Minnesota Hospital Association


June 01, 2018

Mental and behavioral health priorities

Minnesota’s hospitals and health systems are committed to working collaboratively with mental and behavioral health care providers, policymakers and other health care stakeholders to create an effective and accessible health care system that meets the needs of individuals, families and communities.

Without policy changes and additional funding, Minnesota residents will continue to rely heavily on hospitals and emergency departments for mental and behavioral health care. Access will remain inadequate; available workforce will still be insufficient; and the struggles to find appropriate, effective, convenient and affordable services will continue to grow year over year.

MHA’s recommendations:

  • Clearly define roles and responsibilities: Policymakers, health systems, clinicians and other key stakeholders such as law enforcement agencies must clearly define and agree to the state’s and counties’ roles and responsibilities with respect to meeting residents’ mental and behavioral health needs.
  • Fund appropriate resources: The Legislature and counties must fund and provide sufficient access to the mental and behavioral health facilities and services necessary to meet their roles and responsibilities for the populations for which they are accountable.
  • Create a coordinated system of care: Health systems need active partnership and support from federal, state and local community organizations in order to build a cohesive and sustainable system of care for mental and behavioral health patients across the state. This includes expanding access to community-based settings of care such as assertive community treatment (ACT) teams, Intensive Residential Treatment Services (IRTS), Community Behavioral Health Hospitals (CBHHs) and a full range of outpatient care and social supports to provide the right care at the right time in the right setting.
  • Improve financing and payments: State and federal public health programs – including Medicare, Medicaid and MinnesotaCare, as well as commercial health insurers – must increase reimbursement rates to mental and behavioral health providers to ensure Minnesotans have affordable and timely access to clinically appropriate services, including those delivered via telemedicine. Payments and payment structures for mental and behavioral health must be on par with those for other medical conditions, and sufficient to recruit and retain the caregivers Minnesotans need.
  • Enhance information exchange to coordinate care: Minnesota’s health records privacy laws need to be improved to allow for safe, secure exchange of clinically appropriate medical information under the legal standards and protections that exist in 48 other states and under federal law. Timely and accurate health record information is crucial for providing coordinated and patient-centered care for all patients, including those experiencing mental and behavioral health illnesses.

Mental health emergencies in Minnesota are increasing.

  • Minnesota’s hospitals and health systems serve thousands of patients with mental health and addiction treatment needs. From 2010 to 2017, mental health and substance abuse emergency room (ER) visits have substantially increased.
    • Total ER visits increased 16.2 percent, but mental health and substance abuse ER visits increased 75.1 percent.
      • As a subset of the 75.1 percent increase, substance abuse ER visits increased 145.6 percent and mental health ER visits increased 51.4 percent.

Continue to build mental and behavioral health services and supports in our communities.

  • Mental and behavioral health treatment in Minnesota is very different than the large state institutions of the past. Today, nearly 75 percent of mental and behavioral health care is delivered in community settings. When people experiencing mental illnesses, substance abuse and/or co-occurring conditions are able to access these services, they can maintain a much higher quality of life, reduce their risk of other chronic conditions, miss fewer days of work or school and continue living in their own homes and communities.
  • A study by MHA found that nearly one in five days individuals spend admitted to community hospitals’ inpatient psychiatric units is potentially avoidable. “Potentially avoidable days” are days that mental health patients spent admitted to a hospital when they would receive more appropriate care if they could be treated in a different care setting. Unfortunately, they remain in hospitals longer than necessary because openings are not available at those more appropriate care settings.
    • The most frequently cited reasons for potentially avoidable days were lack of capacity for services provided at state-operated CBHHs, substance abuse treatment facilities, IRTS and the state’s Anoka Metro Regional Treatment Center (AMRTC), as well as delays for patients involved in the judicial system.
  • Community-based services are needed throughout the state for all age groups. Examples of these services include supportive housing, ACT teams, crisis services, community competency restoration, addiction treatment and support, residential treatment and school-based services.
  • Individuals needing counseling or medication management could be served by providers using teletherapy and telepsychiatry, or through other arrangements with local providers. MHA supports reimbursement for telemedicine services provided to individuals in their homes and funding for mental health services to students in schools via telemedicine technology.
  • Minnesota is one of eight states chosen to participate in the federal pilot project to create Certified Community Behavioral Health Clinics (CCBHCs) as part of the Excellence in Mental Health Act. As a participating state, Minnesota has established a network of CCBHCs that provide outpatient mental health and addiction treatment services as well as coordinated and integrated care with hospitals, health systems and other medical and social service providers.
    • MHA members are working with CCBHCs to develop standard communication methods and processes to ensure coordination of care for CCBHC patients who present to a hospital with physical and/or mental and behavioral health needs. As the pilot project enters its second year in July 2018, MHA,its members and CCBHCs are focusing on identifying best practices for dissemination to and from CCBHCs and hospitals and health systems as well as educating CCBHC patients on how to communicate to a hospital that they are receiving services through a CCBHC.

Build on recent state investment in mental health and urge greater federal support.

  • The Legislature made significant investments in Minnesota’s mental health delivery system from 2015 to 2018, but demand for services continues to grow. More public investment and capacity are needed to prevent mental and behavioral health illnesses in the first place and, when they do occur, provide sufficient access to the most appropriate and effective care Minnesotans need.
    • In 2015, MHA partnered with mental health providers and advocates to support a historic investment of $51 million in new state spending for mental health care.
    • In 2016, the Legislature supported MHA’s top three priorities: enacting the Excellence in Mental Health Act, which created CCBHCs; additional resources to increase capacity at the state’s CBHHs; and new funding for competency restoration services.
    • In 2017, the Legislature approved funding for state-operated services and allocated $2.1 million for mental health innovation grants to generate the care models of the future.
    • In 2018, the Legislature expanded mental health infrastructure, including $30 million of bonding for new behavioral health crisis centers to serve as an alternative to hospital emergency departments and another $30 million for housing infrastructure bonds for persons with serious mental illnesses. MHA successfully advocated for legislation that will streamline the facility licensing process for IRTS and mental health crisis services so these important elements of the care system can be built and begin serving residents sooner and with less bureaucracy.

MHA supports other policy changes and initiatives to improve mental and behavioral health care in Minnesota.

  • Additional substance use disorder resources: State and federal governments need to provide additional resources targeted at addiction prevention, treatment and post-treatment support, as well as improving Minnesota’s prescription monitoring program to better integrate with electronic medical record systems. At least part of the funding of these initiatives should come from the drug manufacturers that profited from unsafe use of opioids.
  • Change the 48-hour law: Minnesota’s 48-hour law that gives priority placement in limited state psychiatric hospital facilities to individuals being transferred from county jails needs to be revised so placements in these specialized hospitals are based on individual patient needs rather than status in the criminal justice system. Jails and prisons must expand the mental and behavioral health services, including prescription medications, available to individuals in their custody.
  • Workforce: Minnesota has a shortage of mental and behavioral health providers and caregivers. Nine of Minnesota’s 11 geographic regions are designated as mental health professional shortage areas by the U.S. Health Resources Services Administration. Increased reimbursement rates for mental and behavioral health services would help recruitment into these professions. State and federal investments in educational programs for mental and behavioral health caregivers must be increased to help generate the workforce needed by both the public and private health care sectors.
  • Allow innovations: Regulatory hurdles and barriers that make it more difficult to provide innovative or more cost-effective mental and behavioral health care delivery models, including but not limited to telemedicine services, school-based care and non-emergency medical transportation, need to be removed or modernized to reflect new technology and changing population needs.