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State report questions management of psychiatric facilities

ST. PAUL – Hundreds of people in Minnesota with mental illness remain stuck in state-run psychiatric facilities for months or years after they are ready to leave, according to a report released last week by the state Office of the Legislative Auditor.

The failure to discharge patients or provide community housing options may violate patients’ legal rights and likely puts the state at risk of lawsuits, the audit found.

More than one-third of patients at the Anoka Metro Regional Treatment Center are ready to be discharged but remain hospitalized, in part because of a lack of community resources, according to the 136-page report.

Management Questioned

Auditors found top administrators at the state Department of Human Services failed to adequately manage programs for people with mental illness, chemical dependency and developmental disabilities. The programs, collectively known as State Operated Services, provide residential treatment for nearly 1,300 Minnesotans. They include small group homes and large facilities such as the Minnesota Security Hospital in St. Peter.

“Simply put, we found significant and persistent problems,” Legislative Auditor James Nobles said.

When state lawmakers requested the audit last year, they asked for an evaluation of how well the Department of Human Services manages state-run programs and whether some services could be better provided by private companies. The report recommends DHS consider using private providers for a small number of services, including group homes for people with developmental disabilities, but does not recommend privatizing the Minnesota Security Hospital or the Anoka hospital.

The report raises serious concerns about how the state cares for people with severe mental illness.

The auditors questioned whether the state’s civil commitment law violates patients’ legal rights. The report notes that in Minnesota, patients who are committed as “mentally ill and dangerous” receive no routine review to determine if they still meet the legal requirements to be committed.

Some patients have lived at the Minnesota Security Hospital for as long as 30 years with no judicial review of their civil commitment, the audit found.

“It’s important for the legislature and DHS to address situations that, frankly, could be lawsuits waiting to happen,” Joel Alter, who led the review for the Office of the Legislative Auditor, told lawmakers at a Senate Finance subcommittee hearing on Wednesday.

Auditors said the Legislature should amend Minnesota law so that everyone who is civilly committed receives a “periodic judicial review of their need for continued commitment.”

DHS Commissioner Lucinda Jesson said she welcomed the auditor’s report.

“There were no findings that surprised me,” Jesson said. “Overall, we agree with the legislative auditor’s report. We thought it was thorough. It was well done, and the recommendations are ones we embrace and we’ve already started to work on.”

Jesson said State Operated Services “has operated in a backwater for a long time” and was neglected by the Legislature and previous DHS commissioners. The auditor’s report, she said, provides an opportunity to push for significant changes.

However, she rejected the claim that the state may be violating patients’ rights to due process by detaining people in hospitals who do not meet hospital criteria.

“I don’t think that we’re currently violating any laws, but I don’t think we’re doing as good a job as we should be doing as far as moving patients who could be served in the community out into the community,” Jesson said.

She noted that Gov. Mark Dayton’s budget proposal includes new funding for transitional housing and supportive services for people discharged from state-run facilities.

Limited treatment

Auditors uncovered troubling information about treatment at one of the state’s largest psychiatric facilities.

They found patients at the Minnesota Security Hospital rarely receive therapy or meet with psychiatrists, even though many of the facility’s 400 patients are committed as “mentally ill and dangerous” and are considered to be among the most mentally ill residents in the state.

The St. Peter facility has attracted scrutiny in recent years for high rates of patient assaults and patient and employee injuries, as well as the controversial tenure of administrator David Proffitt, who was forced to resign last year.

Auditors reviewed the amount of time patients at the Minnesota Security Hospital spent participating in scheduled activities. They found patients, on average, spent 16 hours a week in activities such as “employment, wood shop, physical fitness and recreation, library visits, hobby-related courses, and social activities.”

Only slightly more than one hour per day, on average, was spent on “scheduled therapeutic activities,” according to the report. Even that hour was not reserved for traditional therapeutic interventions, such as group therapy.

Instead, the report said, “this small amount included mental health treatment-related meetings or groups, educational courses (such as math, reading, English as a Second Language, and driver’s education), and ‘community meetings’ that most residential units held on weekdays.”

In contrast, the report notes, patients at the Minnesota Sex Offender Program receive at least 12 hours of treatment per week, including several hours of group therapy.

More than half of the patients at the Minnesota Security Hospital have not seen a psychiatrist in the past 30 days, the audit found.

Auditors spoke with the facility’s medical director who told them “most of the facility’s patients are psychiatrically stable and probably do not need to see a psychiatrist more than once every three months.”

The Minnesota Security Hospital, the report said, should adopt policies on “the hours of counseling, therapy and other treatment offered per week to help patients address their underlying mental health issues.”

Auditors also recommended that State Operated Services “develop clear, consistent standards that address how often Minnesota Security Hospital patients should be seen by a psychiatrist, and it should monitor compliance with these standards.”

The report also provides a lengthy review of previously reported increases in patient assaults and inconsistent communication about when to restrain and seclude patients. It also cited frequent turnover of administrators at the facility.

Lack of Transparency

Auditors found the Department of Human Services “has provided little useful information to the Legislature and the public for evaluating the performance of its state-run services,” the report said.

Auditors looked at performance data presented by DHS to the Legislature in biennial budget documents over a 12-year period. In all but two occasions, DHS failed to present any “actual performance data,” Alter said.

“That’s not a lot of accountability, given the $300 million in spending that occurs in this program annually,” Alter told lawmakers.

Lawmakers at the Senate Finance subcommittee meeting on Wednesday raised concerns about how the department communicates both internally and to the Legislature.

State Sen. Kathy Sheran, DFL-Mankato called the recent increase in patient assaults “an outrage.” She called for DHS administrators to do a better job of listening to the concerns of employees who provide care to patients.

“We can change the mission statement but if we’re not fixing this relationship that’s occurring between management and the staff on how to approach patients, it just continues,” she said.

Article written by  Madeleine Baran of MPR News 91.3 FM