Managing mental health: Jesson visits Worthington to discuss Dayton's proposed budget

April 04--WORTHINGTON -- Minnesota Human Services Commissioner Lucinda Jesson met with mental health providers who work together for the southwestern corner of the state Friday in Worthington. The visit marks the first time a human services commissioner has visited Worthington in at least 34 years. Jesson presented a proposed budget from Gov. Mark Dayton that would help fill gaps in mental health services.

$39 million

Dayton's budget allocates $39 million for mental health over the 2016-2017 biennium. The plan outlines four initiatives intended to strengthen the state's mental health system: build a more solid foundation of prevention and early intervention, reform and enhance Minnesota's mental health treatment system, expand capacity to care for children and adults with complex needs and promote and support recovery.

Jesson said the state doesn't have consistency in what services are available around Minnesota. Information released by the Department of Human Services (DHS) backs that claim. Last year, DHS staff traveled around the state to understand the issues facing the mental health system.

Minnesota's fragile system

According to the DHS, one in four adults and one in five children will experience a mental illness in a given year. Between 70 and 90 percent of individuals who receive treatment for serious mental illness have significant reduction of symptoms and improved quality of life. However, while residential services are needed, the capacity is diminishing. The Woodlands Center intensive residential treatment services (IRTS) closed earlier this year, while others are in financially difficult positions.

Riverwood Community Mental Health Center, which serviced 3,000 clients, closed in 2014.

Jesson noted providers are reimbursed at different rates, which has led to some of the disparity in funding. The new mental health reform plan would look at the mental health services payment structure and attempt to correct the problem.

One of the problems facing mental health providers is a lack of qualified workforce. Don McCoy, human resources manager for Southwestern Mental Health Center said the center has had a number of positions vacant for over six months.

Jesson said the problem is one felt around the state.

"One thing that is a bigger issue in rural Minnesota are the workforce issues when it comes to our mental health workforce -- a problem statewide, but even bigger in rural Minnesota," Jesson noted. "I've heard that in a lot of places, and I certainly heard that loud and clear here (in Worthington)."

Service availability

Nobles County is part of an 18-county region for adult mental health provision. An overview of the state's adult mental health services shows an overall good system with many areas for improvement. In this region, services are more available but are limited.

IRTS available are meeting the current demand, according to information from the Department of Human Services. Likewise, assertive community treatment (ACT) is also meeting the needs.

The region offers only limited resources in 9 categories: inpatient psychiatric hospitalization, residential crisis services, permanent supportive housing, partial hospitalization, mobile crisis, day treatment, adult rehabilitative mental health services (ARMHS), case management-MHTCM and medication management.

The DHS notes limited availability statewide in ARMHS, case management-MHTCM and medication management.

In children's mental health services, Nobles County's region is lacking in several areas. Currently, inpatient hospitalization, psychiatric residential treatment facilities (PRTFs), children's residential treatment (CRT), treatment foster care, partial hospitalization, youth ACT and family peer specialists are not available in this corner of the state. Worse, family peer specialists are not available in any region of Minnesota.

Positively, Nobles County youths do have access, albeit limited, to day treatment, crisis services, case management, children's therapeutic services and supports (CTSS), school-linked mental health services, early childhood mental health, outpatient treatment, psychiatry, diagnostic assessment from ages 0-21 and integrated PCP.

Dayton's proposals

Gov. Dayton has put forth six budget proposals relating to youth for the 2016-2017 fiscal biennium.

* Enhance the state's capacity to serve children with the most intensive mental health needs closer to home by establishing PRTFs while closing CABHS.

* Develop services for youth experiencing their first episode of serious mental illness.

* Provide mental health consultation to child care agencies to support the children they serve.

* Support families of children with serious mental health issues by expanding respite care.

* Pilot innovative strategies to support students with mental health and substance abuse challenges.

* Develop capacity for communities to address adverse childhood experiences (ACEs) and trauma.

For adults, Gov. Dayton advanced the following proposals:

* Stabilize the mental health payment infrastructure.

* Establish new models for integrated mental health, substance abuse and physical health care.

* Increase capacity to serve individuals with complex conditions.

* Develop more supportive housing options for adults with serious mental illness.

* Improve and expand access to effective community-based services including mental health crisis services and ACT.

* Grow the mental health workforce through expanded psychiatric residency programs.

Scott Johnson, executive director of Southwestern Mental Health Center, said the governor's proposals would be a boost to not only his facility but others around the state.

"All of these things have the potential to help us with our mission and the communities we serve," Johnson said. "(Funding for) Unity House, our residential treatment facility ... that's crucial."

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