Facing chronic shortages, Minnesota's mental health system gets a boost

In an effort to ease chronic overcrowding of hospital psychiatric wards, the state will add 150 pediatric mental health beds in the next three years as part of an unprecedented expansion of services for children with mental illnesses.

The Legislature last week approved funding for a network of small treatment centers, to be built across the state, anchoring a broad package of preventive services so children don't wind up in emergency rooms and inpatient psychiatric wards, where many are discharged prematurely for lack of beds.

After relentless lobbying by parents of mentally ill children and their advocates, a bipartisan coalition of lawmakers approved a record $13 million in new funding for the next two years. That includes $6.6 million to create a network of 30-bed treatment centers for children with highly aggressive or self-injurious behaviors, who often are turned away from hospital inpatient units.

For Dan and Kyle Riley of Elko, Minn., the new centers will begin to fill a critical gap in the state's strained mental health system. Last October, the Rileys had to send their 17-year-old son, Michael, to a treatment center in Des Moines, Iowa, after more than 30 residential facilities across the region turned him away because they lacked beds and staff to deal with a child with unpredictable behavior. Michael was recently diagnosed with bipolar disorder and struggles with thoughts of harming himself and others.

The Rileys described living in a perpetual state of anxiety and crisis as their son rotated in and out of hospital emergency rooms while they scoured the region for a psychiatric bed. Last year alone, Michael was hospitalized six times; usually, he was discharged within a short period after receiving heavy doses of antidepressants and mood stabilizers.

The Rileys' experience is not uncommon. Officials estimate that each year, 300 to 400 children with mental illnesses in Minnesota go untreated; many wind up going out of state, far from their families, because of a shortage of pediatric mental health beds.

"No parent should have to send their child hundreds of miles away just to get treatment," said Kyle Riley, who testified about her son at the State Capitol this spring.

The new 30-bed treatment centers will help children and adolescents who are too unstable for outpatient care in the community but not acute enough to require hospitalization. "We can now feel better about those kids not falling off a cliff once they are discharged" from a hospital, said Dr. George Realmuto, a child and adolescent psychiatrist in Minneapolis.

For years, children who exhibit highly aggressive or violent behavior in Minnesota have been forced to drift from one short-term hospital stay to the next, often returning to their families heavily medicated but with their illness still largely untreated. Most small group homes lack the staff to handle their extreme behaviors, and inpatient psychiatric wards at hospitals are often too crowded to treat them for more than a few days.

The challenge came into sharp focus last year, when some residents of Golden Valley raised bitter opposition to a new day treatment program for children with mental illness. Residents packed a City Council hearing, warning of home invasions and violence from "emotionally disturbed" children.

A lack of county funding also has contributed to the problem across broad swaths of the state. A 2013 state survey found that only 39 percent of counties have residential treatment services for children with mental illnesses. In many rural counties, facilities with pediatric beds are 200 miles or more away from the children who need them; many families have to wait up to 60 days for admission.

The situation worsened early last year with the abrupt shutdown of Riverwood Centers, a large community health provider that offered mobile crisis services and psychotherapy to children and adults across a five-county region in north-central Minnesota.

"There are big gaps in our state …" Human Services Commissioner Lucinda Jesson said in an interview. "If we can reach children earlier, we're not only going to help those kids, but we're really going to help prevent the increasing mental health needs in our adult population over the long term."

After a vigorous lobbying effort by mental health advocates, county officials and hospital executives, lawmakers surprised everyone by approving more funding than even these groups sought. All told, the state Legislature approved $46 million for child and adult mental health services, surpassing the record amounts allocated under the Pawlenty administration. The package includes major increases in funding for crisis teams, suicide prevention, respite care and early detection of psychosis among youth, among many other services.

State officials said they expect 50 new pediatric psychiatric beds to be available by July 2017 and the full complement of 150 beds by July 2018. The new facilities will be funded through Medicaid, the federal-state program for low-income Americans, pending approval by the federal government.

The burst of legislative activity reflects a broad easing of the social stigma associated with mental illness and psychiatric care, said Sue Abderholden, executive director of the Minnesota chapter of the National Alliance on Mental Illness. "More people are coming forward to say, 'This happened to me and this happened to my family, and we need to do something about it.' "

Chris Serres • 612-673-4308

Twitter: @chrisserres