Innovative plan gets mentally ill help faster, frees up beds

Thursday, December 15, 2016

Tired of waiting for the state of Minnesota to come up with more beds for Hennepin County residents suffering from certifiable mental illness, Senior Supervising Attorney Bill Neiman, a Hennepin County District Court judge and representatives of several local hospitals developed a way to get them help and break the logjam.

Hennepin County residents who were coming to court for mental health commitments were ordered to the care of the Commissioner of Human Services. That usually meant being sent to Anoka Metro Regional Treatment Center for up to 180 days of treatment for their problems. Twenty years ago, those patients would check into a local hospital and within 48 hours be transferred to Anoka. However, the regional treatment center has fewer beds and more people needing treatment, so patients now are spending weeks in the local hospital.

Many of those patients would be restored to health at the local hospital, but because the court order said they were to go to Anoka, only Anoka could order the provisional discharge, said Neiman, senior supervising attorney for the Hennepin County Attorney’s Office’s Adult Services Division. With a provisional discharge, the patient is released back into the community. They are assigned a case manager who checks on the patient at his or her home to make sure they are taking any medications and are functioning well.

The solution Neiman and the attorneys in the adult services division developed was dual commitment. The court order would state that the patient would be committed to Anoka and to a local hospital, such as Hennepin County Medical Center.

Neiman said that when Hennepin County District Court Judge Jamie Anderson took over the commitment cases, they approached her with the dual commitment proposal.

“I was hearing it directly that folks were being hospitalized well beyond the time that was appropriate,” Judge Anderson said. “The law doesn’t give approval for dual commitment, but it doesn’t prohibit it either, so I said let’s do it. It cut hospitalization by weeks. It cuts the stress on hospital psychology staff.”

There was another flaw in the system that needed to be resolved, Neiman said. Say the patient was committed to both Anoka and Hennepin County Medical Center. The medical center eventually provisionally discharged the patient, but days later he has a major episode and winds up in the emergency room at Abbott-Northwestern. How could Abbott-Northwestern doctors release the patient after he is stabilized?

Neiman and doctors from several of the local hospitals began meeting. Dr. Tom Keul, who was the medical director for medical health services at Abbott-Northwestern Hospital for more than nine years, was a member of that group, said that the other hospitals didn’t want to be on the commitment orders. If they were, they would be responsible for the patient.

But if Hennepin County Medical Center was on the dual commitment, and the patient wound up at Abbott or North Memorial Medical Center’s emergency room after provisional release, could they just call HCMC for permission to release the patient again or send them back to HCMC?

“Nobody had ever done it with just a phone call before,” Keul said. “But we all had the same problem. So we had to devise some end run because Anoka just was not taking them. We had to have confidence in each other.”

Keul said the solution has worked well and because it is benefiting everyone, and was worked out voluntarily, there has been no pushback. The five hospitals who signed on to the program in December 2013 were HCMC, North Memorial, Abbott-Northwestern and University of Minnesota Medical Center (Fairview) and Fairview Southdale. Neiman said those five represent more than 80 percent of the Adult Services Division’s 1,400 annual commitment petitions. Hennepin County’s Human Services and Public Health Department, which provides the case managers, also supported the change.

It also has worked out well for Anoka. In the 17 months between April 2015 and September 2016, the average daily waiting list from all referrals dropped from 111 to 63.

“I’m on the governor’s taskforce for mental health,” Judge Anderson said. “People outside Hennepin County are very interested in this.”

Both Neiman and Judge Anderson stressed that one of the biggest benefit is to the patient, because she or he is returned to the community, and their homes, much more quickly.

“This was a big deal that took a lot of work,” Neiman said. “Hospitals had to change the way they did it, judges had to change. This was an invention of necessity. It was three years in the making.”