The Minnesota Department of Human Services (DHS) needs to find new ways to manage state-operated facilities and services for persons with chemical dependency, mental illness and developmental disabilities. The call for change is made in the wake of a critical report by the Minnesota Legislative Auditor’s Office.

The report details problems ranging from a rise in assaults, to patients kept at facilities for longer than they should. State lawmakers requested the audit last year. The audit report states that “a wide range of significant problems” were found as a result of the auditor’s scrutiny.

“Of particular concern, we found that the department’s approach to managing state-operated services has caused confusion and resulted in inadequate oversight and accountability,” Legislative Auditor James Nobles said. “Among other recommendations, we call on the legislature to more clearly define in law the state’s role and objectives in directly delivering human services and operating facilities.”

Nobles presented the report February 27 to state lawmakers, telling them the audit revealed “significant and persistent problems.”

Members of the Senate Health and Human Services Committee said they are frustrated about the problems. Sen. Tony Lourey, (DFL-Kerrick) was among those expressing frustration at how long problems have gone on and the lack of communication about problems. He and other lawmakers said they support the recommendations from the legislative auditor.

In a statement, DHS Commissioner Lucinda Jesson said, “We agree with each and every recommendation in the auditor’s report. We have already begun implementing many of the auditor’s recommendations.” DHS has already taken a number of steps ranging from changing division leadership and installing new managers for the troubled state security hospital in St. Peter. That facility is currently under probation, after violations including seclusion and restraint of residents, were found in 2011.

Jesson also pointed out that Gov. Mark Dayton’s budget includes money for transitional housing and supportive services for people discharged from state-run facilities.

The DHS State Operated Services division has a budget of almost $300 million. It runs about 130 residential facilities, ranging from group homes to the Minnesota State Security Hospital in St. Peter. Almost 1,300 people live in the facilities. Thousands more are served as outpatients.

Nobles questioned whether some clients can be better served by private providers and whether other clients are better off in community-based settings. The recommendation for privatization would be for smaller facilities and not for larger state hospitals.

One huge problem is that of safety for residents and employees. The number of assaults involving staff or residents at DHS facilities almost doubled in 2012 with a total of nearly 2,000 incidents. The report also outlined a rise in reported sexual incidents, self-injuries and threats. While the increased number of assaults may be partially due to changes in reporting standards, legislators expressed surprise at the high numbers. They also are worried about the report’s concerns about use of restraints and seclusion techniques in state facilities.

Another red flag is the number of ongoing problems at the Minnesota Security Hospital in St. Peter. Auditors found that many of the facility’s 400 patients, being among the most mentally in Minnesota, don’t regularly receive therapy or see psychiatrists. More than half of the patients have not seen a psychiatrist in the past 30 days.

Patients spent, on average, about 16 hours a week in various employment, hobby, fitness and recreation activities, with about one hour per day on “scheduled therapeutic activities,” according to the report.

The report calls for the Minnesota Security Hospital to adopt policies on “the hours of counseling, therapy and other treatment offered per week to help patients address their underlying mental health issues.” State Operated Services is urged to “develop clear, consistent standards that address how often Minnesota Security Hospital patients should be seen by a psychiatrist, and it should monitor compliance with these standards.”

Another recommendation is to find better placement operations for people with mental illness who are ready to return to the community. One troubling finding is that many people stay months or even years longer in state facilities than they have to. For example, more than one-third of patients at the Anoka Metro Regional Treatment Center are ready to be discharged. But they remain in the facility, in part because of a lack of resources.

“Some facilities have had significant difficulty finding placements for individuals ready to be discharged, and (the department) should develop or foster additional placement options,” the report states. Discharge problems are one reason that “many behavioral health patients have stayed in state-run hospitals longer than necessary.”

One issue the audit raised is the need for changes in the civil commitment process used to place many people in state operated services. Many states have a regular judicial review process to evaluate people placed in state operated services; Minnesota does not.

“We recommend requiring periodic judicial review of individuals committed as mentally ill and dangerous or as developmentally disabled, “Nobles said. The audit revealed that some patients have lived at the Minnesota Security Hospital for as long as 30 years, yet their cases have had no judicial review.

“It’s important for the legislature and DHS to address situations that, frankly, could be lawsuits waiting to happen,” said Joel Alter. He led the study for the Office of the Legislative Auditor.

People with developmental disabilities are also a focus of the report. The report recommends that DHS develop a plan to reduce the number of group homes it operates for people with developmental disabilities, and that state lawmakers address the issue in 2014.

“There are a lot of other capable providers who run group homes for the developmentally disabled,” said Alter. But he did concede that some more challenging individuals may be best served by the state and not private providers. The text of the report can be seen at www.auditor.leg.state.mn.us/ped/pedrep/sos.pdf