During the 2016 election season, HealthBasics asked Minnesota experts to identify some of the critical health issues facing the state. One issue that came up time and again was mental health care.

Sheila Kiscaden, an Olmsted County commissioner and a former state senator, put it this way:

“Minnesota’s mental and behavioral health services are in crisis at every level.  Staffing and funding shortages limit the necessary services Minnesotans are able to obtain in both out-patient and in-patient care settings. As a result, patients in crisis too often end up in county jails and acute care hospital emergency rooms and are forced to stay there for long periods because there are no in-patient beds available.  State-operated services are understaffed and have quality of care issues. Patients who do get in-patient mental health treatment stay longer than medically necessary because there are no transitional care beds available.  Our ‘system’ is inefficient, struggles to provide quality care, and rather than intervening quickly, delays treatment which puts people with behavioral health issues at greater risk.”

Mental illness affects an estimated 5.4 percent of all Minnesota adults, according to a report issued by the Governor’s Task Force on Mental Health in November 2016. That means nearly a quarter of a million adults are diagnosed as having a serious mental illness that affects their daily lives.

According to the report, “Minnesota’s mental health system provides a variety of effective services that can assist people in their recovery from mental illnesses.”

However, “system inadequacies create significant problems for people with mental illnesses, their families, and organizations that seek to contribute to solutions. Not only must they fight the stigma and discrimination that is directed at people with mental illnesses, but they must also fight through a confusing maze of insurance benefits, eligibility requirements, financial arrangements, service providers, treatment plans, and logistical challenges to get the services they need. Even if they are able to find local providers, the services are sometimes a poor fit with their sense of what they need and they are sometimes difficult to access due to physical, language, or cultural barriers. Moreover, individuals and families often struggle to integrate their care across a range of public and private providers and across institutional sectors that have conflicting expectations and incentives.”

Stigmatizing those with mental health issues often surfaces after a mass shooting. That was the case with the tragedy at the First Baptist Church in Sutherland Springs, Texas.

“‘Victims of severe mental illness are much more likely to be victims of crime than to perpetuate crimes,’” said Dr. David Baldes, a psychiatrist at St. Luke’s hospital. “’On average, mental illness is not associated with violent behavior.’”

“Just as society accepts that people with chronic severe medical illnesses may need to live in a nursing home, it should be understood that people with severe mental illnesses may not be able to live independently, Baldes said.

“Moreover, he said, when mental health hospitals were closed, it was with the assurance that community mental health centers would be able to take their place. But those centers have been chronically underfunded, Baldes said.” Baldes was quoted in the Duluth News Tribune.

The Minneapolis Star Tribune reported on a “a decision that has dismayed mental health advocates…” Essentia Health, a large health care network, no longer is admitting patients with severe mental illness to its psychiatric unit at St. Joseph’s Medical Center in Brainerd. According to the StarTribune, “The hospital’s 16-bed psychiatric unit now admits only patients who voluntarily accept treatment — who tend to have less-acute mental health problems than those who are civilly committed.”

Essentia cited safety concerns as the reason for the decision. It adds to the growing shortage of beds for those with mental illnesses, including those with severe issues. The Star Tribune points out that the shortage of facilities “was exacerbated by a 2013 law that requires the state to find a psychiatric bed within 48 hours for anyone in a jail who is determined by a judge to be mentally ill. The law was meant to reduce the number of inmates sitting in jail without mental health treatment; however, it has forced hospitals to keep mental health patients longer because they have nowhere to send them.”

In one piece of good news, Minnesota Public Radio reported on the increasing focus on de-escalation training for Minnesota police departments. A 2016 law requires police officers to take at least one hour a year of de-escalation training. “Authorities say that expertise is crucial because of the growing number of police calls involving people who are in the throes of a mental health crisis when the squad cars roll up. Of the 14 Minnesotans shot and killed by police in 2016, six were in the throes of some kind of mental health crisis,” according to the MPR report.