What is community's role in mental health?

Nov. 08--In its last session the Minnesota Legislature approved a $43 million funding package to address mental health and chemical dependency treatment -- but how should that system work?

The state government and county governments are in the process of finding a functional balance, a balance between the more intensive inpatient services the state has historically provided and the community-based services operated by counties.

In the $43 million in funding targeted for 2016 and 2017, the state has placed an emphasis on growing community programs and addressing mental health and chemical dependency issues outside of the most costly environments: hospital emergency rooms and inpatient treatment centers. Community services include mobile crisis response and permanent supportive housing, both of which Olmsted County currently provides.

"This place has saved my life," said Monte Bothun, a 57-year-old resident at Olmsted County's Silver Creek Corner, one of three supportive housing options in the county.

Bothun has been in and out of local and state-level programs for decades. He has had some success in addressing his mental health conditions and his substance abuse in inpatient settings in the past, but when he would return to the community without a plan for continuing care, he would fall back into problematic behaviors, he said.

Silver Creek Corner provides group supportive housing, a stable housing situation where residents can be connected to outpatient care in their immediate area. Bothun meets regularly with his caseworker and has a plan for his continuing care.

In four years, he has reached and exceeded every goal he and the professionals he works with have set.

"I can't say enough good about this house. It changed my life," he said.

The state's expanded funding to community mental health services came at the same time another problem arose: a shortage of inpatient residential psychiatric beds. Hospitals, jails and community service providers are struggling to find placements for people who need a higher level of care in inpatient environments.

"What we kind of see or notice most is that there are no inpatient beds for people; people sit in the (emergency room) and they wait and they wait. That's a real challenge," said Amy Shillabeer, a program manager in Olmsted County's adult behavioral health unit.

Developing community-based services is part of the solution, said Jim Behrends, county adult and family services director.

Behrends has identified four priorities to improve the county's response to mental illness and chemical dependency: hire psychiatrists to the county's full capacity; advocate for an appropriate amount of inpatient beds at the state level; increase supportive housing options; and expand the county's mobile crisis response capacity.

Psychiatry is the cornerstone of the system, Behrends said. Zumbro Valley Health Center, with which the county contracts for a variety of services, announced the hiring of a psychiatrist last week. There is funding for another at Olmsted County and the search continues.

Advocating for more inpatient beds comes next, Behrends said, because there is no direct replacement for the intensive level of treatment provided at these facilities.

The county can assist in opening more of these beds by providing healthy environments for people to be discharged to, including permanent supportive housing, Behrends said.

Rep. Tina Liebling, a state representative and DFL lead on the House Health and Human Services Finance Committee, said lawmakers are aware of the shortage of public psychiatric beds, but also aware of the value of community-based services.

"The hospital is kind of a last resort situation, and it's only as good as the resources you've got when the person comes out," Liebling said.

After housing, the county's fourth priority is for increased crisis response capabilities. Olmsted County and Zumbro Valley Health Center are the lead providers of crisis response services, said Dave Cook, Zumbro Valley executive director.

Zumbro Valley has also worked to improve its continuum of services, in addition to the county's priority areas. The health center now provides primary care, dental care, employment assistance and other services.

"We have been working toward a much more integrated system here at Zumbro Valley," Cook said. "We understand that these things are not divorced from one another; they're all part of what may be impacting a person's life. We want to connect on that continuum as much as we can."

It is too soon to tell how the state's most recent funding will impact mental illness and chemical dependency treatment, but advocates recognize the opportunity.

"This last session was a terrific session in terms of increasing levy dollars for our mental health system," said Sue Aberholden, executive director at the National Alliance on Mental Illness -- Minnesota.

"People used to always say '(the system) is broken,' but I would really say that it's not broken -- it was never built," Aberholden said.

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