LEGISLATIVE ISSUES 2019 - NAMI Minnesota
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2019 LEGISLATIVE ISSUES
MENTAL HEALTH LEGISLATIVE NETWORK
OF MINNESOTA
1919 University Ave. W., Suite 400, St. Paul, MN 55104
MENTAL HEALTH LEGISLATIVE NETWORK 2019
The Mental Health Legislative Network (MHLN) is a broad coalition that advocates for a statewide mental health
system that is of high quality, accessible and has stable funding. The organizations in the MHLN all work togeth-
er to create visibility on mental health issues, act as a clearinghouse on public policy issues and to pool our
knowledge, resources and strengths to create change.
This booklet provides important information for legislators and other elected officials on how to improve the
lives of children and adults with mental illnesses and their families and how to build Minnesota’s mental health
system.
The following organizations are members of the Mental Health Legislative Network:
Amherst H. Wilder Foundation MN Office of Ombudsman for Mental Health and Devel-
AspireMN opmental Disabilities
Barbara Schneider Foundation Minnesota PROOF Alliance, formerly MOFAS
Canvas Health Minnesota Psychiatric Society
Catholic Charities of St. Paul and Minneapolis Minnesota Psychological Association
Children’s HealthCare Minnesota Minnesota Recovery Connection
Community Involvement Programs Minnesota Society for Clinical Social Work
Emily Program Foundation Minnesota School Social Workers Association
Fraser NAMI Minnesota
Goodwill Easter Seals National Association of Social Workers, Minnesota
Guild Incorporated Chapter
Lutheran Social Service of Minnesota MN Office of Ombudsman for Mental Health and Devel-
Mental Health Minnesota opmental Disabilities
Mental Health Providers Association of Minnesota People Incorporated
Mental Health Resources Resource, Inc.
MMLA/Minnesota Disability Law Center Rise
Minnesota Association for Children’s Mental Health State Advisory Council on Mental Health
Minnesota Association of Community Mental Health Subcommittee on Children’s Mental Health
Programs Touchstone Mental Health
Minnesota Coalition of Licensed Social Workers Vail Place
Minnesota Association of Marriage and Family Thera- Wellness in the Woods
py
Minnesota Behavioral Health Network
Minnesota Department of Human Services
If you have questions about the Mental Health Legislative Network or about policies related to the mental
health system, please feel free to contact NAMI Minnesota at 651-645-2948 or Mental Health Minnesota at
651-493-6634. These two organizations co-chair the Mental Health Legislative Network.
2TABLE OF CONTENTS
Mental Illnesses 4
The Mental Health System 5
Key Issues for the 2019 Legislative Session 6
System Issues 7—8
Reimbursement Rates
Mental Health Parity
Network Adequacy
Certified Community Behavioral Health Clinics
Telemedicine
Adult Mental Health Services and Supports 9—12
Flow Issues
Housing
Crisis Response
Peer Respite
Clubhouse or Community Support Programs
First Episode
Employment
Farmers
Children’s Mental Health 13—15
Early Childhood Consultation
School-Linked Mental Health Grants
Residential Treatment
Children’s Mental Health Supports
Education
Conversion Therapy
Access to Mental Health Treatment 16—17
Workforce
Duty to Warn
Suicide Prevention
Community Mental Health Treatment
Racial Disparities and Mental Health Equity
Criminal Justice 18—19
Prisons
Administrative and Disciplinary Segregation
Jails
Ombudsman
Other Issues 20
Civil Commitment
Provision of Care in Integrated and Culturally Diverse Settings
3MENTAL ILLNESSES
Mental illnesses are medical conditions that disrupt a Resilience becomes a key component of recovery.
person's thinking, feeling, mood, ability to relate to oth-
ers and daily functioning. Mental illnesses affect about Some people need access to basic mental health treat-
one in five people in any given year. People affected ment. Others need mental health support services such
more seriously by mental illnesses number about 1 in as case management (and/or care coordination) to as-
25. Mental illnesses can affect persons of any age, race, sist them in locating and maintaining mental health and
religion, political party or income. social services. Still others need more intensive, flexible
services to help them live in the community.
Examples of mental illnesses include major depression,
schizophrenia, bipolar disorder, obsessive compulsive Depending on the severity of the mental illness and
disorder (OCD), anxiety, panic disorder, post-traumatic whether timely access to effective treatment and sup-
stress disorder (PTSD), eating disorders and borderline port services are available, mental illnesses may signifi-
personality disorder. There is a continuum, with good cantly impact all facets of living including learning,
mental health on one end and serious mental illnesses working, housing stability, living independently and
on the other end relationships.
Mental illnesses are treatable. Most people diagnosed Although there are effective treatments and rehabilita-
with a serious mental illness can get better with effec- tion, the current mental health system fails to respond
tive treatment and supports. Medication alone is not timely to the needs of too many children, adults and
enough. Therapy, peer support, nutrition, exercise, sta- their families. Timely access to the full array of neces-
ble housing, and meaningful activities (school, work, sary mental health benefits and services, whether treat-
volunteering) all help people recover. ment or rehabilitation, is often limited due to lack of
insurance coverage, low payment rates, workforce
The Substance Abuse Mental Health Services Admin- shortages or geographical or cultural disparities.
istration (SAMHSA) defines recovery as a process of
change through which individuals improve their health Without access to treatment and supports, people with
and wellness, live self-directed lives, and strive to reach mental illnesses may cycle in and out of the criminal
their full potential. Recovery is characterized by contin- justice system or homelessness, drop out of school, be
ual growth and improvement in one’s health and well- unemployed and be isolated from family, friends and
ness that may also involve setbacks. the community.
4THE MENTAL HEALTH SYSTEM
The mental health system is not broken. It was never vices in the community such as affordable supportive
built. The old state hospitals were not a system and housing, community supports, employment supports,
there were very good reasons that they closed. Most educational services, respite care and in-home sup-
of the beds closed by 1980 and since then we have ports. These services are often funded by state
identified what works and advocated for funding to grants and county funds.
build our mental health system. Barriers to progress
Workforce: Psychiatry, psychology, clinical social
exist and we hope to address them this session.
work, psychiatric nursing, marriage and family thera-
Insurance Coverage: The main access to the men- py and professional clinical counseling are consid-
tal health system is through insurance – either pri- ered the “core” mental health professions. For many
vate health plans or a state program such as Medical years, Minnesota has experienced a shortage of men-
Assistance (MA) or MinnesotaCare. For those who tal health professionals. This shortage has been felt
have no insurance or poor coverage, access is then most profoundly in the rural areas of the state and
through the county or a community mental health within culturally specific communities.
center. Private health plans often do not cover the
Reimbursement Rates: Historically, poor reim-
full array of mental health services. Mental health
bursement rates in public mental health programs
parity only requires plans to ensure parity IF they
have contributed to the problems of attracting and
cover mental health or substance use disorder treat-
retaining mental health professionals. Improved pay-
ment. Under the Affordable Care Act (ACA) individual
ment to mental health providers allows providers to
policies and small group plans must cover mental
hire and supervise qualified workers to better meet
health and substance use disorder treatment and fol-
the needs of people with mental illnesses in a timely
low mental health parity laws. Enforcement needs to
way. Rates paid through managed care Medical Assis-
be stronger.
tance are often lower than fee-for-service rates.
Community Services: Some people who have the
most serious mental illnesses need additional ser-
5KEY ISSUES FOR THE 2019 LEGISLATIVE SESSION
More than ever before, we know what works. Early intervention, evidence-based practices and a wide array of men-
tal health services has created the foundation for a good mental health system in Minnesota. Unfortunately, work-
force shortages, poor reimbursement rates, and lack of coverage by private plans have resulted in a fragile system
that is not available statewide and is not able to meet the demand.
People often look for “quick fixes” such as more beds. Children and adults with mental illnesses spend the majori-
ty of their lives in the community. Thus, the “fix” is more complex in that we need to provide early identification
and intervention, be able to address a mental health crisis, and provide ongoing supports in the community.
While the focus tends to be on the delivery of mental health treatment, other areas need attention as well. People
with mental illnesses rely on the CADI Waiver (Community Alternatives for People with Disabilities) or on Com-
munity First Services and Supports (which will replace the old PCA program) for day-to-day help in their homes.
Yet changes to both of these programs have resulted in them being less available to people with mental illnesses.
Affordable and supportive housing are very important to recovery. If you are homeless or have unstable or unsafe
housing, it is difficult to focus on getting better. Everyone needs a reason to get up in the morning and yet people
with serious mental illnesses have one of the highest unemployment rates.
Graduating from high school is important to future success. Many young people with serious mental illnesses
drop out of school. Often, they lag behind their peers due to being in day or residential treatment and yet cannot
access summer school. These students face the use of seclusion and restraints more frequently and schools are
often at a loss as to what to do to keep the child safe.
Our juvenile justice and criminal justice system have been used for over 50 years to care for youth and adults
with mental illnesses who have committed largely nonviolent crimes. Steps have been taken to address this in-
cluding training of public safety officers, the development of mental health courts and the creation of mental
health crisis teams _ but it isn’t enough
Suicide rates are increasing in Minnesota. Nearly 800 people took their lives last year. Given the scale of this prob-
lem – exceeding even the opioid crisis – it is imperative that we recognize Minnesota’s suicide rate as a public
health crisis that requires immediate action.
Low rates and workforce shortages add to the stressors on the system. Providers are not paid for what they are
required to do. Low rates make it difficult to attract new people to the field. Workforce shortages make it difficult
to hire enough people to meet the needs.
The Mental Health Legislative Network believes these challenges, though very significant, are not insurmounta-
ble. Again, we know what works. Let’s build our mental health system.
Key Issues for the 2019 Legislative Session
Stabilizing and increasing access to effective mental health care throughout the state by increasing rates and
funding and eliminating barriers to development
Enforcing Mental Health Parity laws
Expanding access to intensive treatment and supports
Providing supports and education that support children to live with their families
Helping people living with mental illnesses obtain stable housing and employment
Expanding access to home and community supports through waivers and in-home services
Ending the inappropriate use of the criminal and juvenile justice systems for children and adults with mental
illnesses and providing adequate mental health care in these systems
Expanding the mental health workforce
6SYSTEM ISSUES
providers are paid less than the fee- delivery and payment system to ad-
for-service rate. dress the immediate need and long-
Reimbursement term solutions to solvency, includ-
Providers serving the most vulnera- ing:
Rates ble face additional pressure because Addressing mental health ser-
they cannot gap-fill losses with com- vices' payments under managed
Issue: There is not a sustainable mercial payments and do not refuse care by requiring that mental
reimbursement rate for mental services to clients for any reason. health services payments must
health providers. be at least equal to the published
Sustainable reimbursements for ser- fee-for-service schedule
Background: Reimbursements for
vices are key to addressing work- Providing a rate increase for
mental health services under Medi-
force shortage, program cuts/ flat- community mental health ser-
cal Assistance have been a concern
tening, and safety net services. vices
for many years. We are now at a crit-
Revise payments so that there is
ical time in which demand for more
Policy Recommendations: a sustainable payment method-
access is catalyzing increased invest-
The MHLN propose a three (3) part ology for mental health services
ments to build more services on top
reformed mental health service under Medical Assistance
of a very unstable foundation. Many
Mental Health maximums for mental health care. the NQTLs.
Parity Treatment Limits: Health plans can-
not establish different quantitative
Policy Recommendations:
limits for mental health care than Require private health plans to
Issue: Mental health services are other medical benefits. demonstrate that their plans are
not covered by insurance in the in compliance with parity regu-
same way as medical health ser- Non-Quantitative Treatment Limit lations, including non-
vices. (NQTL): Requires plans to make the quantitative treatment limits
scope or duration of benefits for such as network adequacy, wait
Background: The Mental Health
treatments the same. An NQTL can times, formularies, etc. before
Parity and Addiction Equity Act of
take the form of step-therapy for a they are certified by the Depart-
2008 (MHPAEA) is a federal law
medication, different standards for a ment of Commerce
aimed at requiring health insurance
provider to enter a network includ- Require the Departments of
to cover mental health or substance
ing reimbursement rates, or other Commerce and Health to moni-
use disorder services in the same
limits based on facility type or pro- tor the implementation of men-
way plans cover other medical ser-
vider specialty that limit the scope tal health parity, including mar-
vices. Minnesota statutes require
or duration of health plan benefits. ket conduct examinations
plans to follow the federal law.
Mental health parity stipulates that Require the Departments of
The three pillars of mental health the standards that a health plan uses Commerce and Health to provide
parity are: when making an NQTL cannot be a report to the legislature every
any more stringent or restrictive for year regarding their efforts to
Out of Pocket Costs: Mental health
mental health and substance use dis enforce the parity law
parity requires that copayments
cannot be higher for mental health order treatment than it is for other
care than other medical surgical categories of health care.
benefits, nor can there be a different
deductible or higher out-of-pocket Violations still occur in all three
areas, but the most common one is
7For specialty services, the maximum in-network providers.
Network travel time must be less than 60
minutes or 60 miles. These criteria
Policy Recommendations:
Measure wait times and other
are not adequate because they do
Adequacy not consider wait times or whether
criteria as a better predictor of
network adequacy
in-network mental health providers
Require health plans to annually
Issue: Minnesotans seeking men- are even accepting new clients.
attest to the active status of pro-
tal health care face narrow net-
Plans can apply for a waiver from viders within their network
works, particularly in rural commu-
these network adequacy require- Require a public hearing on re-
nities.
ments. If the plan would like to re- quested waivers to network ade-
new their waiver after it expires, the quacy
Background: Health plans con-
Department of Commerce must take Require licensing boards to
tract with hospitals, doctors, and
into consideration steps taken by the share their lists with the MN
other providers to provide health
plan to expand their network when Dept of Health
and mental health care for its plan
reviewing this waiver request. Acknowledge the crisis in access
members. These providers consti-
to care by requiring health plans
tute a health insurance plan’s net- Over 800 Minnesotan’s died by sui-
to contract with any willing
work and plan members pay more if cide last year. To respond to this cri-
mental health provider to pro-
they receive care out of their net- sis and ensure that Minnesotan’s
vide services in-network if they
work. have access to mental health ser-
are willing to comply with the
vices, NAMI Minnesota believes it is
Minnesota law requires health plan same standards and accept the
necessary to allow any willing men-
networks to offer mental health ser- same rates as other in-network
tal health provider to offer in-
vices with a maximum travel time of providers. And require training
network services if they are willing
no more than 30 miles or 30 minutes for health care and mental health
to abide by the same requirements
to the nearest provider. care providers on how to treat
and rate structure as other
ments, implementing new tools, Background: Internet-based
Certified enhanced care coordination, models
for addressing the opioid epidemic
telepresence offers broad applica-
tions to assist in rapid innovation
Community and a sustainable payment system
for delivering mental health ser-
and statewide service implementa-
tion. Increasingly, different
Behavioral vices. telepresence platforms are being
used by different sectors and disci-
The CCBHC model is an opportunity
Health for laying a new foundation in men-
plines, making it difficult to efficient-
ly and effectively connect with criti-
tal health services delivery in Minne-
cal partnerships, providers and indi-
Clinics sota.
viduals that depend on access. Lim-
Policy Recommendation: its on the type of provides and num-
Issue: Minnesota needs to sustain Expand and continue develop- ber of visits limits access.
and expand the CCBHCs. ment of the CCBHC model be-
Policy Recommendation:
yond the FY 2019 demonstration
Background: The Certified Eliminate the cap on the number
end date and authorize sustaina-
Community Behavioral Health Clin- of encounters permitted in a
ble funding options
ics (CCBHC) model is a federal pilot week
of the Excellence in Mental Health Create a Telepresence Task
Act. Minnesota is one of eight states Force to evaluate leveraging the
selected for the pilot. CCBHCs are Telemedicine State of Minnesota’s
“one stop” shops that provide more telepresence network to connect
seamless care. Issue: Current statute limits the providers of critical mental
frequency and type of providers who health services and to better
To date, we found the model pro- can use telemedicine to serve people serve individuals that lack access
vides great service flexibility, inno- experiencing mental illness. due to geography, lack of trans-
vation and efficacies. portation or incarcerated
These include: aligned intake assess-
8ADULT MENTAL HEALTH SERVICES AND SUPPORTS
the community who may be more ill Expanding the Transition to
and need to continue their care at Community Initiative to serve
Flow Issues AMRTC are unable to transition out people over age 65, people in
of community inpatient beds and Community Behavioral Health
Issue: People are waiting in the into AMRTC. This has created a sig- Hospitals (CBHHs), and people
emergency room for a bed and in nificant bed flow problem for com- in community hospitals seeking
community hospitals to get into munity psychiatric units. To make admission to AMRTC
Anoka Metro Regional Treatment the situation worse, over 20% of Fund projects that offer high
Center (AMRTC) or an Intensive Res- people at AMRTC do not need that intensity, secure facilities for
idential Treatment Services (IRTS) level of care and are waiting to tran- people with complex mental
facility and people are waiting at sition into the community and the health needs
ARMTC for community services. state is not using all of the beds that Increase the number of Forensic
are licensed or funded. The Minne- Assertive Community Treatment
Background: The “48 hour rule” sota Hospital Association reports Teams
gives jail inmates who are commit- that roughly 20% of the people in an Expand the Elderly Waiver to
ted priority to access state facilities, inpatient unit are waiting for anoth- meet the mental health needs of
in particular AMRTC. The number of er level of service. older adults at AMRTC or MSH
people found incompetent to stand Fund community competency
trial has increased greatly resulting Policy Recommendation: Address restoration programs
in most of the people at AMRTC the “flow issues” by: Break off State Operated Ser-
coming from jails. It went from 44 Provide funding for mental vices from DHS to become its
people a year from jails in 2013 to health treatment to inmates in own agency
227 in 2017. As a result, patients in jail
operated facility, access to perma- of Ramsey and Hennepin Counties.
Housing nent supportive housing significant-
ly reduces their time in these sys-
Bridges provides housing subsidies
to people living with serious mental
tems. In one study, 95% of the costs
illnesses while they are on the wait-
Issue: There is limited access to of supportive housing were offset by
ing list for federal Section 8 housing
affordable and supportive housing. lower treatment costs.
assistance. There are long waiting
Background: People with mental The grant program called Housing lists for this program.
illnesses are much more likely to with Supports for Adults with Seri-
Recommendations:
face housing instability or even ous Mental Illness provides grants to
Increase funding for the Bridges
homelessness. Unmanaged mental housing developers, counties and
Program
health symptoms, job loss, inpatient tribes to increase the availability of
Increase funding for housing
mental health treatment, or an expe- supportive housing options. In the
supports for adults with serious
rience with the criminal justice sys- 2017 Legislative Session, supportive
mental illnesses
tem all increase the challenges that housing funding was increased by
Expand the landlord risk mitiga-
people with mental illnesses face $2.15 million dollars in one-time
tion fund and provide the funds
when trying to find and maintain a funding. The 2018 bonding bill also
to agencies serving people who
stable housing situation. People with included $30 million dollars to de-
are homeless
mental illnesses cannot achieve re- velop or renovate supportive hous-
Block DHS’s efforts to limit the
covery without stable housing. ing for people with mental illnesses.
number of people in a building
Many studies show that supportive As of October 2018, over 5,280 Min- on a home and community-
housing successfully interrupts this nesotans with mental illnesses were based waiver to 25%
cycle. For those with a history of in- on a waiting list to receive support-
carceration or treatment in a state- ive housing, including 2,390 outside
9linking people in crisis to outpa- Mobile crisis services are available
Crisis Response tient services, and
Effective in finding hard-to-
throughout Minnesota for both
adults and children. Hours of cover-
reach individuals age vary as does ability to respond.
Issue: Minnesota residents do not Providing a mental health response
have the appropriate level of mental also limits interactions with police. Other components of the crisis sys-
health crisis services available to tem should include: Urgent care or
them in an appropriate or effective Mobile crisis interventions are face- walk in clinics, direct referral from
time frame to-face, short-term, intensive mental 911, psychiatric emergency rooms
health services provided during a and crisis homes.
Background: Mobile crisis teams
mental health crisis or emergency.
reduce psychiatric hospitalizations.
These services help the recipient to:
Research has shown that mobile Policy Recommendations:
Cope with immediate stressors
crisis services are: Increase state funding for crisis
and lessen his/her suffering
Effective at diverting people in teams and homes
Identify and use available re-
crisis from psychiatric hospitali- Allow flexibility with funding in
sources and recipient’s strengths
zation order to meet demands at key
Avoid unnecessary hospitaliza-
Effective at linking suicidal indi- times
tion and loss of independent liv-
viduals discharged from the Require training on children’s
ing
emergency department to ser- mental health
Develop action plans
vices Continue to move to have one
Begin to return to his/her base-
Better than hospitalization at (not 44) crisis numbers
line level of functioning
engagement, and established men- while using supports of the person’s
Peer Respite tal health services and supports. own choosing.
Peer respites are voluntary, short- An August 2018 study compared
term, services provided in a home- costs of service by analyzing the
Issue: Adults with serious men- like setting designed to support indi- month of crisis respite use and the
tal illnesses seeking help through viduals experiencing, or at-risk of, a 11 subsequent months. Medicaid
local hospital emergency rooms psychiatric crisis. “Most peer res- expenditures were on average
and/or experiencing interventions pites work to mitigate psychiatric $2,138 lower per Medicaid-enrolled
via local law enforcement, often emergencies by addressing the un- month with 2.9 fewer hospitaliza-
learn that there are no community derlying cause of a crisis before the tions for crisis respite clients than
services that can assist them until need for traditional crisis services would have been expected with ab-
they are experiencing marked in- arise.” sence of the intervention.
creases in symptoms or even a Ostrow, Laysha & Croft, Bevin. (2015). Peer Res-
E Bouchery (2018 Aug 3) The Effectiveness of a
mental health crisis. Then, many pites: A Research and Practice Agenda. Psychiatric
Peer Staffed Respite Program as an Alternative to
Services, 66(6), 638-640.
are deemed “eligible” to access Hospitalization. Psychiatric Services. 68(10) 1069-
more acute or subacute treatments 1073.
The foundation of PRS is the Peer
in hospitals, intensive residential
Support model itself. Peer Support Policy Recommendations:
treatment services, or face incarcer-
is rooted in the empathic under- Approve development of stand-
ation within jails and prisons. The
standing of shared experiences of ards for and implementation of a
purpose of Peer Respite Services
psychological and/or emotional dis- minimum of two (2) consumer-
(PRS) is to alleviate situations such
tress, rather than the medical treat- run peer respite services admin-
as these.
ment model. PRS differs from pre- istered through DHS
Background: With a lack of ear- sent crisis response and stabilization Provide annual funding of
ly, preventative community-based programs due to the holistic support $370,000 beginning in fiscal year
alternatives, such as PRS, unneces- of the guests learning and growing 2019-2020 with an additional
sary and damaging trauma is expe- during their stay rather than a focus $60,000 being to evaluate the
rienced by the person and their on medication, diagnosis and thera- new services during year one
family and friends. Often, there are py. Peer respite promotes empower- and two
unwarranted losses of housing, ed- ment, self-advocacy, and personal
ucation, employment, community responsibility for one’s recovery
10quality of life, and mental health re- support services available, and have
Clubhouse or covery. It provides a unique-
ly integrated approach to recovery,
been proven effective.
Policy Recommendations:
Community combining peer support with a full
array of services. Studies have Ensure that State funding to
shown Clubhouse Programs de- counties is used to support Com-
Support Programs crease isolation, reduce incarcera- munity Support Programs and
tion and hospitalizations, and in- Clubhouse Model Programs.
Issue: Increase access to Communi- crease employment opportunities. Fund Community Support Pro-
ty Support Programs and Clubhouse grams and Clubhouses to carry
Model programs across the state. Funding: Community Support Pro-
out employment programming
grams/Clubhouse Programs rely on
Background: Community Support a limited funding stream: Communi-
programs and Clubhouse Model pro- ty Support Grants (part of the State
grams help people with mental ill- Adult Mental Health grants) and lo-
nesses stay out of the hospital while cal county dollars. Reliance on this
achieving social, financial, housing, often at-risk funding restricts the
educational and vocational further dispersion of community
goals. People are referred to as support and Clubhouse programs
members not clients. The Club- across the State of Minnesota. De-
house Model is an Evidence– spite the fact that they are among
Based Practice for employment, the most cost-efficient community
First Episode deal in terms of hospitalizations, While 10% of the federal mental
homelessness, and involvement health block grant must be used for
with the criminal justice system. It first psychotic episode programs,
Issue: There are limited programs
and services available for people costs the individual even more. state funding is needed to develop
experiencing their first psychotic or enough programs around the state
First Episode Projects, focusing on
mood episode. The results are ad- to meet the need - which we calcu-
psychosis and mood disorders, will
verse outcomes and disability late to be at least eight programs.
offer coordinated specialty care in-
caused by their untreated mental
cluding case management, psycho- Policy Recommendations:
illness.
therapy, psychoeducation, support Increase the number of first epi-
Background: Individuals experi- for families, cognitive remediation, sode psychosis (FEP) programs
encing their first psychotic or manic and supported employment and/or so that young people experienc-
episode are not receiving the inten- education. These programs provide ing their first psychotic episode
sive treatment they need to foster intensive treatment right away. receive intensive treatment
recovery. On average a person waits They have been researched by the Fund the first early episode of
74 weeks to receive treatment. Our National Institute of Mental Health mood disorder program to pro-
mental health system has relied on a and found to be very effective. vide treatment for young people
with bipolar disorder or depres-
“fail-first” model of care that essen-
sion
tially requires people experiencing In rural areas the catchment area
psychosis or serious mood disorder would need to cover many miles
to be hospitalized or be committed which means that housing must be
multiple times before they can ac- made available for the young person
cess intensive treatment and sup- and their family to access this outpa-
ports. With schizophrenia being one tient treatment program. Currently
of the most disabling conditions in there are only four programs in
the world it is crucial that we inter- Minnesota, three in Hennepin Coun-
vene early with intensive services. ty and one in Duluth.
Waiting costs our system a great
11mental illness. not have jobs.
Employment IPS is an evidence-based employ- Policy Recommendations:
ment program for people with seri- Require the commissioner of
ous mental illnesses. There are only DEED, in consultation with
Issue: Persons with mental ill-
eight in the state. IPS State grant stakeholders, to identify barriers
nesses have the highest unemploy-
projects have received no cost of liv- that people with mental illnesses
ment rate and yet employment is an
ing increases. In SFY 2015 all IPS face in obtaining employment,
evidence-based practice, meaning it
grantees experienced cuts of 8.6 per- identify all current programs
helps people recover. Programs that
cent that have not been restored. that could assist people with
are designed specifically for persons
mental illnesses in obtaining em-
with mental illnesses are underfund- Statewide expansion would require
ployment and submit a detailed
ed and serve a limited amount of new funding for direct service
plan to the legislature how to
people. (grants to providers) and infrastruc-
expand the numbers of people
ture to support training, technical
Background: People living with with mental illnesses working
assistance, data collection, program
mental illnesses face a number of Increase funding for the IPS pro-
monitoring, and evaluation. Not all
barriers to finding and keeping a job. gram for both expansion and
counties follow the requirement to
They often face discrimination when infrastructure, explore the use of
use some of their state mental health
applying for jobs and may face other Medicaid for IPS, require a mem-
funds for IPS.
obstacles such as losing health insur- orandum of understanding be-
ance coverage for their mental Vocational Rehabilitation Services tween DEED and DHS
health treatment and medications or continues to have three out of four Require workforce centers to
have a lack of transportation. In ad- service categories closed. This have training on accommoda-
dition, few receive the supported makes it hard for people with mental tions for a mental illness
employment opportunities shown to illnesses to access help through VRS. Fund community support pro-
be effective for people with mental With hardly any programs to help grams to assist people with
illnesses and few employers know people with mental illnesses find mental illnesses to find and keep
about accommodations for a and retain employment, most do employment
Researchers are examining why the Background: This proposal aims
Farmers rate is higher in rural areas and have
to strengthen the existing frame-
found that isolation, substance use work of BHH services to support the
disorders, an aging population with capacity of providers delivering BHH
poor physical health and financial services and to increase access for
Issue: People in farming commu-
issues are some of the contributing individuals with mental illness and
nities are experiencing high rates of
factors. co-occurring medical conditions.
stress and distress.
These changes are expected to result
Policy Recommendations:
Background: Men in the farming, in approximately 300 additional in-
Increase funding for counselors
forestry and fishing industries have dividuals accessing BHH services
through the Department of Agri-
the highest rate of suicide. A recent each year.
culture
CDC report found that suicides in
Fund efforts to increase aware- Policy Recommendations:
rural areas were higher and the in-
ness about stress and mental Update eligibility requirements,
creased rate has been higher than
health and suicide prevention service standards, provider re-
other communities. In Minnesota,
quirements, and reimbursement
counties with the highest percent-
rates
ages of suicide per population be- Behavioral Include four elements: Certifica-
tween 2012 and 2016 include coun-
tion process and stand-
ties that have a high percentage of
farmers. The suicide rate in Greater
Health Homes ards, Streamlined BHH rate
structure, Improved access to
Minnesota increased from 13.1 to
Issue: There is a need to make BHH services, New/ added staff
15.9 in this same period, while the
changes to Behavioral Health qualifications
rate for the seven county metro area
Homes.
went from 11.2 to 11.1.
12CHILDREN’S MENTAL HEALTH
culturally appropriate services for 2) Referral for children and their
young children. families who need mental health
Early Childhood services
Early childhood mental health con-
Consultation sultation grants support having a 3) Training for child care staff in
mental health professional, with child development; trauma/
knowledge and experience in early resilience; working with families
Issue: Child care providers and
childhood, provide training and reg- who have their own mental
educators do not have the necessary
ular onsite consultation to staff serv- health issues; and skills to better
training or skills to adequately sup-
ing high risk and low-income fami- support the emotional health
port children with mental health
lies, as well as referrals to clinical and development of children
needs. Children are getting kicked
services for parents and children they work with. These trainings
out of child care instead of receiving
struggling with mental health condi- would be built into the Parent
the supports and treatment they
tions. Early childhood mental health Aware ratings of participating
need.
consultation has three main compo- child care agencies
Background: Since 2007, Minne- nents:
Policy Recommendation:
sota has invested in building infra-
1) On-site mental health consulta-
structure to address early childhood Appropriate funds to expand
tion and support for child care
mental health through grants to sup- early childhood mental health
agency staff. Mental health agen-
port and develop the availability of consultation grants
cies will also work directly with
and access to developmentally and
families as appropriate
un/underinsured and for services grants for co-locating mental
School-Linked for which you can’t bill insurance.
Grants are used to build the capacity
health professionals in Interme-
diate Districts, special ed cooper-
Mental Health of the school to support all children. atives and at level four settings
and allow these grants to sup-
We know that 50% of the children
Grants had never been seen before & 50%
port developing innovative ther-
apeutic teaching models in addi-
had a serious mental illness. In
tion to other school-linked prior-
2017, 16,284 children were served
Issue: Expand School-linked Mental ities
in 288 districts and 953 school
Health (SLMH) Grants. Require DHS to work with
buildings.
stakeholders to assess the school
Background: Since 2008, grants
Last year the Intermediates and co- -linked mental health program
have been made to community men-
operatives received funding to sup- and develop recommendations
tal health providers to collaborate
port their students. on how to improve it including
with schools to provide mental
Policy Recommendations: promoting sustainability among
health treatment to children. This
grant attendees, determining the
program has reduced barriers to ac- Increase funding for school-
staffing necessary for a success-
cess such as transportation, insur- linked mental health grants so it ful program, reviewing what da-
ance coverage, and finding provid- is in every school building ta is collected, and analyzing out-
ers. Ensure that grant funds are used comes when school buildings
This program works collaboratively to build the capacity of schools have access to a school-linked
with school support personnel such to meet the needs of students mental health program, suffi-
as school nurses, school psycholo- with mental illnesses such as cient school support personnel
gists, school social workers and staff development and Positive Behavioral Inter-
school counselors. The providers bill Utilize telemedicine to increase vention and Supports
private and public insurance and access in Greater Minnesota
grant funds pay for students who are Fold in and increase existing
13children residing in IMDs lose their sion. The legislature authorized 150
Medical Assistance eligibility. Minne- beds in 2015. Only one PRTF is op-
Residential sota has over 800 beds in the contin- erating in the state.
uum of care that would be affected
Treatment by this loss of funding. Policy Recommendation:
Immediately pass legislation to
In 2017, the legislature appropriated cover the loss of federal funding
Issue: Since 2001, with approval
bridge funding to cover the lost fed- until June 30, 2019
from the Center for Medicaid and
eral share. However, this funding is Fund the loss of federal funding
Medicare (CMS,) Minnesota has used
set to expire on April 30, 2019, be- for the next two years
Medical Assistance to pay for the
fore the end of the biennium. With- Increase the number of PRTF
treatment portion of the per diem
out funding, counties will have to beds
for children’s residential treatment
bear 100% of the costs of this vital Implement the recommenda-
services. Last year CMS decided
part of our continuum of care. tions from the residential treat-
that most of the residential facilities
in Minnesota meet the definition of Psychiatric Residential Treatment ment report that will be released
Institutes of Mental Disease (IMDs) Facilities (PRTF) provide active in late February
which makes them ineligible for fed- treatment rather than rehabilitation
eral Medicaid funding. and must have a psychiatrist or phy-
sician as a medical director, and re-
Background: Programs that are
quire 24 hour nursing. The rates in-
larger than 16 beds that provide
clude room and board under MA and
mental health treatment are consid-
PRTFs are exempted from the Insti-
ered an IMD and not only does Medi-
tute for Mental Disease (IMD) exclu-
caid not pay for the treatment, but
illness so that they can raise healthy Explore developing intensive
Children’s Mental children. in-home services for children
with a mental illness
Building on these efforts and provid-
Health Supports ing more community-based supports
Expand Youth ACT teams to a
younger age
will allow children with mental ill-
Fund shelter-linked mental
nesses to get the level of care they
Issue: When a child is facing sig- health providers
need in the community where they
nificant mental health challenges, Fund child care for mothers with
live.
there are not enough options for the mental illnesses who have MFIP
child and their family to obtain the Policy Recommendations: child only grants when it is rec-
level of support they need. Without Fund training for crisis teams to ommended by a mental health
adequate support in the community, understand the unique needs of professional
children and youth will develop children and their families expe- Fund multi-generational treat-
more serious mental illnesses and riencing a mental health crisis ment teams
require more intensive treatment. Clarify that a child does not need
Fund community and technical
a case manager in order to re- college mental health programs.
Background: While some progress
ceive respite care Fund transition age programs
has been made there are still signifi-
cant gaps in our children’s mental Increase funding for respite care.
health continuum of care. Respite Fund crisis respite services
care is a very successful program Develop and fund crisis homes
where the parents of children with a for children and youth
mental illness are given a break to Move funding for Evidence
recharge. There are currently no Based Practices out of school-
crisis homes for youth or crisis res- linked grants and other grants
pite care. Youth in shelters also need and concentrate all in one grant
access to more intensive mental to an agency to increase training
health care. We also need to support and their use of Evidence Based
parents who are living with a mental Practices.
14CHILDREN’S MENTAL HEALTH
difficult to meet the needs of stu- Supports (PBIS)
dents. Fund social emotional learning
Education programs to reduce use of sus-
Minnesota students are often unable
pensions in grades K-3
to access even basic information
Issue: Schools have an important Provide year round education to
about what mental illnesses are,
role to play in supporting students students who miss out on school
what the symptoms are of mental
with mental illnesses, but they don’t due to being in the juvenile jus-
illnesses, and what they need to do if
have the resources to do this work tice system or intensive mental
they are worried about themselves,
effectively. health treatment
a friend, or someone in their family.
Fund an online training for all
Background: While some students
Policy Recommendations: teachers on suicide prevention
with significant mental health needs
Increase number of student sup- Increase funding for substance
will require more intensive treat-
port personnel use disorder services in the
ment from a mental health profes-
Require schools to include men- schools
sional, most youth can greatly bene-
tal health and recognizing the
fit from mental health supports pro-
symptoms of a mental illness in
vided by school staff. Academic
their health curriculum
counselors, school social workers,
Increase funding for school-
nurses, school pyschologists and
based mental health providers
other student support personnel all
such as licensed PreK-12 school
have a very important role to play in
social workers, so that every
the continuum of care for students
buildings student’s have lower
having some mental health challeng-
barrier access to evidence-based
es.
education, behavior, and mental
School support personnel have in- health services
credibly high caseloads making it Expand and continue Positive
Behavioral Interventions and
ness or developmental disability to thoughts, suicide attempts, and sub-
be cured. Scientific evidence, in con- stance abuse in adults.
Conversion trast, has found same-sex attraction
Recent research has found adoles-
and gender non-conformity are
cents surviving conversion therapy
Therapy healthy aspects of human diversity.
to have less educational attainment
Conversion therapy practitioners
in addition to the increased depres-
base their treatments on unscientific
sion and suicide risk adult survivors
Issue: Conversion therapy to alter and inaccurate understandings of
of conversion therapy experience.
or change an individual’s sexual ori- sexual orientation, gender identity,
entation is not supported by rigor- and gender expression. Being LGBTQ All the major health and mental
ous scientific research and is proven is not a mental illness and therefore health organizations support ban-
to increase levels of depression, sui- therapy is not needed. ning conversion therapy.
cidal thoughts, suicide attempts, and Policy Recommendation:
There is no scientifically rigorous
substance use disorder.
evidence demonstrating the effec- Ban conversion therapy as a
tiveness of conversion therapy. Sci- harmful and ineffective practice
entific studies have found negative
Background: Conversion therapy
effects associated with conversion
is usually defended by proponents
therapy, however, including in-
because of their belief that same sex
creased levels of depression, suicidal
romantic orientation is a mental ill-
15ACCESS TO MENTAL HEALTH TREATMENT
work to expand access to mental Require insurance to cover treat-
Workforce health services across the state,
there is a great urgency to increase
ment and services provided by a
clinical trainee
the supply of community mental Add LMFTs and LPCCs to the
Issue: There are not enough men- health professionals. MERC program
tal health practitioners and profes- Provide grant funding to every
In 2015 the Mental Health Work-
sionals to meet the needs of the chil- Tribal Nation and Indian Com-
force Task Force released the report
dren and adults requiring mental munity in the state of Minnesota
with recommendations to address
health treatment and services. and (5) urban Indian communi-
workforce shortages by increasing
ties to support a full-time tradi-
Background: Psychiatry, psychol- the number of qualified people
tional healer
ogy, clinical social work, psychiatric working at all levels of our mental
Fund a program to train pedia-
nursing, marriage and family thera- health system, ensure appropriate
tricians on how to treat mental
py and professional clinical counsel- coursework and training for mental
illnesses in children
ing are considered the “core” mental health professionals and create a
Extend the state funded primary
health professions. For many years, more culturally diverse mental
residency program from three
Minnesota has experienced a short- health workforce.
years to four for psychiatrists
age of providers of mental health
Policy Recommendations: Create an alternative pathway to
services. This shortage has been felt
Ensure access to affordable su- licensure for mental health pro-
most profoundly in the rural areas of
pervisory hours for mental fessionals from diverse back-
the state. There is also an ongoing-
health certification and licensure grounds
shortage of culturally competent and
Increase funding for the rural
culturally specific providers.
health professional education
Nine of eleven geographic regions in loan forgiveness program and
Minnesota are designated mental set aside funds for people work-
health shortage areas by the Health ing in metro area programs
Resources and Services Administra- where more than 50% of the pa-
tion (HRSA). As more people seek tients are on Medicaid or unin-
mental health treatment and as we sured
specific, clearly identified or identi- Counseling. Social Work and
Duty to Warn fiable potential victim. If a duty to Licensed Professional Clinical
warn arises, the duty is discharged Counselor trainees were not cov-
by the provider if he or she makes ered in the legislation.
Issue: Current Minnesota statute “reasonable efforts”
covers only certain mental health (communicating the serious, specif- Policy Recommendation:
professional or practitioner trainees ic threat to the potential victim and Expand duty to warn to other
under duty to warn protection and if unable to make contact with the appropriate mental health
liability. potential victim, communicating the trainees
serious, specific threat to the law
Background: Minnesota statute enforcement agency closest to the
defines duty to warn as the duty to potential victim or the client.) to
predict, warn of, or take reasonable communicate the threat.
precautions to provide protection Legislation was changed in 2016 to
from violent behavior when a client provide duty to warn protection for
or other person has communicated trainees in the disciplines of Psy-
to the provider a specific, serious chology, Marriage and Family Ther-
threat of physical violence against a apy, and Licensed Alcohol and Drug
16Minnesota has made slow progress Increase funding for suicide pre-
Suicide to address the significant increase in vention training
death by suicide. In addition to in- Provide targeted support to
Prevention creasing access to care increased communities experiencing high
suicide prevention efforts must take rates of violence, trauma, and
place. The federal suicide prevention suicides
Issue: Suicide is one of the leading grant requires states to have accred- Fund lifelines
causes of death for Minnesotans and ited lifelines which MN does not Fund an online suicide preven-
has become a public health crisis have. tion training for teachers
with close to 800 people dying by
suicide this past year. Policy Recommendations:
Increase training and education
Background: Suicide is a public in suicide prevention and treat-
health crisis and must be tackled like ing people who are suicidal for
the opioid crisis with improved co- health and mental health profes-
ordination and additional resources. sionals
mental health services system, we Policy Recommendations:
Community must continue to grow our commu-
nity based mental health service
Increase funding for the commu-
nity mental health system, in-
system in order to meet the critical cluding grant programs that sup-
Mental Health mental health needs present in our port Assertive Community
communities. We know what works Treatment (ACT) teams, First
Treatment in the area of community based Episode Psychosis programs,
mental health services: earlier inter- mental health crisis teams, and
Issue: Minnesotans continue to vention services provided where more
lack access to adequate mental Minnesotans with need for services Expand ACT teams to people ex-
health treatment in the community are located and a continuum of care periencing depression
where they live. with transitions allowing individuals Review the role of the county as
to move to levels of care that meet the mental health authority
Background: While we have come their changing levels and kinds of Expand transportation options
a long way in Minnesota in the de- need. so that more people can be
velopment of our community based involved in the community
but we have yet to take action to and substance use disparities expe-
Racial Disparities begin meeting the needs of indige- rienced by Native Americans. This
nous communities and people of col- work engages all aspects of living:
and Mental or across Minnesota. emotional, physical, and spiritual to
promote the health and healing of
Health Equity In addition to the possibilities in Native Americans.
trauma informed care and develop-
Issue: People of color and new im- ing a diverse mental health work- Policy Recommendations:
migrants are much less likely to force, the Mental Health Legislative Require continuing education on
have access to culturally appropriate Network is particularly interested in cultural competency
care from a mental health provider the possibility further investment in Increase the funding for multi-
they trust. traditional healing. generational treatment methods
that include adults and children
Background: The racial dispari-
Traditional healing is a multigenera- Fund Native American healers
ties in Minnesota’s mental health
tional, multi-disciplinary approach
care system are well documented,
to reduce the chronic mental health
17CRIMINAL JUSTICE
they need to recover while in prison for corrections officers, support per-
and successfully transition back to sonnel, and especially the mental
Prisons the community. health workforce. Without an ade-
quate workforce investment, staff
Minnesota has slowly expanded the
Issue: More people than ever are turnover will continue to be a prob-
access to mental health services in
entering the prison system with lem and the prison environment will
the Corrections system. In 2016, the
mental illnesses, while other in- not be safe for inmates or staff.
legislature made new money availa-
mates are developing a mental ill-
ble for treatment beds, with Policy Recommendations:
ness during their time in prison.
$750,000 in fiscal year 2017 for 70 Increase staffing levels, including
Background: Whether it’s a nui- new chemical or mental health beds mental health and substance use
sance crime like spitting or some- and $250,000 for two chemical de- disorder treatment staff
thing more serious, people with pendency release planners, one at Increase funding for mental
mental illnesses are much more Stillwater and one at Shakopee. health services
likely to have an experience with Place fewer conditions on eligi-
However, these increases are not
the criminal justice system. This bility for mental health services
keeping pace with larger prison pop-
can result in a dangerous encounter in prison
ulations and higher needs for mental
with the police, time in jail, or incar-
health and substance use disorder
ceration. For those people with
treatment.
mental illnesses who become incar-
cerated, it is imperative that they The Corrections System has also
receive the mental health treatment faced persistent staffing shortages
with no contact with others. The use their changes.
Administrative of segregation and isolation is also
Policy Recommendations:
extremely expensive and counter-
and Disciplinary productive if the hope is to support Require graduated sanctions for
rule violations, so that segrega-
rehabilitation back into the commu-
Segregation nity. tion becomes the last resort
Establish appropriate physical
In 2017, the Department of Correc-
Issue: Segregation and isolation conditions of segregated units,
tions made a series of policy changes
have a negative impact on a person’s including reduced lighting dur-
regarding the use of solitary confine-
mental health. ing nighttime hours, rights of
ment. These policies were developed
communication and visitation,
Background: "Disciplinary segre- internally without the consultation
and furnished cells
gation" is used when an inmate was of key stakeholders, were never
Require mandatory review of
found in violation of a facility rule or properly explained to the staff
disciplinary segregation status
state or federal law or when segre- tasked with implementing these
by the warden of the prison and
gating the inmate is determined to policy changes, and have only very
commissioner or deputy or
be necessary in order to reasonably recently been adequately staffed.
assistant commissioner
ensure the security of the facility or Given this lack of transparency, it is
Prohibit releasing an inmate to
the inmate. not surprising that there has been a
the community directly from
great deal of confusion amongst
There is research to support the psy- segregated housing
Department of Corrections adminis-
chological stress and strain that re- Require the Department of
trators, prison staff, and inmates.
sult from the use of disciplinary seg- Corrections to issue a yearly
regation in prisons, especially for Other states who have made much report to the legislature with
persons with mental illnesses. Indi- stronger solitary confinement re- data on the use of solitary con-
viduals who are held in solitary con- forms – including Maine and Colora- finement
finement spend nearly every hour of do – have seen a significant decrease
the day in a small windowless cell in violence following the roll-out of
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