As summer drew to a close, the Minnesota Department of Human Services (DHS) held a series of six listening sessions around the state, designed to give providers, consumers, administrators and other stakeholders an opportunity to share their insights and concerns about state-provided safety-net services for people with mental illness, substance-use disorders and disabilities.
Steven Pratt, M.D., DHS executive director of behavioral health, attended all of the regional meetings, held in Marshall, Fergus Falls, Duluth, Bemidji, Rochester and St. Paul. He explained that the department holds these kinds of meetings on topics of legislative concern “periodically but not regularly. For example, last year,” he continued, “our policy division scheduled a series of listening meetings to get input from stakeholders about how to enhance community behavioral health services that are overseen by DHS policy. Those meetings led to good partnerships and good outcomes, things that will really improve the community behavioral health system in the state.”
Pratt said that this summer’s series of listening sessions were focused on issues surrounding care and treatment programs where the state is the direct provider of services for people whose needs are so complex that they are at risk of slipping through the cracks: “That is when the state provides services that we think of as a ‘safety next,’ ” he explained. “These are cases where community-based services are not always able to fully meet the needs.”
One issue that inspired this summer’s stakeholder meetings was a systemwide struggle created by the “48-hour rule,” recent legislation that requires state-run mental health hospitals to admit jail inmates to their programs within 48 hours, creating a service backlog for other individuals with mental illness seeking treatment. The “48-hour rule,” which has been popular with corrections officials, has been a point of contention for some mental health service providers. This issue was discussed at the meetings, Pratt said.
“We had some concerns that the state’s available services might not be meeting all the needs. This came to public attention earlier this year when we at DHS were not able to admit someone to our hospital coming out of jail within 48 hours. When that happened, we realized that we needed to try to enhance our services.”
Discussion topics at the meetings were open-ended, but tended to focus on a few central themes, Pratt said.
One key concern was the difficulty of securing residential care for people with mental health issues.
“Access to beds was one theme,” Pratt said. “We hear a lot of stories about people’s frustration with not being able to access inpatient beds in the state. The need for more beds for children and adolescents was also mentioned several times.”
A persistent discussion theme that surprised DHS officials was that mental health and addiction stakeholders “wanted more in terms of training,” Pratt said. “They were not so much focused on the amount of service provided but rather on the quality of service.”
Ben Ashley-Wurtmann, policy and outreach associate for Mental Health Minnesota, a mental health advocacy and education organization, attended the listening session in Bemidji. He recalled that another key discussion topic was the 48-hour rule and the challenges it creates for the state’s community-based mental health providers.
There was enough interest in that topic that Ashley-Wurtmann believes DHS should organize another meeting focused specifically on the issue.
“The data DHS is pulling together seems to indicate that some advocates’ concerns around this issue are warranted,” he said. “They need to be revisited.”
Pratt said that DHS officials took notes at the meetings, which were attended by “representatives of law enforcement, county human service agencies, private provider organizations, nonprofits, people who received services in the mental health system, county court personnel.” They plan to develop a departmental response in the coming months.
“Our process is that we will take all of the input that we heard and compile it and think about what some positive solutions might be,” he said. “We want to have a two-way dialogue with stakeholders.”
Some members of the state’s mental health community said that they found it difficult to actually engage in that two-way dialogue.
Notice about the sessions, which Pratt said were announced six days ahead via press releases and notices sent to “various stakeholder communication networks, to law enforcement agencies and courts,” came too late for many to make room in their late-summer schedules.
“They actually released notice about these listening sessions so late that a lot of our providers were not able to attend,” said Claire Wilson, executive director of the Minnesota Association of Community Mental Health Programs (MACMHP). “I myself was not able to attend.”
Sue Abderholden, executive director of NAMI-Minnesota, also was unable to make the meetings. “It was extremely late notice,” she said. “Literally a couple of days. It’s a bad time to pull a meeting together, anyway. They were scheduled at the end of August, when people are away on vacation, trying to get their kids ready for school.”
Though he was able to attend the Bemidji meeting, Ashley-Wurtmann agreed that the listening sessions’ timing was not ideal.
“The amount of notice was less than desirable,” he said. “I certainly appreciate Commissioner Jesson’s intent in wanting to open up that conversation right away. But it is critical that they be held to their stated intent of following up these meetings with others in the future. This is not a one-and-done. This is critical.”
Ashley-Wurtmann added that he did not think the meetings were intentionally timed to limit participation.
“If the question is, ‘Do you think thee meetings were held on short notice in order to cut people out?’ I don’t think so,” he said. “I think they got rushed. There is a pretty long timeline out from session in terms of when legislative asks need to be crafted and vetted and brought to the governor’s office. I think they are working on a different timeline than the rest of us.”
The discussion continues
Community-based mental health providers will have another opportunity to speak with DHS officials next week, at the 2015 MACMHP conference.
The meeting was scheduled in part as a way to give providers who couldn’t make this summer’s listening sessions an opportunity to engage in a conversation with department staff, Wilson said. “They are going to come to our conference in Duluth next week. This way they can talk to more providers.”
Ashley-Wurtmann was pleased to hear about the added listening session. “I’m glad to hear that there’s further interest in more dialogue,” he said.
The statewide meetings were just a first step in soliciting input, Pratt said. Beyond the MACMHP session, other meetings have been scheduled with specific stakeholder groups, including the Minnesota Sherriff’s Association and the Minnesota Hospital Association.
“It’s too early in our process to know for sure what concrete solutions are going to come out of this process,” Pratt said. “This was our first step. Other meetings are still coming up. We are seeking a broad array of input.”
And discussion of these issues is not limited to mental health workers, Pratt added. The general public is also invited to email suggestions and comments to firstname.lastname@example.org.
Despite scheduling snafus, Pratt said that he and other DHS officials were pleased with the sessions, which he said drew “several hundred” attendees.
“I am satisfied with the meetings,” he said. “I think we are getting good input. We have people wanting to work with us to come up with solutions, and that’s always a good first step. So far the mood has been cautiously optimistic.”