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"Well, I guess one of the most poignant questions is: How did this happen in the first place?" Quam asked during the hearing. "I take it...you agree that it's not appropriate to leave someone like Mr. Brewer or Mr. Gates or others in a jail for an extended period of time?"
"Your honor, we are in complete agreement with that," replied Mike Tessneer, then CEO of the Department of Human Services.
Tessneer explained that the system is simply overwhelmed. Patients are being committed to hospitals from all over the state faster than others are leaving. When there is a sudden influx of patients, there just aren't enough beds for everyone. "The flow looks like it works, but there will be times when it does not."
Quam later called Lt. Tom Sizer, a Hennepin County sheriff's deputy who works at the jail, to testify about the problems of mentally ill inmates.
"As far as psychiatric care, mental health care for the persons confined within the jail, I think we're doing a pretty dang good job compared to statewide," testified Sizer.
But even with all the resources and training of the facility, the jailers can only do so much, Sizer continued. The care the jail can offer is limited, especially for people who are mentally ill and dangerous.
"One of the biggest frustrations for the jail is the Rule 20 process itself," explained Sizer. "By nature of just being a jail, we are essentially a warehouse for the court."
Tessneer ultimately proposed a triage plan that would move mentally ill patients out of the jail within seven days of commitment. But nine months after the most recent hearing, questions persist about whether the Department of Human Services is keeping up its end of the bargain. Just last month, for example, a man named Abdiyare Abi sat in jail for twice that time waiting to be transferred to a hospital.
The problem continues to be a simple lack of resources, says Tessneer, now project manager in the State Operated Services compliance office.
"We have a finite number of beds, so we try to maximize the number of beds and efficiency and use of those beds," he says.
Today, people like Abi are the exception rather than the rule, says Maureen O'Connell, assistant commissioner for the Department of Human Services for chemical and mental health. O'Connell says her office is working on a system that will move patients through inpatient treatment and back into their communities faster, freeing up more hospital beds.
"Anticipate over the next year that we will be working very hard on this issue across the state," she says.
But the damage may already be done. In Minnesota, we've slipped further and further down a road where jails and prisons are replacing mental health facilities. It may be too late to go back now, says Dr. Lawrence Pancieria.
"We've gone down that road big time," says Panciera. "I don't know if you'll be able to reverse that.
"We've set up a system where a lot of mentally ill people are being managed in the jail system. And if you were to do it differently, it would be very, very expensive. I just don't see that happening in the near future."