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Q&A: DHS Commissioner says improving mental health system requires 'concerted effort'

Commissioner Emily Johnson Piper
MinnPost photo by Briana Bierschbach
Commissioner Emily Johnson Piper

Over the last few months, much of Minnesota Department of Human Services (DHS) Commissioner Emily Johnson Piper’s attention has been focused on sorting out troubles at Anoka-Metro Regional Treatment Center, a state-run hospital that provides inpatient and transitional services to metro-area residents with severe and persistent mental illness. In the wake of funding cuts and worker shortages, as well as reports chronicling patient mistreatment and staff injuries, she’s worked to engage the wider public by holding public events and press conferences. She even hosted a job fair to attract desperately needed workers — an exercise she hopes other facilities can pursue in the future.

With a new multimillion-dollar funding proposal on the table designed to help shore up mental health programs and facilities statewide, Piper is also making the rounds at the state legislature, hoping to convince representatives to support what she sees as a much-needed investment in the network of services for Minnesotans with mental illness.

I spoke with Piper earlier this week about those lobbying efforts, her assessment of improvements at Anoka-Metro and her plans for the summer.

MinnPost: Governor Mark Dayton has proposed $177.3 million in new funding for state hospitals and mental health facilities, including $30.3 million for the Anoka-Metro Regional Treatment Center and community behavioral health hospitals statewide, and $55 million to stabilize direct care and treatment services across the state. Given that legislators may or may not approve all of these options, what are your top priorities?

Emily Johnson Piper: I feel strongly that this is a crisis package. The needs we are asking for are crisis needs. So it is very difficult for me to try and scale back from what I believe is a package that truly reflects our current needs as we see them today. That said, my focus first and foremost has to be on our hospitals and on the facilities that we own and operate, focusing on the investments that we need to make to sustain our current needs, to advance and improve the environment for the safety of our patients and our staff, and to improve the clinical experience for patients.

When I look at what the top priorities are within our critical needs package, first and foremost the priority is to fund the improvements essential for making the facilities themselves safer. It is also essential to make investments in improving clinical oversight and staffing levels at all of the hospitals.

MP: When we last talked, you were excited about a job fair that you had just held at Anoka-Metro Regional Treatment Center. Are their similar staffing shortages at other state hospitals and mental health facilities? How have you been addressing this issue?

EP: We have been doing smaller-scale job recruiting for our other facilities as well. The challenge is that we don’t actually have the funding needed to sustain increased staffing through the rest of the year at places like Security Hospital in St. Peter and some of our state-operated homes. And we also don’t have enough funding to actually incentivize professionals to come and work at our facilities.  Unfortunately we can’t afford to routinely offer recruitment bonuses or loan forgiveness — recruitment tools that the private sector routinely offers their job candidates. These kinds of steps could play an important role in changing some of the recruitment and retention issues that have been going on at many levels of the organization.

MP: It’s been a few months since the Anoka-Metro job fair. How are the new hires working out?

EP: It was a very successful job fair. We attracted some great people. The increased staffing is paying off at the Anoka facility: We have had no mandated overtime for staff there since April 25. That’s down from where it was when I started as commissioner in December. Back then staff was working under a 12 percent mandated overtime rate. Things have improved significantly since then.

MP: How are workers at Anoka feeling about these changes?

EP: I was out at Anoka a couple of weeks ago and I had a roundtable with direct-care staff and management. I heard from them that overall our job fair and recruitment efforts have been very successful. Of course, when you do a major surge in hiring, certain issues are going to become a challenge: Not everyone is going to work out. But in general our overtime levels are down below what they were at last year, and generally it felt to me that the feedback I got from employees was that the investment we were making in hiring staff has had a positive impact on the patient population and how staff feel about working there. They said that they felt things are starting to move in a more positive direction at Anoka.

MP: Rahul Koranne [MD, Minnesota Hospital Association chief medical officer] has said that Anoka-Metro Regional Treatment Center is in a “crisis state.” Do you agree with this assessment?

EP: We do have a crisis in how we are going to manage our Anoka hospital and our community behavioral health hospitals long term. If we don’t get the funding we very much need for the state hospitals, we will have to impose changes to our statewide safety-net system. And if we don’t close the gap in funding to our group homes, there will be serious, long-term consequences to patient care across the state.

To expand on Dr. Koranne’s point, in addition to insuring the stability of our safety net, when Anoka Hospital is not operating at full steam, there is a serious downstream impact. When the most vulnerable patients are not being served there, it has a larger impact all the way down the health care continuum, and that can create a crisis.

MP: I’ve been thinking about how so many of Minnesota’s mental health care services are dependent on one another. It’s a delicate web, isn’t it?

EP: I believe all the different programs and facilities in the state are connected. It is all part of a continuum of service created with the intent of providing high-quality mental health care to the greatest number of Minnesotans.

To speak to this belief, Governor Dayton has created a Taskforce on Mental Health that will be starting in June. We are taking applications for members. The group will be charged with several duties, including developing and sustaining a continuum of care for adults and children in Minnesota, and clearly defining the roles and responsibilities of all of the different participants in our state’s mental health communities — including hospitals, jails and law enforcement, and the courts.

Roundtable discussion at Anoka-Metro Regional Treatment Center
Minnesota Department of Human Services
On April 26, Commissioner Emily Johnson Piper, center, held a roundtable discussion at Anoka-Metro Regional Treatment Center with, from left: Jane, a client; John Dombrowski, family member of a client; Dr. Rahul Koranne, chief medical officer for the Minnesota Hospital Association; and Roberta Opheim, state ombudsman for mental health and developmental disabilities.

MP: In recent years, the State Legislature has shown bipartisan support for mental health issues. Will that influence the odds of the Governor’s proposal getting full funding?

EP: The House of Representatives have zero dollars allotted in their budget in regard to our crisis package for mental health. This is extremely disappointing. And it is surprising, given that earlier this year, the House held informational hearings about the importance of appropriate care and treatment for the mentally ill. But so far this session has not been fruitful for mental health funding.

I’ve been invited to speak to a House and Senate Conference Committee tonight. I’m hoping to highlight the importance of the investment in these services and the real need for them. It’s always a challenge to advocate for people like the mentally ill who don’t often have a voice. We want to try and raise our concerns as priorities, but we realize we are competing with other legislative priorities.

MP: You don’t sound all that confident.

EP: It’s certainly not a slam-dunk. It has been an uphill battle. And I anticipate that as the legislative session is wrapping up, it will not get any easier. I have been very vocal about these issues at every opportunity I have had to speak out. Plus people on our staff and at the hospitals have been willing to speak up about their concerns. They’ve been wiling to get out there and get their story across. I think they have done an excellent job of raising awareness around patient safety and patient care. They’ve gone to the State Capitol and made visits legislator by legislator to advocate and educate the individual legislators. They’re working to and dispel them of inaccuracies and let them hear their voices and make a connection with real people.

MP: Is this zero-dollar baseline just posturing? Do legislators seem serious about this proposal?

EP: I’m hopeful that the House’s stated position on not funding any direct care and treatment is simply related to the zero-dollar target they were given for Health and Human Services. I’m hoping they will eventually be willing to make changes to that position. 

MP: There seems to be a subtle change in the way Minnesotans are thinking about mental illness. Do you see this shift reflected in the conversations you’ve initiated around state mental health facilities?

EP: I think that there have been improvements in how people view mental illness. At our roundtable, Dr. Koranne and Roberta Opheim, state ombudsman for mental heath and developmental disabilities, compared mental health care to cancer care and treatment and talked about the need to treat mental illness like we would treat any other disease.

I believe that we need to use events like Mental Health Month to try to foster ways to change the narrative about mental health. In my office, we’ve been trying to create opportunities to encourage people to start talking about mental illness and its impact. We need to adjust how we have those types of conversations.

One of the best ways we can reduce the stigma around mental health is to have leadership in the medical profession who are willing to speak out in a way that makes it clear that mental health is just like every other physical condition. I think attitudes have improved in the state of Minnesota, but we still have a long way to go. To continue to make improvements is going to take a concerted effort.

MP: The legislative session is always a busy time around your office. What are your plans for the coming months, when the Legislature is in recess?

EP: I’m excited. Over the summer I plan on getting out into Greater Minnesota. I’m going to be spending time on some of our Native American reservations. I’ll also be going to other parts of the state. I’ll be attending Farmfest and really trying to engage more closely with Greater Minnesota. We have such a broad reach at DHS, but during session it becomes a challenge to leave St. Paul for long. This summer I am looking forward to looking beyond the metro area.

MP: Last time we talked, you’d been in your position just a few months. How are things going for you now that you’ve had time to settle into your role?

EP: I think overall things are going really well. I am excited to move forward on advancing our work on mental health. The Governor’s executive order creating a task force on mental health has created opportunities for other areas of our agency to continue to make improvements in programs like foster care and child protection. I am excited to continue our work on those issues.

I think that we are making a difference in the life of Minnesotans. Coming to work every day it feels really good, like I’m working hard and it is paying off. I feel like we are making a positive impact, and that’s been my goal all along. 

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Comments (2)

Small Steps for Big Issues

It's been quite awhile since I was involved in this topic of State institutional care and funding with respect to often more effective community-based specialized programs.

It is rather disappointing to read Q&A that sounds so similar to that of the 1980s, and continually since.

Commissioner:
"I believe that we need to use events like Mental Health Month to try to foster ways to change the narrative about mental health. In my office, we’ve been trying to create opportunities to encourage people to start talking about mental illness and its impact. We need to adjust how we have those types of conversations."

What have we been doing? More to the point, what have we not been doing for 30 years?

MinnPost, please follow.

Create a training rotation at Anoka

As I psychiatric resident at the University of Maryland I was required to rotate through the state hospital system for 6 months. As a graduate I would have been comfortable working in one, in a way that I never would have prior to that experience. Many University of Maryland psychiatric residency graduates did end up working in the state system, many of them part time, with a great degree of comfort on the very first day.

I would strongly lobby the state to create an academic psychiatric residency rotation at Anoka for the HCMC and UMN psychiatric residents and psychiatric nurse practitioner programs.