Lawmakers fight to boost mental health funding

If you've got a large family, Thanksgiving can double as indicator of who holds the most influence when everyone gets together.

When the pumpkin pies are brought out following the big meal, it's often the most important who get the biggest slice.

Slicing up pieces of funding in the Minnesota Legislature works the same way. There's only so much pie available, so the biggest issues tend to get the biggest slices.

Education, health care, transportation and welfare get the largest pieces, with a plethora of other issues left to fight over the remaining portion.

Mental health is one of those issues. It has been boxed out over the years, leading to a reduced mental health infrastructure. However, some state lawmakers have introduced bills during this legislative session to address these shortfalls, and boost the system.

S.F. 141

The bipartisan bill set to address the shortage of resources for mental health crises is based on a program in Orlando, and authored in the state Senate by Sen. Barb Goodwin, DFL-Columbia Heights.

The bill is a reflection of Goodwin's personal history with mental health issues, as her mother suffered from paranoid schizophrenia. There was a mental health hospital in Golden Valley at that time that helped her during periods of “two to three months where she just couldn't function.”

“That was my original initiation to it, because I was pretty much a caretaker for my mother from the time I was about 10 years old,” Goodwin said. “It just breaks my heart to think about people who really need medical help and they're getting thrown in jail.”

Goodwin also cited a study on deinstitutionalization she worked on in 1985 under former Gov. Rudy Perpich. She also worked in children's mental health in Hennepin County before being elected to the House in 2000.

The bill, S.F. 141, and its House companion, H.F. 240, calls for $4 million to create regional jail diversion hubs throughout the state.

According to S.F. 141's summary, written by the Office of Senate Counsel, Research, and Fiscal Analysis for the Minnesota Senate, the bill would provide grants for counties to “establish mental health centers for individuals who have a mental illness or a co-occurring mental illness and substance abuse disorder, who are under arrest or subject to arrest.”

The bill specifically marks half of the funds for “counties in greater Minnesota with a high rate of poverty and limited mental health services.” It also requires counties to build on existing resources and to keep track of how the center reduces incarceration rates for people with mental illness.

Alyssa Siems Roberson, communications director for the Senate DFL Caucus and representative for Sen. Tom Bakk, DFL-Cook, said the bill “takes a unique approach to the challenges facing law enforcement officers when they interact with individuals in mental crisis.”

S.F. 141 comes from an article Goodwin read in the Star Tribune two years ago on the lack of mental health crisis beds, and how it's resulted in a greater rate of incarceration for people with mental illness.

“We don't have the resources to help people while they're in jail,” she said. “We know a lot of these folks don't need to be in jail, it's low-level crimes like trespassing or disturbing the peace.”

She started looking into the issue and studying what other states were doing about the problem. She found the best practices seemed to be a collaboration involving crisis beds combined with ongoing treatment and care after a patient leaves.

“Those examples were working dramatically well,” Goodwin said.

A center in San Antonio, Texas, has been able to save Bexar County millions of dollars and keep thousands of people out of jail, and has been able to help people served by the center with job skills and placement.

“There's nothing like that in Minnesota,” Goodwin said. “There's no jail diversion program that's specifically designed to divert people from jail in Minnesota.”

The bill is currently in the Senate's Health and Human Services Finance Commitee and has a chance to be included in the overall Health and Human Services omnibus funding bill, Goodwin said.

“I have a tremendous amount of support on this bill,” she added.

Bakk has supported mental health legislation in the past, as well as during this current session, Roberson said.

“Sen. Bakk is supportive of finding ways to address mental health challenges, particularly those that are unique to rural Minnesota in this session,” Roberson said.

Despite the bill's intention to help the mental health community, it has received some opposition from an unusual place: mental health advocacy groups. These groups have struggled for years to get any funding for projects, so they're now wary of a new program which could take away from funding their plans could get.

“Legislators are starting to see that's not an appropriate opposition, that it is more self-serving than anything else,” Goodwin said. “I am encouraging the legislators not to take the funding out of current programs, because we just don't have enough funding in mental health.”

Minnesota has the lowest number of residential treatment beds per capita of any state in the U.S., which might be attributed to mental health advocates' fear of returning to a system of state-run mental institutions.

“They have fought against adding any kinds of beds for many years now, and have said that you can serve them all in their own home,” Goodwin said. “I guess the homeless don't count.”

She said she's hopeful the bill passes, and feels it has a good chance at this point of making its way into the HHS omnibus funding bill.

“It is absolutely not a partisan issue,” she said. “It has that benefit of not having to depend on one party or the other for the votes.”

If enacted into law, Goodwin said there's no way the new programs won't work.

“These two or three pilot programs that are going to start up, I know they're going to be successful,” she said. “They've been extremely successful in other states, there's almost no way they cannot make it.”

H.F. 240

H.F. 240 is the House companion bill to S.F. 141, and its first two authors are Rep. Nick Zerwas, R-Elk River, and Rep. Dan Schoen, DFL-Cottage Grove.

Rep. David Dill, DFL-Crane Lake, chose not to comment on the issue due to his focus on other areas like wetlands and agriculture.

Zerwas said Goodwin reached out to him to author the House bill because it covered a shared topic of interest, and Zerwas had first-hand experience with the issue from working in the Anoka County Sheriff's Office.

“Every single day people are being brought to jail and incarcerated simply because there is no place else for them to go,” Zerwas said. “That does not mean these individuals belong in a jail cell, they belong in a hospital bed getting mental health treatment.”

Zerwas said he presented Goodwin's ideas to Sherburne County Sheriff Joel Brott, who serves one of the counties Zerwas represents. Brott told Zerwas he currently had someone in the jail who was there because there were no mental health beds available in the area.

“He's now in one of our holding rooms and we have two people with him trying to prevent him from banging his head against the brick wall,” Zerwas said Brott told him. “There is no place to bring this individual, there is nothing I can do with him.”

Brott's story isn't unique and it's a version of a story he hears a lot from many people who work in public safety, Zerwas said.

“They don't want to bring sick people to jail,” he said. “They want to get sick people help.”

Zerwas sits on the House's HHS Finance and HHS Refrom committees, and sees the interaction between people with mental illness and law enforcement as a public mental health problem. Detractors have said this program doesn't fix all the problems, but that's not the point.

“I challenge anybody in public health policy to find the silver bullet that's going to address every concern,” Zerwas said. “You're not going to find a cure-all, if this problem was easy to fix, it would be done already.”

Schoen said his involvement with the issue comes from his day job as a police officer in Cottage Grove.

“So much of what we do now is not about black or white, right or wrong,” Schoen said. “It's about crisis intervention. I think we do a better job of recognizing folks that need crisis intervention now versus maybe 20 years ago.”

People being transported all over Minnesota for mental health care aren't suspects, they're patients, Schoen said.

“They might be sitting in the back seat of a squad car, not an ambulance,” he said. “But the reality is they need medical help. It's not a broken leg, it's not the flu, it's a mental illness of some sort.”

Schoen said he put his name on H.F. 240 because “it's the right thing to do.”

“It's a realization that at some point when you know you have folks that need medical help, and just to lock them up, it's inhumane,” he said. “And it's wrong.”

The difficulty in finding a solution to the problem is the finite amout of resources available for mental health, Zerwas said. This has resulted in the bill running into opposition from mental health advocates who feel the bill would take away from funding for existing programs.

Money is always going to be an issue, Schoen said, but it costs much more to incarcerate people instead of giving them the help they need to prevent them from returning to jail when they're released.

“That's the number one goal here, is to put people back into society and have them be functioning and restore their dignity,” he said.

Mental health advocates who are worried about this new program taking away funding from existing programs are part of the problem, not the solution, Schoen said.

“If you're coming to the Legislature and you're trying to help people and you're just going to stick with the status quo that's been tried for decades, that doesn't work for me,” he said. “We need to do better, and we need innovation, and this is an innovative idea.”

Zerwas said a smaller mental health bill, H.F. 339, focusing on Beltrami County and authored by Rep. Dave Hancock, R-Bemidji, has a better chance for passage than the larger-scale H.F. 240.

“I think it's that type of solutions-based approach that really gets traction in St. Paul,” Zerwas said. “I am hopeful that we're able to move forward on that bill.”

Schoen isn't a part of the Republican House majority, so he said he's not sure if the bill might pass or not.

“It's going to depend on the funding that the Republicans want to cut,” he said. “And they want to cut a lot of money that doesn't need to be cut.”

With lawmakers working to address the shortage of mental health services in Minnesota, one thing is clear: it resonates because it directly or indirectly affects every Minnesotan, Schoen said.

“Maybe they don't directly have a diagnosis,” he said. “But I can assure you, they have a loved one that does even if they don't recognize it, realize it or know it.”

Boost the system

In the executive side of the state government, Gov. Mark Dayton has proposed $39 million in the Department of Human Services' budget to improve the state's mental health care infrastructure, and to address the service gaps through a three-part approach.

DHS Commissioner Lucinda Jesson said in 2014 her department went throughout the state to perform what they called a “gaps analysis.” Region by region, they assessed mental health services, and color-coded the results. Green represented adequate services, yellow meant limited services, and red stood for no services at all.

“There's a lot of yellow, and frankly, more red than green,” she said.

Those roundtable talks last summer resulted in a resounding message.

“I heard loud and clear from so many Minnesotans that our mental health system needs are increasing, we have more demand for mental health services,” she said. “But our capacity in our mental health system is actually diminishing. So we really need to right the ship.”

The governor's budget proposal looks at a whole continuum of services, Jesson said. It focuses on three specific areas: prevention and early intervention, treatment and recovery services.

“From our perspective, if you just do one of these things, it's not going to solve the problem,” she said. “We really need to look at all three of those.”

Prevention and early intervention for adults and children can delay and minimize the full onset of mental illness later on.

“What we found out is children start having these mental health problems before they even get to school,” she said. “So we need to provide referrals and expertise to centers that serve our poorest, most vulnerable children.”

The treatment portion includes more hospital beds for the most complex patients, both adult and child, Jesson said. The proposal also calls for funding a residency program at the University of Minnesota for psychiatrists who want to serve in public and community psychiatry programs.

Supporting people in recovery will help prevent them from cycling back through the system. The proposal calls for supportive housing for adults and respite care for families with children with mental illness, so those families can catch a break.

“If we don't support them, people with mental illness won't recover,” she said. “We have to give them the support they need.”

Adding more mental health hospital beds, as outlined in the proposal, would directly benefit Koochiching County. But boosting community support services would also provide a great benefit.

“A lot of people with serious mental illness, they don't need to go to a hospital, but you can't just discharge them back to an apartment living alone,” Jesson said. “They need support.”

Securing that support requires Dayton and Jesson to work with both political parties in the House and Senate to ensure the governor's budget proposal is funded. While it's impossible to predict the future, especially when it comes to politics, there is hope.

“When I became commissioner of Human Services, no one gave me either a crystal ball or a magic wand,” Jesson joked. “But I must say, when you look at some of the bills that are in the Legislature, in addition to what's in the governor's proposal to bolster our mental health, you see bills that are authored both by Democrats and Republicans.”

Mental health is an issue that stretches across the aisle in St. Paul, across Minnesota's numerous acres of lakes, rivers and streams, and into every home in the state.

“On a personal level, who amongst us doesn't have a close friend or family member that suffers from mental illness?” Jesson said. “I think anyone in Minnesota that doesn't recognize that maybe doesn't know.”

Read the first part of this series here.

Read the second part of this series here.