Mind Games

"The problem is, our system is so focused on crisis management": Hennepin County Commissioner Gail Dorfman
Courtesy of Gail Dorfman

The thousands of mentally unstable people in Minnesota who have difficulty receiving timely emergency treatment are not crazy for thinking that Gov. Tim Pawlenty has demonstrated a greater financial commitment toward the well-being of animals at the Minnesota Zoo than toward addressing their needs. Over the past three years, Pawlenty has recommended spending $25 million, $34 million, and $21 million, respectively, on state bonding projects for the zoo, including the construction and stocking of a trout-filled stream for brown bears on the premises, and the expansion of retail space and food service options at the Biodiversity Center.

During that same period, the state has actually reduced its complement of psychiatric hospital beds, putting tremendous pressure on psychiatric clinics and emergency rooms around Minnesota. Ground zero for this problem of limited supply and overwhelming demand is Hennepin County Medical Center, the only around-the-clock facility in the state specifically designed to provide acute psychiatric services (APS), and one of the few that will readily accept and treat indigent patients. Last year, HCMC's Crisis Intervention Center served 11,811 clients in person--that's more than 32 per day--from 48 counties across the state, plus another 70,000 by telephone. The average waiting time to see a psychiatrist, who are on duty 24/7, was more than eight-and-a-half hours.

In an attempt to ease this situation, HCMC is expanding its APS unit from 3,129 to 5,790 square feet, enough to add seven assessment and treatment spaces to the nine it already deploys. As a unique service fulfilling an urgent need for citizens throughout Minnesota, the expansion project seemed tailor-made for inclusion in the state's bonding bill. Yet Hennepin County's request for $2.4 million--approximately half the construction costs, and about a tenth of what Pawlenty annually recommends in bonding money for the zoo--was not endorsed by the governor and couldn't even get a hearing in the Republican-controlled House last year. (It passed the DFL-controlled Senate.)

Pawlenty and other legislators opposing partial state funding for the expansion correctly surmised that Hennepin County taxpayers would bite the bullet and fund it themselves. The county moved ahead and approved $4.8 million in funding in August of last year. The project will be completed this summer, paid for by the county. Pawlenty and his cohorts from outside the county likewise correctly gambled on not being penalized for their lack of participation in the funding. Surely the demand is great enough that APS could limit its services to Hennepin County residents and still operate at full capacity. Instead, as with many other aspects of HCMC, no one is denied service and Hennepin County pays a disproportionate share of the cost to expand the space and provide indigent care. APS racked up $2.36 million worth of uncompensated psychiatric care expenses in 2005 alone, $443,000 of it used to treat patients from outside Hennepin County.

As a practical matter, legislators were content to let the issue slide without having to actually vote against funding HCMC's program. "I don't know of anyone who has openly opposed [state bonding money for APS expansion]," says Lee Greenfield, a former state representative and HCMC's lobbyist at the Capitol. "Legislators might say that we don't have enough money, but nobody will say it is the wrong thing to do." Ironically, Pawlenty himself has described the annual bonding packages as "a quality-of-life quilt...different people need and enjoy different things. And you have to make sure you have a balanced perspective."

One proven way to shake the money tree at the Capitol is to scare the bejeezus out of the citizenry. Pawlenty and other typically tight-fisted politicians fall all over themselves ensuring that facilities are built and staffing is made available so that sexual predators are under apparently permanent lock and key. Yet over the years there has been a sparse but fairly steady stream of people who have turned violent because of serious mental illness. On December 30, less than three weeks before Pawlenty recommended paying for more food vendors at the zoo, a 23-year-old Eagan man allegedly killed and then decapitated his stepmother after unsuccessfully seeking treatment for his condition at a local emergency room. (See "A Prescription for Mayhem," CP 1/11/06.)

According to Hennepin County Commissioner Gail Dorfman, 20,000 people have been diagnosed with serious persistent mental illness in Hennepin County alone, along with 12,000 children diagnosed with serious emotional disturbance. If even a minuscule percentage of these people have violent tendencies and are denied proper treatment, doesn't that constitute a threat to public safety?

"The problem is, our system is focused on crisis management," Dorfman says. "It would be cheaper and more humane to prevent the crisis. We need to have better access to APS, and work on early prevention in the schools. The other thing is families who have experience with mental illness often talk about how long it takes to get an accurate diagnosis and stable housing and the medication they need. It can be a decade or more, and it costs taxpayers more when people are unsuccessfully cycling through the system. Unfortunately, some people never figure it out and commit suicide or hurt somebody else."

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