2019                 LEGISLATIVE ISSUES

           OF MINNESOTA
       1919 University Ave. W., Suite 400, St. Paul, MN 55104
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

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
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.

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

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.


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-


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

                                      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

For 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-
                                         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-
                                         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-
face housing instability or even         ous Mental Illness provides grants to
                                                                                Increase funding for the Bridges
homelessness. Unmanaged mental           housing developers, counties and
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

linking 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
    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

quality 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:
                                       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-
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

mental 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.
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-
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
went from 11.2 to 11.1.

                                       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
                                       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
                                                                                   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

children 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
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.

                                       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
                                           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-

                                        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

Minnesota 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


                                         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
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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