Legislative auditor urges overhaul of mental health services for jail inmates

Hundreds of Minnesotans with mental illnesses are being confined in county jails — in some cases, illegally — because of a severe shortage of psychiatric services and long-standing gaps in state law.

In a scathing report issued Thursday, the Minnesota Legislative Auditor found that nearly two-thirds of those deemed too incompetent to stand trial because of mental illness are jailed while courts decide whether to commit them, in direct violation of state law.

While in county jails, mental health care is woefully inadequate and often falls short of professional standards, the auditor found. Jails across the state are often failing to perform mandatory checks of inmates' well-being, which has put them at greater risk of self-harm and suicide. Since 2000, there have been more than 50 suicides and 770 suicide attempts in Minnesota jails — some preventable, the auditor found.

While the report focused on mental health services in jails, the auditor also highlighted deep flaws throughout the state's system of treating people with serious mental illnesses. These include a statewide shortage of psychiatric beds, limited access to outpatient mental health services, and laws that prevent the timely admission of jail inmates to state-operated psychiatric facilities.

"The Legislature, [the state] and the counties should continue to work toward a comprehensive mental health system," said Joel Alter, evaluation coordinator for the state legislative auditor, at a Senate hearing Thursday. "We are not there yet. And arguably, we are a long ways away from being there."

The findings were disclosed at a Senate health and human services committee hearing on Thursday, where several lawmakers called for broad-based reforms and expressed frustration with the state's piecemeal efforts to relieve chronic shortages in the delivery of mental health services.

In an interview Thursday, Gov. Mark Dayton said his office will make a series of recommendations to the Legislature that would address the patient-flow bottlenecks in Minnesota's mental health system. He said the recommendations would be "expensive," but added that, "It's money we absolutely have to spend."

"I use the word 'crisis,' " Dayton said. "I think we have a crisis in our whole mental health system, starting with those in jails. … We don't have facilities available to move people to a therapeutic environment."

Sen. Kathy Sheran, DFL-Mankato, and chairwoman of the Senate health and human services committee, called for a comprehensive review of mental health services. The review should be similar in size and scope to the state's evaluation of the child protection system following the death of a 4-year-old boy from Pope County after repeated warnings to child protection, she said.

"The bottom line is, we are not meeting our obligations under the law," Sheran said. "We're getting various pieces of legislation that make an attempt to fix some piece of the mental health system here or there — but we fail to look at the whole system."

Last year, the Legislature approved a record $46 million in funding for mental health services, for everything from suicide prevention and early psychosis intervention among youth to the development of teams to coordinate mental health care for inmates being released from prisons.

While these initiatives have been heralded by mental health advocates, they have yet to make a significant dent on the state's large population of jail inmates suffering from mental illness. One indicator of the problem is the dramatic surge in the number of criminal cases in which a court has ordered a mental examination of a person's ability to stand trial. Statewide, the number of such cases has nearly doubled from 844 in 2010 to 1,657 in 2014, the auditor found.

The Hennepin County Sheriff's Office estimates that about one-third of the 35,000 to 40,000 people admitted to the county jail have some form of mental illness.

"Minnesota's county jails have become de facto warehouses for the mentally ill, because there simply are not enough beds, community placement options, stabilization facilities, or arrest alternatives," Sheriff Rich Stanek testified at the hearing. "And in many cases where mental illness is involved, these inmates stay, and they stay, and they stay."

Yet, across Minnesota, jails lack consistent standards for treatment, the auditor concluded. For example, professional standards suggest that jails develop individualized treatment plans for inmates with mental illness, yet Minnesota rules do not require such plans. Professional standards also suggest that jails assess the mental health of inmates within prescribed time periods, yet Minnesota does not require such assessments, the auditor found.

At the hearing, Legislative Auditor James Nobles highlighted the case of a woman found naked on top of a pickup truck on the side of a highway, on a night last winter with subzero temperatures. The woman was brought to a hospital, which contacted the state Department of Human Services to check for available beds. None were available. Lacking other options, local law enforcement decided to hold the woman in jail on criminal charges rather than release her to the streets, the auditor found.

"She clearly belonged in a treatment facility and not in a jail," Nobles said.

Many such inmates languish for weeks or months in jail while they await court action on civil commitment petitions — a violation of state law, the auditor found.

Under Minnesota law, individuals who are awaiting court decisions cannot be held in jail, except in extreme cases. The legislative auditor found that 63 percent of incompetent individuals were in jail for all or part of the commitment process.

Staff writer J. Patrick Coolican contributed to this report.

Chris Serres • 612-673-4308