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Beltrami County Board: Consortium will fund mental health transports, for now

John Casper attempted suicide with a gun and ended up in the North Country Regional Hospital emergency room.

"I drove myself to Grand Forks," he told Beltrami County commissioners this week, as there was no available transport to take him to a mental health treatment facility in Grand Forks.

And as of Jan. 1, the Beltrami County Sheriff's Department, which has been doing such transports, will stop the service, which isn't mandated by state statute.

Costing about $30,000 a year in overtime pay, and needing two deputies to transport a patient to an out-of-town facility, Sheriff Phil Hodapp said his department can no longer financially support the service, given county budget cuts.

'You don't want to turn someone out on the street when they're psychotic," Casper said.

A task force, led by County Board Chairman Jim Lucachick, has been meeting to find solutions, and a temporary one may be in place on Jan. 1. The met with the County Board during the board's Tuesday work session.

A pot of money has been raised to help reimburse mental health transports, and would spread the trips to a private service and ambulance service, restricting the most serious cases to sheriff's transport.

Emergency room Dr. Bob Rutka provided a triage approach, suggesting that mental health transports be categorized in five categories.

Category 1, severe behavioral disorder with immediate threat of dangerous violence, and Category 2, significant toxic ingestion or violent or aggressive behavior that requires restraints, would see transports by deputies.

Category 3 involves patients who are very depressed with risk of self-harm, acutely psychotic or thought disordered, situational crisis, deliberate self-harm, agitated or potentially aggressive.

Category 4 is semi-urgent mental health problems or under observation and/or no immediate risk to self or others.

And, Category 5 is known chronic mental health symptoms or conditions or social crisis but clinically well.

Categories 3 and 4 may require an ambulance transfer, but 80 percent of those in Categories 4 and 5 may not need immediate hospitalization.

Lucachick said that funds have been put in a pot, with $10,000 from North Country Health Services, $4,000 from the Upper Mississippi Mental Health Center, $2,500 from Stellher Human Services, and $8,000 to $10,000 from county funds outside of the Sheriff's Department.

"That's about $25,000 to $35,000 put into a reimbursement fund," Lucachick said.

Aside from the county and ambulance service, private carrier First City Safe Ride is interested in providing service. Will Weaver said the firm has modified a car to provide secure transport.

Many of the transports are within the city, to a community-based behavioral clinic.

"We need to ask the Legislature to come up with an appropriation," said Commissioner Jim Heltzer. "I know we're not the only county."

Several county sheriffs have stopped the service, Hodapp said, with an interpretation that state law doesn't mandate county law enforcement to provide the service. "It's a medical transport, not a public safety transport."

But Heltzer said it is a public health problem, and as such the county must assume control. Better, he said, is that the state Department of Human Services consider it a needed service and adequately fund it.

"We can do this short term, but a long-term solution needs to be found," said County Administrator Tony Murphy.

So far this year, the Sheriff's Department has done 209 mental health transports, with 40 of them going out of town. Twenty of the out-of-town transports were children, which cannot be held in any facility in Bemidji.