Parents say Minnesota’s involuntary commitment system failed their sons. What should change?

DULUTH — On a 5-below day in January, Marianne and Scott Jones’ son left his group home in the woods 15 miles northwest of Duluth without a jacket, hat or gloves. He was found about an hour later walking along a highway.

He took off again, jacketless, on an even colder day in February. It took two days to track him down at the Duluth Transportation Center.

This month, he left in the night and, when he was found in Duluth in the morning, he refused to return to the group home, where he has been writing on the walls and refusing food because he believes staff are sneaking medication into it.

The Joneses have been pleading with St. Louis County to place their son, who has schizophrenia and struggles with addiction, back under civil commitment, a last resort for people who pose a threat to themselves or others. It could remove some of his autonomy and require him to get involuntary treatment.

His parents believe it’s the only way to keep their son safe and get him to take his antipsychotic medication.

“I don’t know what they are waiting for,” Marianne said, pulling a photo of her son, lying in a hospital bed eight years ago, from the piles of medical documents in her Rice Lake home north of Duluth.

Their son, who wasn’t available for comment and whom the Minnesota Star Tribune isn’t naming to protect his privacy, hadn’t been taking his medication then. Believing he was being poisoned, he drank so much water he started having seizures.

“It’s going to happen again,” Marianne said of her son landing in a hospital, or worse. “You can see it coming.”

Minnesota is ranked as having the nation’s best involuntary commitment laws by the Treatment Advocacy Center, which pushes for more outpatient treatment and assessed whether someone who needs involuntary evaluation or treatment can get it under the law.

But family members of people with serious mental illness said when it comes to executing those laws, counties and the state fail to adequately protect their loved ones. They have struggled to get their family member committed and said there’s a dangerous lack of oversight for people on commitment and insufficient follow-up when commitment ends.

St. Louis County files far more petitions for civil commitment than it did a decade ago, Assistant St. Louis County Attorney Joe Fischer said. But he said what the law allows doesn’t align with the reality on the ground, where there are backlogs of all types of mental health beds, from emergency rooms to voluntary treatment to locked state behavioral health facilities.

Lawmakers recently proposed creating a civil commitment coordinating division in the state Attorney General’s Office to get a better grasp on gaps in the system — an idea many mental health advocates oppose. Legislators also want additional funds to improve counties’ outreach to people who are mentally ill, outpatient civil commitment, supervision and services when someone is transitioning out of commitment.

“The system is failing, so it needs some system overview and oversight,” said bill sponsor Sen. Ron Latz, DFL-St. Louis Park. “People are falling through the cracks.”

When he was younger, Marianne and Scott Jones’ son liked guitar and had a dry sense of humor. They nicknamed him “Burger King” as a kid, because he did things his way, like the restaurant slogan.

But he had a hard time in school and struggled with drug and alcohol addiction. He ended up in prison after assaulting a police officer and later stealing a car in California, where the family lived.

While he was incarcerated, his parents moved to the Duluth area, where Marianne grew up. She drove her son across the country after he was released and said he was unlike she had ever seen him — paranoid and hearing voices. She hoped Minnesota could provide the help he needed.

“We thought it would be a slower pace of life,” she said. “We thought he’d be able to get the care up here.”

Over the decade their 44-year-old son has lived in Minnesota, he has been in and out of hospitals and civil commitments, with his latest commitment ending a year ago. During that commitment he was living in the same group home he’s in now, and regularly received the Invega shot, a long-acting medication for schizophrenia.

A court order made a difference in his willingness to take medication, Marianne said. However, she fears he’s become so unstable that the only option now is commitment, with a stay in a state community behavioral health hospital. She said he doesn’t believe he has schizophrenia and won’t voluntarily accept help, and his mental health nurse practitioner recommends commitment.

Fischer, who couldn’t comment on specific cases, said the county gets commitment referrals from hospitals, courts and family members. If someone is in an emergency room and medical professionals determine they should be committed, that can be a pipeline to get them help, he said. But he said hospitals are so overloaded that if someone’s needs aren’t acute enough and they have food and shelter, “hospitals these days, if even if there is a court order, are booting people out of their facility.”

“We have to make a decision about, can we actually even help this person?” Fischer said. “Is there a lesser-restrictive, voluntary alternative that will appropriately meet their needs? … If we look at the fact that the hospital likely may not hold this person and a person is, say, in a group home and is getting their basic needs met, that’s just not somebody who is going to get screened in for civil commitment.”

Marianne said Duluth police have declined to bring her son to the hospital unless he agrees to go voluntarily or is under commitment. Mental health advocates said they have been hearing about that issue across the state as police, concerned about changes to the state’s use of force laws, aren’t transporting folks who are unwilling to go with them.

“They move on to the compliant ones and he gets lost in the shuffle,” Scott said. He said the system’s focus is: “‘You can’t impede self-will.‘ At what point does that stop? When he’s in the ground?”

Tim Eastman, an area director at TBI Residential & Community Services, which operates the home where the Joneses' son lives, said over the past year they have seen an increase in counties not wanting to pursue recommitment.

It is difficult to get data on how many people are being committed or recommitted across Minnesota counties. Lawmakers aim to change that.

The civil commitment bill proposed this session has been in the works for years, Latz said, and was initially inspired by the death of a son of Norman Ornstein, a political scientist, writer and Minnesota native. His son had mental illness.

Minnesota needs a government entity gathering data, looking at the big picture to spot shortcomings and propose solutions, he said. That would probably start as one person in the Attorney General’s Office, guided by an advisory committee, Latz said.

Accountability is key, along with building inpatient treatment capacity and investing in support services after someone leaves a hospital to ensure they get adequate follow-up, said Sen. Paul Utke, R-Park Rapids, one of the measure’s co-sponsors.

The bipartisan bill doesn’t have a price tag yet and with a slim surplus projected and a deficit on the horizon, it will be competing with many priorities for limited funds.

It also faces pushback from many mental health advocates, including the Minnesota chapter of the National Alliance on Mental Illness. Having the Attorney General’s Office at the center of the effort raises “pretty serious concerns” for Mental Health Minnesota CEO Shannah Mulvihill, who said mental illness is too often tied to the criminal justice system.

Mulvihill questioned the need for the division at all.

“I hate to see money spent on something new when we don’t have enough funding to support the things that we’ve already identified that could be helpful,” she said.

She would rather see the state bolster county case management and allow more people to qualify for that support, address a looming drop in mobile crisis team funding, and put more money toward first episode psychosis programs to assist people when symptoms emerge. And she said funding outreach, potentially by peer specialists, to persuade people who don’t meet the commitment threshold to voluntarily get treatment could help families like the Joneses.

Last year, lawmakers funded outreach pilot programs to help people avoid commitment, but advocates noted the Department of Human Services has not yet released a request for proposal for counties to seek the money. The bill that legislators proposed this year would supplement county funding for such engagement.

Megan Mulkey of Cambridge hears echoes of her son’s story in the Joneses' experience.

The challenges of schizophrenia paired with addiction. The powerlessness of watching your child’s condition worsen. But she also knows civil commitment doesn’t guarantee safety.

One year ago, a handful of days after he was hospitalized at HCMC, her son Drake Lymer, 31, died of an overdose. He was civilly committed at the time. While committed, he was living in a north Minneapolis duplex. She said other people were using drugs there.

She wishes there were more oversight for people who are committed, to ensure they have safe housing, structure and frequent check-ins from case managers.

When someone in that situation is released from the hospital, they shouldn’t return to the same place that contributed to an overdose or mental health crisis, she said. And in the month after a hospital stay, case workers should check in more than once a week in person, and frequently drug test people with substance use disorder, Mulkey said.

It’s been a year since her son’s death, and during that time Mulkey has posted 31 sets of photos on Facebook to honor him. In her initial post, she said he courageously battled addiction and mental illness.

“He was Drake — a son, brother, grandson, great grandson, uncle, nephew, cousin, friend, dog dad and now a piece of my heart is with him forever,” she wrote. “Please remember this when you see someone on the street that you may fear. Be kind they are also someone’s heart.“

The Joneses fear a similar fate for their son, who has refused to return to his group home since he walked away more than a week ago.

“We’re worried we’re going to get a knock on the door,” Marianne said, and find out their son has died. “How would you like it if it’s your child on the street and not getting the care?”