Some of the hardest-to-serve Minnesotans are the 1,300 who live in state-run residential facilities. These programs provide treatment and housing for people with chemical dependencies, mental illnesses, and developmental disabilities. Last week the Office of the Legislative Auditor issued a scathing review of how the Department of Human Services (DHS) manages their residential facilities. The report noted several major shortcomings that should be of concern to all of us, since our tax dollars fund these programs and our most vulnerable citizens reside in them.
The report devotes an entire chapter to the Minnesota Security Hospital in St. Peter, which serves up to 408 “mentally ill individuals who have committed crimes as a result of their illness or who have the potential to commit crimes while ill.” The report lists several concerns about the hospital’s leadership, security, treatment, and critical lack of staffing. One of the most interesting assertions is that the Security Hospital has a lot of patients who don’t need to be there.
For the majority of patients, the hospital’s goal is to improve the patient’s health enough for them to transfer to a less-restrictive setting. Unfortunately, the report found that the treatment provided is modest: patients average just 16 hours of scheduled activities each week, and only small portion of that is focused mental-health treatment. The hospital’s psychiatric team is critically understaffed and the majority of patients see a psychiatrist less than once a month. (There aren’t any standards of treatment regarding this frequency.)
For those who do manage to improve their health despite the dearth of treatment, discharge is a challenge. Administrators said that there are “likely dozens” of patients who are well enough to move out of the hospital, but that there isn’t anywhere else for them to go. “Once patients are at the Security Hospital, it has proven very difficult to find less restrictive treatment settings that will accept these patients after their acute psychiatric symptoms have abated. Patients who have been treated at the Security Hospital frequently have histories of criminal—even violent—behavior while under the influence of their mental illness.” In addition, county and state agencies often have a hard time figuring out how to pay for ongoing care. County human-services directors are well aware of the problem. 70 percent of them responding to a survey said “there are insufficient community-based resources for individuals awaiting discharge from the Security Hospital.”
Taxpayers foot much of the roughly $500 per day per Security Hospital patient cost (that’s a total of over $200,000 each day if the hospital is full). The knowledge that we’re spending this for people who could be successful–and potentially happier and healthier–in less-expensive community settings is concerning. Moving people out of the hospital would also make it easier to admit new patients needing critical care, some of whom are currently turned away. We’re keeping our healthier patients locked up while not providing treatment for those who are truly ill and dangerous.
The report didn’t delve too deeply into proposed solutions to this discharge issue. Some of the problem can likely be blamed on DHS’s shortcomings in this area. However, I also wonder if we’re all a little bit to blame for the lack of community-based treatment options for people with severe mental illness. I’ve seen that when service providers try to open new programs (such as group homes or small treatment centers) the community often opposes it. This “not in my backyard” mentality, when extended to everyone, leaves our vulnerable citizens with nowhere to go. This is yet another example of our penny-wise, pound-foolish approach to social services.