Grading the States 2006: Minnesota - Narrative
Minnesota has a reputation for independence and innovation and may compare well with other states, but its mental healthcare system still has problems.
During FY 2004-2005, with a budget deficit of approximately $4 billion, mental health services escaped direct cuts - but related programs, such as vocational rehabilitation, were not as lucky. In addition, for the first time, the state Medicaid program instituted prior authorization requirements and co-payments for medications. Although psychiatric medications were excluded, the state should be seen as moving toward restrictions on access to care, requiring vigilance by family and consumer advocates. Because of reduced state dollars, counties - which share responsibility for helping people with serious mental illnesses - in turn have reduced local services.
The State Mental Health Authority (SMHA) has launched an Adult Mental Health Initiative (AMHI) intended to replace regional treatment centers with 16-bed community inpatient hospitals as part of an overall transition to community-based care. Unfortunately, this initiative is taking place at a time when the lack of inpatient acute care beds in many parts of the state has reached crisis proportions. In 2004, the state reported shortages of both public and private psychiatric beds. Community hospitals have been eliminating psychiatric beds and replacing them with more lucrative medical-surgical beds. In the densely populated Minneapolis-St. Paul area, emergency rooms are overflowing with people experiencing acute psychiatric emergencies and with no place to go. Ultimately, if the conversion to a community-based system of care is to be successful, it will be very important to maintain adequate numbers of acute care beds, intermediate and long-term care beds for those who need them, and supportive housing units for people ready to re-enter the community.
As part of this conversion, the SMHA is working with adult residential treatment providers to transform into shorter-term programs providing an array of services, including crisis stabilization, integrated treatment, self-management of illness, and supported employment. These can be positive steps, as long as the needs of people requiring longer-term residential services and supports are adequately addressed.
The SMHA has worked hard to implement evidence-based practices (EBPs). There are currently 25 Assertive Community Treatment (ACT) teams in the state. Four of them serve 18 counties in the rural southwestern area; greater statewide penetration of ACT is needed. The SMHA is also collaborating with the state agency responsible for alcohol and substance abuse services to provide training and other technical assistance for integrated mental health and substance abuse treatment for people with co-occurring disorders.
The SMHA and the Minnesota Housing Finance Agency are collaborating to run the state-funded Bridges program that provides approximately $650,000 in rental subsidies for 450 persons with serious mental illnesses in 2005. The state also has created a crisis housing fund for consumers who need financial assistance to preserve their housing while hospitalized - an exemplary program that other states should study.
The state is beginning to focus on jail diversion and alternatives to incarceration, but there is a long way to go. Mental health courts and jail diversion programs are located only in Hennepin (Minneapolis) and Ramsey (St. Paul) counties. These programs should be replicated in other parts of the state. Preliminary discussions have taken place about implementing a state prison diversion program for individuals with serious mental illnesses convicted of felonies, but this is far from becoming operational.
Increasingly, cultural competency is a necessity for the mental health system in Minnesota. A quarter of the state's federal mental health block grant allocation is targeted to Native American tribal government. The state also has a growing Laotian Hmong population.
Minnesota needs to make careful choices. It faces an equal prospect of moving upward or downward in the years ahead. It will be smart to continue to invest in the mental healthcare system, and to build on existing strengths. It may take time and money to build a good system. Unfortunately, it doesn't take long to wreck one.
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