Faced with a $17 million budget deficit, officials with the Department of Human Services are proposing major changes to programs for people with disabilities and mental health concerns. A handful of lawmakers are hoping to stop them.
State Operated Services is the DHS division that runs campus and community-based programs serving Minnesotans with mental illness, developmental disabilities, chemical dependency and traumatic brain injury, as well as people who pose a risk to society. Last year, the Legislature directed SOS to redesign operations at the Anoka-Metro Regional Treatment Center and the Cambridge-based Minnesota Extended Treatment Options program. A caveat: No layoffs could occur as a result of the restructuring.
In a report released last month, SOS officials took their instructions several steps further and recommended significant changes throughout the division. These include closing or transforming current treatment facilities, opening new psychiatric care centers and eliminating upwards of 200 staff positions.
“We are presenting a report and a plan here that says, ‘This is how we’re solving a $17 million budget deficit,’ yet there’s also a visioning and a redesign process occurring,” said Dr. L. Read Sulik, assistant commissioner for the department’s Chemical and Mental Health Services.
Calling the proposal “a clear indication the DHS is side-stepping the state Legislature,” Rep. Paul Thissen (DFL-Mpls) said he will offer an amendment to the forthcoming omnibus health and human services budget bill that would prohibit the SOS redesign from proceeding without legislative approval. Sen. Linda Berglin (DFL-Mpls), who chairs the Senate Health and Human Services Budget Division, has said she will include funding in her budget bill to stop or delay some of the proposed closures.
New service models
According to the SOS report, changes under the redesign would take place in three phases, with the first phase occurring over the next 15 months. During that time, SOS would close a psychiatric crisis center in Mankato and five dental clinics serving people with developmental disabilities. An adult mental health center in Eveleth would also close, to be replaced with an adult transitional foster care facility at an unspecified location in northeastern Minnesota. Other facilities, including community behavioral health hospitals in Wadena and Willmar and the Anoka-Metro Regional Treatment Center, would also see their services modified.
Over the long term, SOS plans to partner with community-based hospitals, clinics and mental health centers to create regional psychiatric care centers. Some of these new facilities would serve Minnesotans with immediate mental health needs, while others would provide care at a lower urgency level.
According to the report, the redesign reflects not only budget pressures, but findings that SOS inpatient beds were being “inappropriately utilized or underutilized because of a lack of appropriate placement alternatives,” resulting in some people staying in SOS facilities longer than medically necessary.
“We believe, after this entire process, that we can spend less money and improve the care, but it is going to … take a totally different way of doing things,” Sulik said.
Providers and mental health advocates who testified before the House Health Care and Human Services Policy and Oversight Committee in March said they were troubled by the lack of detail in the SOS proposal. The plan hinges on an unprecedented level of collaboration with non-state services, which is described only generally in the redesign’s second and third phases.
Furthermore, the lack of funding facing county and community-based services “leaves a moon-like landscape on which to land this initiative,” said Mark McAfee, who represents AFSCME Council 5. “Partners need money to collaborate and that will not be easy to come by.”
Some critics also accuse SOS of ignoring input from employees and other stakeholders, despite a series of regional meetings on the topic last fall and early this year. Rep. John Ward (DFL-Brainerd) said none of the concerns he heard at a meeting in his district are represented in the proposal. Ed Eide, director of the Mental Health Association of Minnesota, echoed similar sentiments.
“Throughout the state, people feel like their ideas were not listened to and decisions had already been made concerning cuts to services,” he said.
Changes for patients
Providers say they are most concerned about what the changes could mean for patients. Linda Rossow is a psychiatric nurse in Mankato, where the South Central Crisis Center helps divert patients from the local hospital. She is critical of SOS’s proposal to close the crisis center and send patients to a community behavioral health hospital in St. Peter, which Rossow said does not have the space, staffing or access to public transportation needed to accommodate new arrivals.
“The bottom line is that the patients are the ones who will pay the price,” she said.
Meanwhile, dental care providers are upset about the decision to close state clinics for people with developmental disabilities. These patients often have increased dental problems because of their behaviors, said Sue Fields, a dental assistant at Health Source Dental Clinic in Cambridge. They can also be challenging to treat. Fields has been vomited on and spit on by patients; she’s also cleaned body excrement from the floor of the clinic.
“There is no way that a private dental office can see the patients that we see,” said Sandy Johnson, a dental assistant at the clinic in Fergus Falls. She finds it difficult to comfort the caregivers of her patients, like the father who brought his 24-year-old in for a recent visit.
“He said, ‘Where am I going to take my daughter? The doors are closed to her,'” Johnson recalled. “What am I supposed to say to these people? I don’t know.”