County Examples & Solutions

Reducing Mental Illness in Rural Jails Case Study: Minn. Multi-County Partnership

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    Reducing Mental Illness in Rural Jails Case Study: Minn. Multi-County Partnership

    Minn. Multi-County Partnership

    • Aitkin, Cass, Crow Wing, Morrison, Todd, Wadena – 178,426[1]

    The Opportunity for Change

    In 1995, Minnesota began to downsize state mental health hospitals.  At the same time, the state passed legislation authorizing pilot projects that would result in systemic change in the delivery of mental health services for adults with serious and persistent mental illnesses.  The Adult Mental Health Initiatives, administered by the Minnesota Department of Human Services, gives local mental health authorities the ability to design a community-based delivery system to meet community needs.  In 2009, six counties in central Minnesota – Aitkin, Cass, Crow Wing, Morrison, Todd and Wadena – formed a regional partnership (Region V+ Adult Mental Health Initiative-Minnesota) to apply for a state grant to change the way they provide mental health services to residents.  The programs continue to be funded through the Mental Health Initiatives grant and other state grants for crisis services.

    The Multi-County Partnership Model

    County leadership recognized the large geographic region covered by the six counties and determined that building a physical crisis center would not be the best option.  Instead, the multi-county partnership contracted with a local provider for mobile behavioral health services in homes throughout the region.  State funding offers counties the flexibility to influence how these services are developed and implemented to best meet the needs of the communities.

    Crisis services start when a person calls Crisis Line, a non-profit organization that operates a 24-hour, 7-days-per-week crisis hotline.  Trained volunteers received 5,649 calls in 2014 and referred individuals to appropriate community resources.  While most calls are handled over the phone, volunteers may determine that an in-person intervention is necessary to resolve the crisis.  In these cases, Crisis Line will reach out to Mobile Crisis Outreach.

    Crisis Response Services

    Community-based crisis services provided to adults, families and children include:

    • Crisis Assessment – A face-to-face mental health assessment conducted by a mental health professional for evaluation of any immediate need for emergency services.
    • Crisis Intervention – A face-to-face short term intensive mental health service initiated during a mental health crisis or emergency to help the  person cope with immediate stressors, identify and utilize available resources and strengths, and begin to stabilize the crisis.
    • Crisis Stabilization – The provision of short-term individualized mental health services designed to restore the person to a stable level of mental health functioning.

    Mobile Crisis Outreach (MCO) is available 24 hours a day, seven days a week and 265 days per year and responded to 1,105 calls for crisis situations in 2014.  Once MCO arrives, mental health professionals can treat the crisis in the home, suggest community stabilization services or transport the individual to an emergency department, where they will stay with the patient until he or she sees a doctor.  Individuals are set up with next-day outpatient appointments with a mental health professional and can also be connected to community behavioral health and social services.  MCO works closely with county health and human services departments to share information on individuals who use their services to ensure that everyone is working collaboratively to best meet the needs of clients.  MCO serves all county residents, regardless of access to insurance and some counties in the region provide funds to cover crisis services for uninsured individuals.

    County health and human services departments also work with law enforcement and corrections to provide education about the services they offer through Crisis Line and MCO, the benefits of calling MCO and when it is appropriate to call for their assistance.

    Mobile Crisis Outreach helps connect individuals to:
    • Rapid Access Psychiatry
    • Next Day Outpatient Appointment
    • Adult Rehabilitative Mental Health Services (ARMHS)
    • Assertive Community Treatment (ACT)
    • Community Transition Support Services
    • Children’s Therapeutic Support Services
    • County Social Services
    • Crisis Residential Services

    In addition to mobile crisis, the counties’ health and human services departments developed a system for providing follow-up appointments in a timely manner through Rapid Access Psychiatry (RAP), which allows staff to set up an appointment with a psychiatrist within 72 hours of the crisis. Typically, the wait time for a community psychiatric appointment can be up to six months.  They also employ peer support specialists to work with clients receiving mental health services and have been working to raise public awareness of mental illness to reduce stigma surrounding the illnesses.

    Successes and Outcomes

    “The scope of challenges that need to be addressed regarding persons with mental illness and chemical dependency diagnoses in jails and rural settings are significant.  As a Minnesota State Public Defender, I deal with duel-diagnosed clients on a regular basis and experience the difficulties firsthand of obtaining evaluations and placements in a timely manner,” says Aitkin County Commissioner Anne Marcotte.  “Aitkin County has established programing whereas Aitkin County Health and Human Services and the county jail work together to bridge the gaps between release and provider services which has, and will continue to make a remarkable difference to the client and the community as a whole.  With such innovative ideas being implemented, the crisis of meeting the needs of those with mental illness should continue to be lessened.” 

    Mobile Crisis Outreach serves individuals in a timely manner throughout the region and reduces the number of hospitalizations and treatments in the Emergency Departments.  For police, MCO offers a resource for calls involving individuals with mental illnesses, and allows them to concentrate on public safety issues.

    Individual counties within the region have been implementing additional and complementary programs and services for individuals with mental illnesses within their regions. After passing a resolution to participate in the Stepping Up initiative, Aitkin County has developed a discharge planning program for people leaving the jail. They’ve been able to provide referrals for 31 people since they started in July 2015.

    Resource

    Ann Rivas
    Chair, Region V+ Adult Mental Health Initiative-Minnesota
    Aitkin County Social Services Supervisor
    218-927-7215
    ann.rivas@co.aitkin.mn.us

     

    [1] U.S. Census Bureau, State & County QuickFacts, http://quickfacts.census.gov/qfd/maps/minnesota_map.html. Accessed November 19, 2015.

    Minn. Multi-County Partnership Aitkin, Cass, Crow Wing, Morrison, Todd, Wadena – 178,426[1] The Opportunity for Change
    2016-02-16
    County Examples & Solutions
    2017-03-30

Minn. Multi-County Partnership

  • Aitkin, Cass, Crow Wing, Morrison, Todd, Wadena – 178,426[1]

The Opportunity for Change

In 1995, Minnesota began to downsize state mental health hospitals.  At the same time, the state passed legislation authorizing pilot projects that would result in systemic change in the delivery of mental health services for adults with serious and persistent mental illnesses.  The Adult Mental Health Initiatives, administered by the Minnesota Department of Human Services, gives local mental health authorities the ability to design a community-based delivery system to meet community needs.  In 2009, six counties in central Minnesota – Aitkin, Cass, Crow Wing, Morrison, Todd and Wadena – formed a regional partnership (Region V+ Adult Mental Health Initiative-Minnesota) to apply for a state grant to change the way they provide mental health services to residents.  The programs continue to be funded through the Mental Health Initiatives grant and other state grants for crisis services.

The Multi-County Partnership Model

County leadership recognized the large geographic region covered by the six counties and determined that building a physical crisis center would not be the best option.  Instead, the multi-county partnership contracted with a local provider for mobile behavioral health services in homes throughout the region.  State funding offers counties the flexibility to influence how these services are developed and implemented to best meet the needs of the communities.

Crisis services start when a person calls Crisis Line, a non-profit organization that operates a 24-hour, 7-days-per-week crisis hotline.  Trained volunteers received 5,649 calls in 2014 and referred individuals to appropriate community resources.  While most calls are handled over the phone, volunteers may determine that an in-person intervention is necessary to resolve the crisis.  In these cases, Crisis Line will reach out to Mobile Crisis Outreach.

Crisis Response Services

Community-based crisis services provided to adults, families and children include:

  • Crisis Assessment – A face-to-face mental health assessment conducted by a mental health professional for evaluation of any immediate need for emergency services.
  • Crisis Intervention – A face-to-face short term intensive mental health service initiated during a mental health crisis or emergency to help the  person cope with immediate stressors, identify and utilize available resources and strengths, and begin to stabilize the crisis.
  • Crisis Stabilization – The provision of short-term individualized mental health services designed to restore the person to a stable level of mental health functioning.

Mobile Crisis Outreach (MCO) is available 24 hours a day, seven days a week and 265 days per year and responded to 1,105 calls for crisis situations in 2014.  Once MCO arrives, mental health professionals can treat the crisis in the home, suggest community stabilization services or transport the individual to an emergency department, where they will stay with the patient until he or she sees a doctor.  Individuals are set up with next-day outpatient appointments with a mental health professional and can also be connected to community behavioral health and social services.  MCO works closely with county health and human services departments to share information on individuals who use their services to ensure that everyone is working collaboratively to best meet the needs of clients.  MCO serves all county residents, regardless of access to insurance and some counties in the region provide funds to cover crisis services for uninsured individuals.

County health and human services departments also work with law enforcement and corrections to provide education about the services they offer through Crisis Line and MCO, the benefits of calling MCO and when it is appropriate to call for their assistance.

Mobile Crisis Outreach helps connect individuals to:
  • Rapid Access Psychiatry
  • Next Day Outpatient Appointment
  • Adult Rehabilitative Mental Health Services (ARMHS)
  • Assertive Community Treatment (ACT)
  • Community Transition Support Services
  • Children’s Therapeutic Support Services
  • County Social Services
  • Crisis Residential Services

In addition to mobile crisis, the counties’ health and human services departments developed a system for providing follow-up appointments in a timely manner through Rapid Access Psychiatry (RAP), which allows staff to set up an appointment with a psychiatrist within 72 hours of the crisis. Typically, the wait time for a community psychiatric appointment can be up to six months.  They also employ peer support specialists to work with clients receiving mental health services and have been working to raise public awareness of mental illness to reduce stigma surrounding the illnesses.

Successes and Outcomes

“The scope of challenges that need to be addressed regarding persons with mental illness and chemical dependency diagnoses in jails and rural settings are significant.  As a Minnesota State Public Defender, I deal with duel-diagnosed clients on a regular basis and experience the difficulties firsthand of obtaining evaluations and placements in a timely manner,” says Aitkin County Commissioner Anne Marcotte.  “Aitkin County has established programing whereas Aitkin County Health and Human Services and the county jail work together to bridge the gaps between release and provider services which has, and will continue to make a remarkable difference to the client and the community as a whole.  With such innovative ideas being implemented, the crisis of meeting the needs of those with mental illness should continue to be lessened.” 

Mobile Crisis Outreach serves individuals in a timely manner throughout the region and reduces the number of hospitalizations and treatments in the Emergency Departments.  For police, MCO offers a resource for calls involving individuals with mental illnesses, and allows them to concentrate on public safety issues.

Individual counties within the region have been implementing additional and complementary programs and services for individuals with mental illnesses within their regions. After passing a resolution to participate in the Stepping Up initiative, Aitkin County has developed a discharge planning program for people leaving the jail. They’ve been able to provide referrals for 31 people since they started in July 2015.

Resource

Ann Rivas
Chair, Region V+ Adult Mental Health Initiative-Minnesota
Aitkin County Social Services Supervisor
218-927-7215
ann.rivas@co.aitkin.mn.us

 

[1] U.S. Census Bureau, State & County QuickFacts, http://quickfacts.census.gov/qfd/maps/minnesota_map.html. Accessed November 19, 2015.

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