Minnesota's mental health system like bad 'traffic jam,' report says

Minnesota's patchwork mental health system suffers from chronic shortages and significant barriers to treatment that require wide-ranging reforms and legislative action, a task force reported Monday after four months of work.

The task force was created by Gov. Mark Dayton amid complaints that delays had hit crisis levels, with chronic bottlenecks at state mental health facilities and overcrowded psychiatric wards at the state's hospitals.

"We see people languishing in emergency rooms. We see them in homeless shelters, and we see them in our jails," Human Services Commissioner Emily Johnson Piper said in an interview Monday. "This [report] is not just about how we get people access to really intensive services but also how we get them to not need those services — so we don't have this backlog in our system."

In a draft report released Monday, the group issued nine recommendations, from expanding the state's mental health workforce to enforcing parity laws that require private insurance companies to cover more treatments. The detailed road map calls for a continuum of mental health services that follow people at each stage of their lives, instead of just responding to crises.

The 78-page draft report is the product of four months of study and a series of all-day meetings by state lawmakers, advocates, state health officials and individuals with experience with mental illness. Unlike previous groups, the panel was more focused on providing systemwide solutions than in identifying gaps that already are well known, officials said.

A study released in August by the St. Paul-based Wilder Foundation found that nearly one in five psychiatric patients across the state is stuck in a hospital bed even after being stabilized and ready for discharge because of bureaucratic delays and a lack of other treatment options. Across the state, some patients are waiting up to three months for placement in state-run psychiatric sites.

The long delays for care mean that people are cycling through settings, such as emergency rooms and county jails, that are not equipped to treat people suffering through mental health crises, officials said.

"Like a traffic jam caused by construction, the slowdown reverberates through the system and multiple roads are affected," the report said.

Although there is broad agreement that Minnesota suffers from a shortage of inpatient psychiatric beds, the task force urged a more "systemic" approach than just adding more hospital beds. For instance, recognizing the crucial role that stable housing plays in a person's recovery, the panel called on the Legislature to expand Medicaid coverage for mental health services provided in individual homes.

Similarly, private insurers should be required to cover treatment in residential treatment centers for people transitioning into the community after a hospital stay, the task force concluded. Such a move would bring psychiatric care more in line with treatment for other forms of illness such as heart surgery or hip replacement.

We "envision the day when the response to a mental health crisis is at least as well funded and coordinated as the response to a heart attack or stroke," the task force said.

Along these lines, the task force called for more aggressive enforcement of a 2008 federal law requiring that health insurers cover mental health like any other condition. The so-called mental health parity law was championed by the late U.S. Sen. Paul Wellstone and was heralded as a major civil rights victory. Yet, nearly a decade later, parity laws have not had much impact on access to health services in Minnesota, the task force concluded. For example, a person who experiences early symptoms of cancer can expect immediate access to diagnostic tests, while mental health services often are not covered by insurance until a person shows severe symptoms.

"It is impossible to build a comprehensive system of mental health care without private insurance plans paying for treatment," said Sue Abderholden, executive director of the National Alliance on Mental Illness of Minnesota.

The task force urged more regular reviews of private health plans to detect when insurers are not following mental-health parity laws. This includes expanding the capacity of the Minnesota Department of Commerce to examine insurers and investigate complaints from consumers.

A final report of the task force recommendations is set to be released by Nov. 15.

Chris Serres • 612-673-4308

Twitter: @chrisserres