Mental health system must be able to help those who don't know they need it

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A woman with schizophrenia calls 911 but won't respond to paramedics, case managers or social workers embedded with police. So, police bust down her door. Despite pleas from her family that she hasn't eaten or taken her medication for days and is catatonic, she refuses to go with them. So, they leave. All agree she has to say she wants help.

Sadly, hundreds of Minnesotans are living out this harrowing scenario.

We can do better. A bipartisan group of Minnesota legislators has been working to accomplish that. In 2020, they enacted nation-leading legislation that allows help for vulnerable people like the woman above.

The legislation provided an "engagement" component to our civil commitment statute, which allows families and mental health professionals to seek help for people with serious mental illnesses who do not recognize they are sick and won't accept help. Counties that opt into this can send mental health staff, including peers, to work with such people for up to 90 days to convince them to accept help. This ends the "there's nothing we can do" mentality.

The hitch? Due to lack of funding, legislators made this help contingent on counties opting in to the new law. According to the National Alliance on Mental Illness (NAMI) Minnesota, no county has done so.

Let's implement this game-changing law, already on the books, by providing state leadership and accountability.

Our mental health system is broken, in Minnesota and across the nation. But our state is already rightly giving attention to what happens to people with a serious mental illness after they have committed a crime. A significant bill to fund and implement humane competency attainment practices for those who have committed a crime but are not deemed competent to stand trial was passed last year.

This year, funding is being fast-tracked. We are working to get people with serious mental illnesses out of our jails and into more appropriate state treatment facilities, such as Anoka Metro Regional Treatment Center. These efforts are needed to help those who our mental health system has failed.

But the problems in the system are broader, affecting those with serious mental illnesses who have not committed crimes. Those are the people waiting in emergency rooms because hospital behavioral health units are full, or the people who are turned away from hospitals or by crisis teams because they do not believe they need help and aren't sick enough yet for intervention.

One of the authors of this commentary is chair of the Minnesota Senate's Judiciary and Public Safety Committee, focused on interrupting the cycle of so many people with mental illness only getting proper help after they commit a crime. The other authors have lived experience with anosognosia (a lack of understanding of one's mental illness) via their sons.

One was a brilliant and talented young man who had a psychotic break at age 24 which included no insight into his serious mental illness. What followed was 10 years of hell for him and his family, as his refusal to accept any treatment, in a failed mental health system that left his family powerless to help, led to deterioration and ultimately his death. Preventing such tragedies is a moral imperative and a responsibility of government.

The legislation we are working on would meet that responsibility. It provides startup funding and creates a new state authority to provide leadership and assist localities in implementing the 2020 law. We know from the experience of other states that providing earlier help saves money by replacing inpatient treatment or jail with more cost-effective outpatient care.

We are pleased that Attorney General Keith Ellison has offered to host this authority, a Civil Commitment Coordinating Office. In addition to helping communities provide earlier engagement and outpatient assistance, the office will work with an advisory committee to set standards, provide oversight, ensure data is collected and the system is accountable. They will advocate for better cross-jurisdictional ways to help vulnerable populations who have a serious mental illness.

Without money for expanded mental health facilities and care and the push of a state authority, the new civil commitment statute has been largely ignored. Lost has been an enormous potential to move Minnesotans with schizophrenia and other debilitating brain diseases into care before they experience the revolving door of our mental health system with repeat hospitalizations, homelessness, suicide or committing a crime. Some aptly call this: fail, jail, treat, street.

Many communities in our state have taken some steps to make improvements. But it is a tragic reality that some Minnesota families say the only way they can get help for their loved ones is when they are arrested and adjudicated. We need to do better — and this legislation is a big step in the right direction.

Mindy Greiling was a DFL member of the Minnesota House, 1993-2013. Ron Latz, DFL-St. Louis Park, is a member of the Minnesota Senate. Norman Ornstein is senior fellow emeritus at the American Enterprise Institute.