system, allowing kids to keep their appointments without the disruption of a long car trip, which can be upwards of 60 miles, Lee says.

“Patients are almost universally positive about it, and any resistance fades quickly,” says Lee. “It doesn’t replace face to face, but you can do more to help people when you have it.”

Childhood prevention and early intervention

School-Linked Mental Health Services already has a track record of improving access for children to mental health services.[18]

According to DHS, in Minnesota, mental health problems affect about 20% of children, and about 9% of school-age children have a serious emotional disturbance that interferes with their ability to function at home and at school.

The School-Linked Mental Health Services program funds the co-location of mental health services in local schools.[19] Community mental health agencies provide the staff at each school, who work directly with kids there.

The program has increased access to mental health services for children, especially those on Medical Assistance programs and those who had never accessed mental health services before.

Treatment courts

Mental health courts are one variety of treatment courts and are modeled after the state’s longer-standing drug courts.[20] Similar to drug courts, the idea behind mental health courts is to divert defendants with mental illnesses away from jail and into treatment and hopefully away from the cycle of behaviors that brought them to court in the first place. Mental health court is voluntary and invitation-only. Those who choose to participate agree to the conditions of community-based supervision. Court staff and mental health professionals then work together to develop individualized plans for treatment and supervision in the community.

While drug courts are more common, currently only Hennepin, Ramsey and St. Louis counties have mental health courts.

Certified Peer Specialists

Individuals who have experience with mental illness can receive training and be qualified as Certified Peer Specialists by DHS to work with individuals with mental illnesses, helping them discover their own strengths and work on recovery goals. CPS’s can work in a number of service areas, including assertive community treatment, crisis response and intensive residential treatment services.

Minnesota Management and Budget’s research into the cost-benefit comparison of CPS[21] showed a decrease in hospitalization and homelessness and an increase in employment and general functioning for individuals. Providers are optimistic about the CPS idea, especially as a connection to diverse cultural groups, but unfortunately it is difficult to find individuals who meet the present qualifications, MMB’s report stated.

“We’re not satisfied.”

Health care issues for rural people are everybody’s business, says Steve Gottwalt, president of the Minnesota Rural Health Association. “How can you accomplish anything else for economic development if you don’t have a healthy population with good health care? It’s everybody’s business to be concerned.”

According to Rep. Clark Johnson, who served on the Governor’s Mental Health Task Force, a lot of good things are going on to improve services for people with mental illness, “but we’re not satisfied, nor should we be. These are our family members, our neighbors, people we love.”

Recommendations

  • See the big picture: Understanding the big picture is important and will help in understanding how potential solutions fit into the larger picture—and what impacts they may have in both rural and urban areas.
  • Workforce is a top priority: Consensus among those interviewed is that workforce is the biggest problem, particularly the lack of psychiatrists and psychiatric nurses (APRNs). Addressing workforce issues is crucial, especially in ways that bring workforce to rural areas.
  • Dedicate funds: Counties—and county taxpayers—are required to pay for the medically unnecessary days people spend at AMRTC because of a lack of community services in their county, but these funds go into the general fund. It is important that they be dedicated to some purpose that improves community services.
  • Build trust I: The mental health system involves many separate groups with different levels of knowledge, interest and trust, and some are only beginning to talk to each other. Be cautious of assuming everyone is in the same place, which will help with keeping the paths of communication open and constructive.
  • Build trust II: In particular, while it was difficult to track officially, there was a perceptible level of friction between law enforcement and the mental health community, brought on by conflicting interests and regulations as the two groups tried to go about doing their jobs. Given the current state of the system, these two groups will continue to be thrown together. Some care can be taken to make their jobs easier by helping them work together.

Diversity: Immigrants and refugees are a growing part of Greater Minnesota’s population. Long-term planning should include addressing their mental health issues, too, especially since many of them went through traumatic experiences to get here.