Mental illness in Minnesota jails: Don't prosecute DHS staff for backlogs; target elected officials

The Minnesota Sheriffs' Association (MSA) has released a statement calling for the prosecution of Department of Human Services (DHS) staff, including the commissioner, for violations of the "48-hour law" ("Sheriffs call for action on mentally ill," March 2).

This law requires the state to place jail inmates assessed to be mentally ill into a psychiatric treatment facility within 48 hours.

The ridiculousness of the call for prosecution should be apparent, but a thorough discussion of the issue clearly needs to occur if some support such a reckless idea. Furthermore, our governor and legislators have known about this issue for years and have refused to act. If we are to prosecute anyone, we should prosecute them.

Hennepin County Sheriff Rick Stanek, quoted in the March 2 article, makes a good point when he says inmates are "withering away and suffering in jail for no good reason." However, his leap to prosecution of DHS staff damages the image of his office and fails our communities by not providing a full picture of the mental health backlog in this state.

A 2016 legislative auditor's report on Mental Health Services in County Jails highlighted these issues in depth and acknowledged that "[t]here is no single solution." One major problem is the low staffing at high-acuity state-run facilities that artificially limits the capacity of the treatment centers and prevents inmates from being transferred. Another issue is the lack of lower-acuity, community-based mental health beds for patients at these state-run facilities to be transferred to once they no longer need a higher level of care, adding to the inmate backlog. (Acuity refers to the intensity of nursing required by a patient.)

The MSA's counsel makes light of these staffing and budgetary issues in a letter to prosecutors by stating an awareness that the state's Human Services commissioner "believes resource constraints prevent her from complying with the law" but maintaining that the law is black and white and should be followed; if it is not, prosecution should be in order.

The legislative auditor, however, acknowledges that sometimes DHS chooses not to comply "due to concerns for staff and patient safety." That statement is not something to take lightly, and the legislative auditor's report recommends that changes in the statute be made to "clarify whether there are circumstances in which DHS is not required to comply with the law."

As a mental-health nurse, I understand the urgency of admissions to psychiatric treatment facilities, but I also recognize the obligation to my current patients. Should an admission be expected when our unit is short-staffed, we have every right to refuse the admission (and should) until conditions that promote a safe environment for staff and patients are met. To not acknowledge this is a gross abuse of power by the MSA. It attacks mental-health professionals for doing their jobs and shifts the blame away from those elected to solve these problems.

Although the statement by the MSA is misguided, I understand where the sheriffs are coming from. Working in a community-based mental health facility, I am privy to the violent assaults on staff by patients who await transfer to a state facility but are being held because of space limitations. We hear too often of jail inmates who have died because they did not receive appropriate treatment. I've also spoken with a sheriff who is concerned about the capacity to ensure the safety of inmates while receiving assessment and treatment on an outpatient basis.

In some circumstances, the jails are ordered to use their resources to provide security details for the transport of inmates between the jail and treatment center. This pulls personnel from the jails and reduces the ability of counties to provide adequate conditions and oversight to other inmates and the community.

This should be testament to the fact that the feud between county jails and DHS is misplaced; the feud should be between Minnesotans and their elected officials. The legislative auditor clearly writes that the Legislature needs to "fully fund" these state facilities, but the response so far has only been crickets.

This won't be an easy or cheap fix, but it's one that needs to happen in the Legislature. The MSA would be a powerful ally in this lobbying effort if it more appropriately and productively redirected its frustrations. Legislators, consider yourself on notice.

Joseph DeBoer, of St. Paul, is a mental-health nurse.