State contract delays thrust mobile mental health crisis services into uncertainty

Minnesota's mobile crisis system for responding to people suffering from mental health emergencies has been thrown into uncertainty, due to bureaucratic delays at the state agency responsible for overseeing the service.

Across the state, local agencies that respond to people experiencing suicidal thoughts and other mental health crises are warning of disrupted services because the Minnesota Department of Human Services (DHS) has failed to deliver tens of millions of dollars in grant contracts that help cover the cost of the life-saving program.

Mental health providers say the timely delivery of grant contracts is critical. Without them, they can't pay for round-the-clock call centers and mobile crisis teams that travel to homes, schools, hospitals and elsewhere to provide counseling and nonviolent conflict resolution.

The mobile teams operate in every county and fill a crucial gap in the health care system, coming to the aid of those who often are too incapacitated by mental illness to visit a clinic or seek professional help. They also reduce burdens on local law enforcement, which often isn't equipped to handle mental health emergencies.

Yet crisis responders have been operating in financial limbo since late December, when the Behavioral Health Division at DHS notified them of delays in completing their contracts. The agency noted that drafts of their grant contracts would not be ready until the end of January — which providers say is more than a month late.

As a result, crisis responders have been put in the extraordinary position of having to provide a safety net service without contracts or assurances they will be paid.

"It's frustrating and disheartening because this is a vital service that we can't just shut off," said Ashley Kjos, chief executive of Woodland Centers, a Willmar nonprofit that provides mobile crisis services in seven counties. "It's not like we can say, 'Sorry, we don't have a contract so we can't take your calls.' We are their lifeline."

DHS officials declined a request for an interview. But in written statements, assistant commissioner Eric Grumdahl said the contract delays stem from leadership transitions, staff turnover and a shift in contract management processes. He said mobile crisis providers can continue to provide services, though they won't be paid until grant contracts are finalized. The agency doesn't expect delays in payments to providers because the contracts should be ready by the time first-quarter invoices are received, he said.

Grumdahl, who oversees the Behavioral Health Division, said the contract delays are related to the rollout of a new contract management system — "a one-time transitional impact" — that will streamline contract renewals across the agency.

"These rapid response teams play a vital role in assessing the individual, resolving crisis situations, and linking people to needed services," Grumdahl said in a statement. "Ensuring that these services continue uninterrupted is critical for Minnesotans and is an important priority for DHS."

Crisis responders say they have been kept in the dark about the reasons for the contract delays, which have already caused service disruptions.

Some providers have suspended hiring staff to fill empty positions in their call centers and crisis response teams, which means they cannot respond as quickly to emergencies and as many calls in person. Others have pulled back on marketing and expansion plans until they know they will get paid, according to a mental health provider association.

"When agencies have to scramble to pull together contingency plans for delayed or disrupted contracts and reimbursements for public programs, folks have to shift it away from other areas of their work to compensate. This diverts attention, resources and capacity from our systems," said Jin Lee Palen, executive director of the Minnesota Association of Community Mental Health Programs, which represents 34 mental health providers.

The contract delays reflect longstanding problems within the Behavioral Health Division, which has been plagued in recent years by pervasive problems with handling grants.

In March 2021, the Office of the Legislative Auditor found the division had doled out tens of millions in grants for mental health and substance abuse services for nearly three years without adequate oversight. The legislative auditor identified problems at almost every step of the grantmaking process, from failing to document potential conflicts of interest to inadequate evaluation of grant recipients. In late 2019, the division also came under fire for its role in overpaying Indian tribes for substance-use treatment services.

Human Services Commissioner Jodi Harpstead has repeatedly pledged to shore up the agency's finances and rolled out a series of measures to improve its grant-making process.

"Make no mistake, there is a basic expectation of state agencies that contracts be completed and delivered on time," said Sen. John Hoffman, DFL-Champlin, who chairs the Senate Human Services Committee. He vowed to look into the cause of the delays.

"If you don't fund mobile crisis teams, then people will die," Hoffman said. "And I don't want people to die."

Mobile crisis teams, often the first responders to mental health emergencies, receive a huge number of calls. In 2020, they responded to more than 16,000 incidents statewide, including about 13,400 face-to-face visits with people experiencing a crisis.

DHS estimates that $41.2 million in state grants are available to mobile crisis providers over the next two years — roughly a third less than providers requested.

Even before the contract delays, providers struggled with tight budgets and surging demand.

Mobile crisis programs are costly to operate because they must keep trained staffers on call 24 hours a day, seven days a week. In rural areas, responders sometimes travel more than 100 miles each way to make house calls. At times, they will spend hours with a person in psychological crisis — helping to calm their anxiety and access psychiatric care.

"We are at an unprecedented time, where mental health is in the forefront, and people are often waiting until things are at a crisis level to get support," said Shauna Reitmeier, chief executive officer of Alluma, Inc., of Crookston, which operates a mobile crisis call center that serves eight counties in northwest Minnesota. "So very often, crisis services are the gateway to getting mental health services."

The 10-person crisis team at the nonprofit Human Development Center (HDC) in Duluth responds to more than 100 calls a month in southern St. Louis County. The team meets people in crisis in fast-food restaurants, skyways, hospitals, homeless shelters, even cars.

At times, responding to a crisis can involve stabilizing a stressful family environment. Crisis responders at HDC have cleaned homes, cooked meals and helped children with homework when their parents were too distressed to care for them, said Cortney Buchholz, a nurse and HDC's community coordinator.

With the help of the state grants, the agency is able to speed up the process for getting people into psychiatric care, often arranging appointments within 48 hours rather than the typical wait of several months, Buchholz said.

"It's a huge, huge boon to our population to get people into treatment rapidly when they are experiencing that high need," she said. "Because that's the time when they are often the most accepting of help."