In her role as commissioner of the Minnesota Department of Human Services, Lucinda Jesson was considered by state mental health activists to be a champion for the rights of Minnesotans facing mental illness. During her time in the position, the state made historic gains in funding for mental health programs. So when Jesson stepped down late last year and Gov. Mark Dayton picked his former general counsel, Emily Johnson Piper, as her replacement, the question on many people’s minds was: Would Piper continue in the same direction as her predecessor?
Piper, who worked in private law practice before entering state government in 2011 as general counsel for the Minnesota Department of Commerce, grew up in North Minneapolis. Her mother worked a nurse in number of Twin Cities mental health programs, and gave her a strong sense of the key role that mental health workers play in the overall health of the state.
Just three months on the job, Piper is excited about her new responsibilities and ready to share her plans for the future. The scope of her new role is expansive, but she feels confident that she will be able to move forward in advancing mental health supports for all Minnesotans.
Earlier this week I met Piper in her St. Paul office. We talked about the challenges of her new role, plans for the future, and about accomplishments she’s made in during her first weeks.
MinnPost: What led you to this role? What made it appeal to you?
Emily Johnson Piper: Through my whole life, I’ve been part a family that’s committed to public service, both personally and professionally. My grandma was the first woman to be president of the Minneapolis City Council. My mom serves on the Minneapolis City Council. I’ve had family members on the Hennepin County board and in the state Legislature, and so I grew up in a family that was very committed to serving our community. When I started in state service in 2011, I felt called to serve the state and the Dayton administration.
I’ve looked at every position that I’ve held during the entire time I’ve been in state service through this lens: How can I best serve the people of Minnesota? This job is so important. There is no other position in the governor’s Cabinet that can touch more people’s lives and serve the people of Minnesota, particularly the most vulnerable.
MP: Your mom worked as a mental health nurse. When you were growing up, did she tell you about her work?
EP: When I first started as commissioner, one of the first things I did was to go out to Anoka Metro Regional Treatment Center. I knew there were real challenges in that hospital, and that we were having really significant issues with patient care and employee safety there.
One of the reasons why I felt like I needed to go talk to the staff at Anoka was because of my mom. I remember as a kid her coming home and talking about being in a really physical environment with people dealing with mental health issues. She worked nights and weekends and every Christmas and every holiday through my childhood. So I have a personal connection with people caring for the acutely mentally ill in crisis. I felt a very strong connection to the people that work at Anoka in a large part because of my mother.
MP: Your predecessor had a clear emphasis on working to improve mental health in Minnesota. Mental health advocates like Sue Abderholden of NAMI say her support helped to make many advances for mentally ill Minnesotans. Are you going to continue to move in that direction?
EP: Absolutely. I feel like Commissioner Jesson’s leadership was instrumental in the gains that we’ve made in mental health and community-based mental health. My most immediate challenge is shoring up our safety-net services, many of them inpatient for some of the most acutely mentally ill in crisis. My most immediate focus and highest priority in the next several months will be to address some of the real crisis issues at Anoka and at St. Peter Security Hospital and at other facilities we operate.
MP: Do you feel like you still have the same strong bipartisan legislative support for advancing mental health issues that existed last session?
EP: Part of the challenge is always going to be that because this is not a budget year, there is significant pressure and varying priorities. But I’m hopeful that we have the legislative support that we need to advance our initiatives. The governor has released his bonding proposal and there’s $70 million there for Security Hospital and over $2 million for Anoka Metro Regional Treatment Center. Those are really significant needs and they’re very important improvements that we feel strongly we need to make to our facilities in order to provide the best care possible to patients and the safest environment to staff.
MP: Tell me a more about what you see is needed at places like Security Hospital.
EP: When I was general counsel to the governor, we were brought issues around workplace safety and challenges in caring for the patient population. One of the things that we — the governor’s chief of staff, me as general counsel and our policy adviser for health and human services — did was work with the staff from all different areas to establish a mediated, facilitated solution-finding process to address the challenges at Security Hospital.
That started in earnest in early September. Since that time, the hospital has formed five committees that are making recommendations to an oversight committee around what they think needs to change about their work environment and pathways to change for their work environment and their patient environment. It’s a consensus-based process. They are presenting recommendations to me and to the governor and to the Legislature on how they think solutions to those problems can be advanced.
One area where they have been very focused for the immediate future is around appropriate staffing for the patient population. They have made recommendations around increasing staffing in particular areas and trying to align Security Hospital’s staffing ratios with other like facilities across the country.
MP: So when you say, “appropriate” staffing, it’s really about getting the right number of staff?
EP: It’s not just the right number of staff. It’s the right kind. Do we have enough security counselors? Do we have enough recreational therapists that take people out to get exercise or do programming with them? Do they have enough treatment time? Do we have enough facilities-management people, based on the needs of that facility and the desire to provide the best care possible for patients?
MP: This ties into the larger mental health work force shortage in the state. That’s a big issue.
EP: There is a work force shortage across all of health care. We’re facing pressures at DHS — not only as a direct-care provider but also because we work so closely with community-based providers and nursing home facilities. We are hearing from all angles that there is a health-care work force shortage. That being said, I feel very strongly that we needed to staff up at places like Anoka. We had a job fair last Tuesday. We had over 50 vacancies and we had over 300 people attend the job fair. So there are positive signs that when you promote job vacancies and you incent people through hiring bonuses, through loan forgiveness, people will come work for you.
MP: Wages for mental health workers tend to be low, so that may be part of the worker shortage.
EP: In places like Anoka, incentives historically have declined relative to the private sector. So we’re trying to find solutions within the collective bargaining contracts that we have now to try to alleviate some of those issues but also with an eye and awareness toward the issues as we go into future contract years.
MP: One concern that’s central for many people is the shortage of beds in the state for adolescents in mental health crisis. Do have plans to try to address that issue?
EP: We have some funding that’s going to be coming through the pipeline from last session. We also have issues with hospital-level care that young people need. The challenge is that with any really difficult challenge there aren’t any easy solutions and usually that involves using several tools in the toolbox. I was out in Willmar two weeks ago at our Child and Adolescent Behavioral Health Services trying to understand more about what the needs what the solutions are in the pipeline. I want to see if this will be adequate, or if we in fact need to add to the options for young people suffering from mental illness.
MP: How do you get a clear picture of the state of mental health in Minnesota? It is such a huge job with so many moving pieces.
EP: Since I became commissioner, I’ve worked with the Minnesota Hospital Association, with the Minnesota Medical Association, with NAMI and other advocacy groups to understand from them where they see the landscape because they really are the people on the front lines.
But I also think it’s really important to go to places and see how things are working there. I’ve talked to nurses and doctors. I’m also public guardian to about 2,000 people in the state of Minnesota. I’ve gone to visit the people that I’m guardian for to understand directly from them, to talk to them and look at where they live and how things are working for them. I want to see how the system’s actually working.
There’s a lot of humanity in human services. I feel very strongly that it’s incumbent upon me to see firsthand how the system’s working for the people in it and the people working in it. That is the only way to understand and make the best-informed decisions.
MP: So you are actually meeting face-to-face with patients?
EP: Yes. I’ve done a fair amount and I plan on continuing in that trajectory, going in and meeting with people in our facilities and in other not-state-run facilities and seeing from them how things are working. I was invited recently to go and shadow an emergency room and see the mental health patients coming in and understand what the challenges are from a front-line triage position how things are working and how they aren’t.
MP: Suicide rates are climbing in Minnesota. Is there anything that your department is doing or thinking about to deal with suicide in the state?
EP: One of the challenges for us as a safety-net service provider is to make sure that people have access to crisis services. Until we can get crisis services to the people who need them, we do have a greater risk of having higher adverse outcomes for our patients like suicide. So that’s part of what we’re trying to do in the direct care and treatment side. We’re trying to provide access to our crisis facilities for people who really, really need it.
MP: Rates of opioid addiction continue to climb in the state. What is your plan for addressing this issue?
EP: In the short term, one of the challenges I face is making sure that we are thoughtful and strategic about who’s at the table trying to come up with the solutions. We have state leadership that’s very engaged in substance-abuse strategy. But we want to make sure that all of the stakeholders and all of the people that can impact the situation are involved in coming up with a solution.
We have to ask ourselves: Are we engaging the Native American bands in the state? Are we engaging in the best possible way with the U.S. Attorney’s Office? With the courts? With county attorneys? With public defenders? Human Services doesn’t have all the answers, but we have a lot of levers that we can pull to move the dial in a thoughtful way. I think we’re trying, but I want to make sure we are doing it as strategically and thoughtfully and comprehensively as we can.
MP: The idea of working with the Native American bands is really important. Rates of opioid addiction are high in that population. Have your conversations been fruitful?
EP: When I was at the governor’s office, I worked on a lot on tribal issues and this was a chief concern amongst many of the Native American bands in the state. They were concerned about opioid addiction and drugs coming in and off of their land and also the disparate impact that they are seeing in their people. It is a struggle, and my impression has always been that the tribal leadership from the bands that I’ve engaged with has been very interested in working together and partnering.
MP: Are there other mental health or addiction initiatives that you are particularly excited about?
EP: I’m really excited about the progress we’ve seen. I’ve been commissioner for three months. I’m excited about the progress we’ve made in the short term in direct care and treatment. I’m excited about the advancements we’ve made at Anoka Hospital in reducing the amount of mandated overtime that staff is being required to work. We are also proactively addressing patient care issues, both internally through better training and support to our employees but also externally, through partnership with the federal government to enter into a systems improvement agreement. That is going to provide us some external resources and external support to make sure we are providing the best treatment possible to our patients.
What else am I excited about? I’m excited about the recommendations of the Healthcare Financing Taskforce around increasing opportunities for people to access MinnesotaCare up to 275 percent of the federal poverty line. And lots of other recommendations: There are over 30 recommendations coming out of that task force. So I see that as very positive.
I was very excited about the job fair at Anoka because the challenges with hiring are so significant. It was exciting to see such a great turnout and exciting to fill a lot of the vacant positions, which were causing some of the mandated overtime and other challenges there.
MP: Anything else on the horizon?
EP: The governor’s bonding proposal is so focused: I believe DHS received more recommendations for funding for our facilities than any other state agency. And then he also recommended $20 million for early childhood facilities. I went to the YWCA a couple of weeks ago and saw the great advancements that they have made in their early childhood programs, thanks to resources from the state. Increasing funding for some of these really great early childhood learning centers that serve underprivileged kids is just really exciting for everyone. It’s a great opportunity that I hope the Legislature capitalizes on.