The Free Press, Mankato, MN

November 12, 2013

Committee hears mental health system slow, crowded

Professionals, patients detail needs

By Dan Nienaber

---- — ST. PETER — About 7 years ago Brian Guess was waiting for a train, in the middle of the tracks it should have been rolling down, depressed and ready to end his life.

"It had been coming through at the same time for two weeks," he said. "That day it didn't come through."

Instead, a law enforcement officer came for him. He was taken to what was then Immanuel St. Joseph's Hospital, which is where many people having a mental health crisis in the Mankato area start what can be a long process for getting the help they need.

There was no room for him at the hospital, so he was sent to another facility in Worthington. He was taken there by a deputy. Deputies also transported him from Worthington to Mankato and back for the civil commitment hearings that followed. A Blue Earth County Health and Human Services employee had to make the 100-mile drive to Worthington to do a one hour assessment.

It's an inefficient process. And it makes an already stressful situation even more difficult to endure, Guess said.

He was one of six people asked to testify Tuesday at a special state Senate joint committee hearing at the St. Peter Community Center. The hearing focused on the mental health services process.

"I know it's your job to make the tough decisions about funding," he said. "But for me, my friends and the people I work with, it's our lives.

"A ride in the back of a sheriff's car to somewhere you don't know is an eternity. It's not an hour-and-a-half or two-hour trip. It's an eternity because you don't know what's going to be there."

Guess is now a certified peer specialist working at the South Central Crisis Center in Mankato. He said sending people out of the community for mental health care creates other problems, too. They don't develop relationships with their doctors, so their medications are frequently changed. Their families, who often don't have a lot of extra money, aren't always able to visit.

Kathy Sheran, chairwoman of the Senate Health, Human Services and Housing Committee, asked everyone testifying to narrow their comments down to one or two things the Legislature can do to improve mental health care. Her committee was joined by members of the Senate Health and Human Services Finance Division.

Subsidized housing and more financial support for long-term services were the two things Sue Serbus, Nicollet County Social Services supervisor, focused on. The Community Behavior Health Hospital in St. Peter has 16 beds for treating people in a mental health crisis, but there isn't enough staff to use all of the beds, she said.

The whole process of providing care hits a log jam when someone is taken to a hospital emergency room to be assessed because there isn't enough places to send someone if they aren't healthy enough to be released, Serbus said. So finding the treatment that is needed is difficult from the beginning of the process.

Dr. Bipinchandra Krishna of Mayo Clinic Health System, Mankato, called for shortening the legal process for committing someone. During Serbus' comments, she said people have been placed on 72-hour hospital holds about 75 times in Nicollet County this year. Of those incidents, there were 23 commitment requests. Only 14 of those requests were approved by a Nicollet County judge during the legal process required for commitment.

The problem Krishna sees regularly is that the people going through the commitment process are kept in a hospital setting because there is no other place, with space available, that is qualified to care for them. So the remaining nine people who weren't committed were taking up bed space for no reason.

If the commitment process was shortened from around six weeks to a week, those people could be moved through more quickly and make room for people who need emergency services, Krishna said.

Another legal problem, which was brought up by Nicollet County Sheriff David Lange during his testimony, is the inability to use interactive video for commitment court appearances. That would save the time and cost of having deputies transport people to commitment hearings, especially when they're at distant locations.

Lange also cited a situation this year were an inmate attempted to commit suicide. Mental health care facilities in the area wouldn't accept the inmate because he was a prisoner.

After the hearing, Guess said the senators were asking the right questions. He also thought those testifying covered things that could make the mental health care system better.

"I think the more conversation we have, the more we are going to address it," Guess said.