Minnesota faces escalating demand for mental health services

On Monday, Jill Stadtmueller's daughter Sienna will start day treatment for her anxiety and depression. The family has waited nine months for this moment.

During the delay, Sienna has been in and out of the emergency room. The 13-year-old has been on and off "heavy duty" medication. And she has struggled to make it through school.

"I'm a planner. I like to have my ducks in a row. I have every resource that I can identify for her in play," said Stadtmueller, of Wayzata. "But when you're waiting, there's nothing you can do. It's a horrible feeling. Your kid's just getting worse and worse."

The COVID-19 pandemic, along with trauma from gun violence and racism, has worn down Minnesota's already stretched mental health safety net. The number of children arriving at many emergency departments with a mental health crisis has climbed over the past two years, as have applications for outpatient and day treatment programs. Meanwhile, staffing shortages have gotten worse, and long-standing problems with low wages and a lack of culturally competent providers persist.

Advocates are urging state leaders to spend hundreds of millions of dollars over the next few years to add providers, improve support in schools and reduce wait times for services. Legislators on both sides of the aisle are getting behind some of the ideas to help with the crisis.

On Thursday, hundreds of service providers, people with mental illness and their family members called, e-mailed or met with state legislators to press for a long list of needs. Last year they helped push lawmakers to expand telehealth services, require 911 dispatchers to send mental health crisis teams when appropriate and put more money toward crisis call lines and services in schools.

"The pandemic has put a tremendous strain on our mental health, especially for some of our most vulnerable, our families, our children, our essential workers," DFL House Speaker Melissa Hortman said in a video shared at Thursday's event, noting that the state needs to use its historic budget surplus — now estimated at $7.7 billion — to do more.

Some Senate Republicans and staff met last week to discuss a significant mental health proposal, said Sen. Julie Rosen, R-Fairmont, and they will debut it soon.

"That's an investment that we need to make," Rosen said, noting that along with public safety and tax cuts this session, "Mental health is one of the top issues."

Nearly 10,000 people were on waiting lists to access mental health services as of last week, according to the Minnesota Association of Community Mental Health Programs. More than half are children. The association also tallied 650 unfilled staff positions across 20 mental health agencies.

Both Democrats and Republicans want to allow more mental health professionals to be eligible for loan forgiveness, expand intensive treatment services now limited to kids in foster care and spend $10.5 million to help children's residential treatment facilities cover overtime and training, recruiting and retaining staff. There is also bipartisan support for grants to treat and support adolescents and adults experiencing their first psychotic or mood disorder episode.

Another measure, which has only DFL backing, would use $62 million of the federal pandemic recovery dollars on emergency grants to community mental health programs to help hire and retain employees.

Sarah Washington, a mother and grandmother, has long been an advocate for her four girls who have had a variety of mental health challenges. One of the parents contacting legislators last week, Washington is Black and lived near the corner where George Floyd was killed before recently moving to Minneapolis' Seward neighborhood. She said some workers in the industry need cultural competency training to better serve a diverse range of clients, many dealing with layers of trauma.

"You have racism. You've got teacher compassion fatigue. You have a workforce shortage. You have trauma on trauma. You got gun violence," Washington said. She urged legislators and DFL Gov. Tim Walz to think "outside the box" to find ways to provide help in schools.

Walz's supplemental budget plan includes more than $100 million dollars specifically for mental health efforts. Two of his largest spending proposals in that arena are nearly $30 million for mental health screening and referral systems for students and school staff, and more than $26 million to add beds at treatment facilities for kids in need of acute psychiatric care.

At Fairview Health Services' emergency departments, the number of children and adolescents arriving with a mental health crisis as the primary concern climbed 17% from 2019 to 2021. Last year, a child who needed to be admitted to an inpatient care program waited an average of 45 hours in the E.R., Fairview's data show.

The average stay for children at HCMC's acute psychiatry services center has nearly doubled from 2017 to last year, and at Allina Health's emergency departments the median stay for a child admitted with a mental health crisis jumped 70% over the past few years.

Fairview aims to add a 144-bed mental health hospital, and a bill with bipartisan support would allow the project to move forward. But some advocates oppose the idea, saying mental health services should not be separated from services for the rest of the body.

There should be more preventative services, day treatment programs and intensive in-home support for families so fewer people need to bring their children to emergency departments, said Allison Holt, physician chief of mental health and addiction services at Fairview.

"These families are just run ragged, really. They are trying the best that they can, but they just don't have the resources," Holt said, then when the family arrives at the emergency department, "It's loud, it's fast, it's scary. It's certainly not calming."

Some children live in that stressful environment for months.

One boy was stranded at the hospital for 11 months, Holt said. For nine of those months he was well and ready to leave, she said, but remained because his county could not find a foster family for him. Adults with intellectual and developmental disabilities are also landing in that situation, she added, noting an adult stayed at the hospital for about 400 days.

Stevie Borne is all too familiar with waiting. For three years her child has faced depression and anxiety. For three years Borne has been on watch. She has spent many nights on the floor of her child's room in a sleeping bag, worried her kid will try to self-harm.

Then there are times when she feels she cannot keep her child safe.

When children arrive at the emergency room for a mental health crisis, their room is cleared of medical equipment they could use to hurt themselves, Borne said. Kids must change into hospital scrubs, they're searched and all their belongings are taken away, she said. Then they wait.

"You and your kid are literally just sitting there not knowing what to do," she said. "Your kid is suicidal ... and then you keep waiting. And you are uncomfortable, the kid is uncomfortable. And you wait."

Staff writer Hunter Woodall contributed to this report.