The Free Press, Mankato, MN

Special Report: Mental Health

May 28, 2012

Suffering in Silence, Part 3: Core services remain, but professionals are spread thin

— When Irvin Schaefer left the hospital, the first thing he did was sign up for day treatment. It’s a kind of step down from the hospital for people who aren’t ready to live on their own.

“It’s really good to speak with people who know where you’re coming from,” the St. Peter man said.

There were counseling and classes to teach skills, such as cooking, to help people live on their own. They’re less likely, the thinking went, to wind up back in the hospital or worse.

But the state no longer pays for day treatment, so people who can’t afford it don’t go.

“It’s too bad they don’t have something like it for people today,” Schaefer said.

He still attends the sole meeting offered, a weekly self-help group.

His experience is typical.

Counties — the last line of defense for mental health — are required by the state to treat people who are what’s called “severely and persistently mentally ill” or SPMI. And they still do.

But all the extras have been shorn away. A bottom line remains.

“We can’t, and don’t, turn people away,” said Dr. Michael Farnsworth, a Blue Earth County psychiatrist.

Mental health, like the rest of medicine, is typically paid for by private insurance or the government. Because most insurance is tied to work and someone with severe mental illness will probably eventually lose their job, the public sector tends to see the worst cases.

“We refer the well insured to the private sector,” Farnsworth said. “We’re the no-money people.”

The no-money people in south-central Minnesota have formed what they say is an innovative approach that relies on long-distance consultations to dispense medication, a practice called “telemedicine.” The client checks in at one of 30 or so satellite locations, then talks to a doctor at a county site.

The nine-county South Central Community Based Initiative, also called the “hub,” is not for long therapy sessions; the meetings-by-screen are for prescribing medication. It might seem like a lot of trouble just for some quick one-on-ones, but prescribing medication is a very expensive part of mental health.

Though it operates its own clinic, Blue Earth County employs only one full-time psychiatrist. Instead, it relies on advanced practice nurses, who can also prescribe medication.

One problem is there are too few psychiatrists. And, being wealthy and well educated, they tend to prefer city life.

“We were desperate to get anyone, for how long they could stay, anywhere they would go, at any cost,” Farnsworth said.

Some counties (Blue Earth included) have hired out-of-state doctors who fly in.

The community based initiative, which is led by Blue Earth County, has a budget of about $5.5 million, of which $3 million is doled out to member counties. As elsewhere in mental health, officials have tried to limit the cuts’ effect on the core service of treating the very ill. Still, wait times are increasing. It takes about two to three weeks for a new patient to be seen.

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Special Report: Mental Health