Rural mental health system criticized

Five years after Minnesota closed its last state hospital and promised a new era of rural psychiatric care, some patients are in limbo. Hundreds of patients with the most acute mental illnesses are cycling through a system ill equipped to treat their disorders and winding up in county jails or hospital emergency rooms.

The Star Tribune investigated the problem in rural Minnesota. In the area near Willmar, where a large state hospital closed in 2008, nearly 1,000 adults with mental illness or chemical dependency were arrested and jailed between 2007 and 2012 for offenses ranging from assault to public nuisance, according to arrest data analyzed by the newspaper.

For thousands of people, community placement, medication and therapy has been a success. But for others it can be difficult. In one recent 18-month period, about 4,000 Minnesotans with acute mental illness ended up in the criminal justice system, ended up in jail and were committed by judges to state facilities.

Two small treatment centers in west-central Minnesota were cited for neglect in cases where patients attempted suicide. Employees of at least three area hospitals have been injured in outbursts by psychiatric patients. The Kandiyohi County sheriff is considering whether to convert an unused part of the jail into a psychiatric wing.

“In my opinion, we’ve gone back to the dark ages,” County Attorney Jenna Fischer told the Star Tribune. She has dealt with the mentally ill for two decades through the court commitment system. “It’s a tiny segment of the mentally ill, but we are failing them.”

“We’re going to have a crisis one of these times,” said Jim Pew, director of behavioral medicine at Stevens Community Medical Center in Morris. Recently a social worker there was pushed to the ground and injured by a patient. “Somebody’s going to harm themselves or harm somebody else because we’re not able to get them placed in a facility that’s set up to deal with [them].” (Source: Star Tribune)

 

 

Court reviewing guardianship case

The Minnesota Supreme Court will review a case with major implications for guardians, and the issue of taking their wards off of life support. The court decided in October to review the case of Jeffers Tschumy.

The review could affect the plus-12,000 Minnesotans under guardianship who don’t have health care directives. The question to be decided is whether guardians must receive a judge’s approval to remove life support, or whether guardians already have that power.

Tschumy was a developmental disabled man with no family and no health care directive in place. After a choking incident last year, he sustained severe brain injury. Allina Health System asked that a judge allow him to be removed from life support, either by clarifying that his guardian had the right to make the decision, or by issuing an order allowing his removal from life support.

A district court denied the guardian’s request forsole power to make that decision, but authorized the termination of Tschumy’s life support. Tschumy later died. The judge in the case stated that while guardians have a strong case to make end-of-life decisions under a state law that grants them the power to allow or withhold medical care, the law doesn’t specifically allow them to end life support. Until the law is changed, only judges or legally authorized representatives can order life support removed. Last summer, the Minnesota Court of Appeals reversed that ruling, stating that the final authority lies with guardians and that end-of-life decisions shouldn’t be dictated by the court. (Source: Associated Press)

 

 

Canceled wedding prompts generosity

What was supposed to be a perfect fall wedding in Fargo became something else after the groom backed out. Michelle Marxen decided that what was supposed to be her October 19 wedding would be a party for Moorhead-based Creative Care for Reaching Independence—a nonprofit that serves people with disabilities.

A year of planning had been completed and invitations sent, when Marxen got the call that her fiancé didn’t want to get married. After finding that she still had to pay the vendors, Marxen and her family repurposed the event into a Halloween party for the Moorhead group and its; clients.

“I was speechless,” Jody Hudson of Creative Care for Reaching Independence told the Fargo Forum. “I could not believe it. I called the next day to make sure it was for real.”

Instead of a weekend of what ifs and whys, Marxen said it’s a way to make the best of a bride’s worst nightmare. “What was supposed to be my special day will now be their special day,” she said. (Source: Fargo Forum) 

 

 

Investigation reveals state hospital problems

Release processes, staff turnover, lack of training and lack of knowledge about homeless shelters are problems found during an investigation of a July Minnesota Security Hospital incident. A hospital patient from the St. Peter facility was discharged and left at a Minneapolis homeless shelter.

Attorney Mary Foarde, who conducted the investigation, also said that more resources are needed for homeless mentally ill people who have been treated and no longer meet the criteria for being an inmate in the state’s most secure hospital.

Foarde reviewed the situation for the Minnesota Department of Human Services after a 23-year-old man was discharged from St. Peter Regional Treatment Center, driven to the Salvation Army’s Harbor Light Center in downtown Minneapolis by hospital staff and left there.

The man was in the St. Peter Hospital after an incident earlier this year. His mental health improved and staff worked to get a Community Alternatives for Disabled Individuals (CADI) waiver so he could be discharged.

The waiver would have paid for Traylor’s psychiatric care outside the hospital. After a series of legal actions, and at least one filing error, the man’s commitment was automatically terminated and after considering other options, he asked to be released and was taken to the Minneapolis shelter.

Foarde recommended that hospital staff create a system of checks, with multiple safeguards that would ensure reports are filed on time and prevent such incidents in the future. She also said the staff in the unit where Traylor was staying needs more training for discharging patients who are mentally ill. Discharging mentally ill and dangerous people is more complex, but staff seemed to have a better understanding of that process, she said. Staff turnover at the hospital, especially with psychologists and psychiatrists, also contributed to the incident. (Source: Mankato Free Press)

 

 

County’s actions spark outrage

A Beltrami County jail inmate who is mentally ill was not only badly beaten in jail, a judge quickly released him from jail so that the county wouldn’t have to pay his medical bills. The judge also failed to ensure that the inmate would be returned to custody and receive proper psychiatric care after being released from the Minneapolis hospital where he was treated. The judge’s actions were revealed by a Star Tribune investigation.

Kristine Koplar, the county’s chief public defender, was outraged. She said local officials placed budgetary savings before the welfare of a vulnerable adult. After the 43-year-old man was discharged from the hospital, he was forced to hitchhike 215 miles to Bemidji. He is now receiving treatment there.

Beltrami County Judge John Melbye told the Star Tribune he gave the man a furlough to go to Hennepin County Medical Center for treatment of a broken jaw sustained in a beating while incarcerated. The furlough was granted without reviewing the man’s criminal and mental health records. Minnesota law states that a jail is responsible for health care costs of inmates while they are in custody. But counties get around paying the costs by asking that judges grant furloughs, to shift expensive treatment costs back to the prisoner’s previous health insurer. (Source: Star Tribune)