A year ago, Minnesota Department of Human Services Commissioner Emily Johnson Piper and I met in her office for an interview. At the time, Piper had been in the job for about three months, and our conversation focused on her goals for the coming year.
Last year, Piper made it clear that, as the daughter of a mental health nurse, she was committed to improving conditions for workers and patients at the state’s residential mental health treatment facilities.
During her first year, Piper made good on that commitment, scheduling a job fair at Anoka Metro Regional Treatment Center and reducing the amount of mandated overtime required by staff there. She was also able to showcase the completion of Phase I of a long-planned expansion and remodeling project at Minnesota Security Hospital in St. Peter designed to improve patient and worker safety. In October 2016, the completion of the $56.3 million facility was celebrated with a rare open house and another job fair.
Piper said she is pleased with these accomplishments, but she also admitted that there is still work to be done to improve mental health care in Minnesota.
“Since last year, I think we’ve moved in the right direction in helping to provide our staff a safer work environment in all of our direct-care and treatment facilities and also in improving patient safety and quality of care,” she said. “At Security Hospital, our new facility should reduce staff injuries, and at Anoka, worker satisfaction is increasing. But there’s always so much more that can be done.”
One of the things that Piper would like to do is to persuade legislators to fund the second phase of the Security Hospital project. While she is pleased with Phase I, she said she’s disappointed that, thanks to budget shortfalls, the building remains “half completed.” Changes to the building, Piper explained, will update the facility and further increase safety for patients and staff, and other supplemental budget requests would have helped fund key staff positions, among other projects.
The shortfall came last year when state legislators rejected Gov. Mark Dayton’s bonding bill. The bill contained key funding requests for DHS-related projects including $70 million for the Security Hospital project.
“The supplemental budget requests for additional staffing and for additional clinical work in our residential treatment centers did not pass, and the bonding bill for Phase II of the Security Hospital project also failed,” Piper explained. Piper said she felt personally disappointed by these legislative rejections, but she felt even worse for the people who would be directly impacted by the budget shortfalls.
“The morning after the budget wasn’t passed,” Piper said, “I drove down to Security Hospital for the day and met with the leadership team there. I also spent time on the floors with staff and patients to talk with them and express my ongoing commitment to making those changes happen.”
Piper blames this legislative failure on a combination of factors. “It was a short session,” she said. “I think a lot of different legislators had a lot of different priorities.” Another reason for the bill’s failure, Piper believes, is that last session, legislators appeared to be less focused on funding existing services and more focused on creating new ones.
“Our request focused on improving services that we already have,” Piper said. “That approach didn’t work last year, and as a result we didn’t receive as significant of an investment in our programs as we wanted.”
While the tepid response to DHS budget proposals was disappointing, Piper said that 2016 felt generally productive for her department. She said she was encouraged to see that lawmakers in both parties often worked together to put the needs of the state over their own interests.
“There were moments in the last year where I felt terribly frustrated and disappointed,” she said, “but on a day-to-day basis I haven’t been all that frustrated, in large part due to the great employees we have at DHS and the great partners we have in our counties, our tribes and our nonprofits. Everybody is trying to roll in the same direction, and that feels good.”
Some departmental achievements Piper singled out included improvements made to the state’s Child Protection Services program, implementation of the Olmstead Plan for people with disabilities, improvements in the MinnesotaCare renewal process, the success of the Governor’s Mental Health Task Force, the confirmed constitutionality of the state’s sex offender treatment program, and the launch of a new statewide adult abuse hotline.
The hotline is an important improvement that was a long time coming, Piper said.
“That has been a great success. We’ve had some challenges along the way in making it fully operational, but we have overcome the majority of those hurdles. Now we have a statewide hotline where people can call and report the abuse of vulnerable adults.”
In the past, Minnesota counties operated their adult-abuse hotlines independently. Since the new statewide program has launched, Piper said, “We’ve seen an over 30 percent increase in reports of abuse for vulnerable adults. Assuming that number doesn’t reflect a 30-percent increase in abuse, it instead reflects a significant increase in reporting due to this new program. That is a significant accomplishment.”
Fighting substance addiction, particularly addiction to opioid-based pain relievers, is at the center of many DHS programs. Piper feels that in the last year her department has made positive progress in that area.
“I think that public awareness of this problem has really increased,” she said. “With that, we’ve made progress in our ability as a state to tackle the problem of addiction going forward. There are some really great, innovative things happening statewide that are moving the metrics for particular populations most at risk of addiction, including American Indians, a population where infants are eight times more likely to be born with opioid dependence.”
DHS recently honored the White Earth Nation for their Maternal Outreach and Mitigation Services (MOMs) program, a holistic health-care service for pregnant women fighting addiction, Piper said: “They’ve had some really great outcomes and we are tying to help other tribes replicate their success.”
For the 2017 session, Piper said that Dayton’s budget proposal is focused on “making significant investments in human services and improving what we’re already doing.” She said that it includes, once again, funding for the second phase of the Minnesota Security Hospital project: “He is trying to make the point that we need to fully fund what we’re doing now to deliver the services that Minnesotans expect and deserve.”
In her first year on the job, Piper said she’s learned that most people don’t understand the scope of what her department does to help ordinary Minnesotans. She believes that even elected officials need to be made aware of this.
“A lot of legislators don’t understand the work that we are doing or that we are the ones delivering the services that so many people receive,” she said. “We are working hard this year not only to provide an education to new legislators about our department and its scope but also about the direct impact of each of our program areas to their districts. We want to show them how many people are directly impacted by our programs and services.”
National shift’s impact
Underscoring the importance of DHS programs is key, Piper noted, especially since a changing political outlook in Washington, D.C., could put some significant statewide programs at risk.
“There are a lot of unknowns on the federal level,” she said. “Half of the DHS budget comes from the federal government. There are conversations nationally around other changes to public health care, including block granting our Medicaid program. I have grave concerns about the impact this could have on the state of Minnesota. And the repeal of the Affordable Care Act alone could take away health-care coverage from 300,000 people covered by public programs in Minnesota.”
Other DHS programs that could be affected by executive actions and resulting federal funding shifts include the state’s Refugee Resettlement Program, and the Supplemental Nutrition Assistance Program (SNAP), Piper said. “I’m very concerned about our ability to continue to serve the million-plus Minnesotans that we serve every month.”
In the face of bad news nationally, Piper said she is heartened by Dayton’s proposed public option for health care. She’s also excited by his proposal to extend dental care to people on medical assistance around the state.
“One thing I consistently hear in Greater Minnesota is that people don’t have access to dental care in the way that they used to,” Piper said. “So much of a person’s health depends on good dental care.”
Piper said efforts like this reconfirm her commitment to her job. Despite any upcoming challenges, she remains enthusiastic and optimistic about the possibilities.
“My job is to leave Minnesota better off than it was when I started,” she said. “I’m focused on that, and in the coming months I will continue to do all I can to move the department’s initiatives forward.”