Last summer, former Freeborn County Court Services Director Tom Jensen oversaw a client who, due to a shortage of local inpatient beds for chemically dependent patients, had to be taken to a facility in Fargo, North Dakota. A judge needed to grant permission for the patient to go to treatment, since he was not allowed to leave the state. 

Jensen, who is now Freeborn County’s administrator, said the situation is evidence of the problem the region and the state are facing as they grapple with a shortage of inpatient mental health services.

He said in Freeborn County, waiting lists for needed mental health services are “extremely long.”

“You don’t have the triage and the people in place to handle these people when they come, and they’re in crisis mode, and there’s nowhere for them to be triaged, to be looked at and get the right service they need,” he said.

“If you’ve been in the system, you’ve been able to see this for a long time,” Jensen said.

Jensen worked for the Department of Corrections in Faribault from 1994 to 1997.

He estimated the 10 to 11 state-run inpatient medical health facilities in the 1980s are now almost completely gone, with at least two of the facilities shifting to prisons.

“That’s when the switch started, and it has culminated now with the lack of resources, the lack of staffing, the lack of funding, the lack of beds, the lack of ability for people with mental health needs to access the system,” he said.

Jensen said he is aware that between 50 to 60 percent of correctional system inmates have diagnosed mental health needs, with that number rising to near 100 percent when taking into account inmates with chemical addictions.

Mayo Clinic Health System’s transition of most inpatient services to Austin includes moving the inpatient behavioral health unit from Austin to Albert Lea. Jensen said the transition will result in longer stays at the Albert Lea hospital, as the average psychiatric hold lasts between 30 to 45 days, much longer than the typical inpatient surgery.

Jensen, who became Freeborn County administrator last year, said emergency rooms and jails have become mental health holding centers.

He noted it has become more difficult to place juveniles in residential treatment facilities due to facility closures stemming from a lack of funding. One juvenile has reportedly been placed in Idaho because of a lack of space.

To address the issue, Jensen said mental health issues need to be balanced with other issues legislators grapple with. He spoke against continuing to raise the tax levy because of demographics in Freeborn County. 

“It’s gotta be a priority,” he said. “I mean, and that goes back to, you’ve got so many hands at the table and you’ve got X amount of dollars, so what do you reduce funding for to increase funding on the mental health side?”

According to a 2016 study by the Office of the Legislative Auditor, service availability problems in Minnesota’s adult mental health system have persisted for years, limiting police officer options for referring people with mental illness they take into custody.

An estimated one-third of jail inmates reportedly may be on medications for a mental illness, according to the report.

The report found rules “do not adequately address some important areas of jail-based services, including mental health assessment of inmates following admission to jail.”

The study found most sheriffs and county human service directors believe jail inmates should have better access to counseling, psychiatric services and case management.

“In addition, these officials widely believe that the number of beds in Minnesota’s mental health facilities — particularly secure inpatient beds — is inadequate to meet current needs,” the report said.

Bruce Sutor, Mayo clinical practice chairman for psychiatry and psychology for the midwestern region, said while people wait in emergency departments for inpatient beds, the full scope of mental health services — psychiatrists, therapists, supportive housing, etc. — are not available.

Sutor said though developing inpatient behavioral unit beds would help “to a limited degree,” it would not change the state’s insufficient community mental health infrastructure.

Albert Lea and Austin are facing “very similar” holes in inpatient behavioral health services as the rest of the state faces, he said.

Sutor, a member of the working group during a 2015 Minnesota Hospital Association study into the issue in Austin, Mankato and Rochester, said the study found that at any time 20 percent of people in inpatient units were ready to be discharged but had no chemical dependency facility units for admission.

Fountain Centers has suspended its residential women’s program because of staffing and space issues.

There is also a shortage of facilities that accept public funding for chemical dependency treatment.

Sutor said the holes in coverage have negative effects for chemically dependent patients who sometimes become more resistant to treatment if they are not accepted into a facility soon enough.

He said the holes in needed services came after the majority of mental health care cases were shifted from state hospitals to local care centers 25 to 30 years ago. Though Sutor agrees with the decision and said it leads to better patient outcomes, he believes local infrastructure — active community treatment, supportive housing, etc. — has not kept up with the change.

He said a long-term fix is needed that includes identifying at-risk children and their families at young ages.

Sutor spoke highly of the proposal by state Sen. David Senjem, R-Rochester, to establish regional behavioral health crisis centers across Minnesota. Senjem planned to present the proposal this week.

To correct deficiencies in the system, the Office of the Legislative Auditor recommended the Legislature, Department of Human Services and counties fund and implement a more comprehensive set of community-based mental health services.

“The Legislature should authorize a streamlined judicial process for individuals deemed incompetent to stand trial to be placed into treatment or referred to county social services,” the report stated. “If the Legislature retains the current process, however, it should specify a time limit in law for incompetent inmates to remain in jail while awaiting commitment.”