Denied key government contracts, all nonprofit day treatment centers for mentally ill sexual offenders in Ramsey County are doomed to disappear by the end of the year. ABC Mental Health Therapy, which has treated this specific population for nine years, plans to close its doors on Friday.
ABC's 15 remaining patients -- those who have not already walked out -- will have to seek treatment elsewhere in a community of dwindling options. The center's team of eight mental health social workers and interns will lose their jobs.
The county says it no longer supports day treatment centers' group therapy model, which enrolls convicted sex offenders in meetings for several hours a day, every day of the week. Instead, government case workers will piece together psychological, rehabilitative, and job and housing services from remaining area agencies, says Alyssa Conducy of the chemical and adult mental health department.
She says the research behind behavioral therapy supports individual treatment over group, which is why Ramsey County is following suit. (Conducy did not have specific studies on hand.)
"The assumption shouldn't be made that groups is what everybody needs," she added. "Day treatment services ... shouldn't be used to provide ongoing structure for people. It's really more of building skills versus therapy. Obviously you can't find a job and keep a job within a day treatment center. You need to do that on a work site."
For their part, ABC social workers believe they are already providing a holistic treatment plan. Their therapeutic regimen starts with correcting impulsive behavior to reduce sex offenders' immediate threat to public safety, then grows into helping them hold down jobs, maintain housing, and develop healthy relationships.
ABC fears that whatever treatment county case workers plan to recommend for their clients will not fully factor in their mental illnesses.
Janet Martin, ABC's clinical supervisor, says the interruption to her clients' treatment has been hard on them. They all struggle with change, she says. "We did have clients who left immediately upon the announcement. I'm sorry to say I don't know what has transpired for the continuation of their treatment."
Martin says she has learned, after years of practicing as a mental health professional, that a group environment is ideal for sex offenders. There are peer checks and balances, less opportunity for patients to manipulate staff. For most offenders, lying and presenting themselves as victims in order to deflect accountability or blame is part of the MO, Martin says.
ABC executive director Dane Jorento is just as perplexed by the county's assertion that individualized treatment is better for long-term rehabilitation. His coaching manual is full of notes from the American Psychological Association, the Journal of Interpersonal Violence, the Journal of Integrative and Eclectic Psychotherapy, and others. He points specifically to studies by Gerry Blasingame, a leader in best practices for adjusting behavior of sexual offenders with mental illness.
Some of ABC's clients need structured therapy because all other options have failed, he says. One autistic patient given the choice of finding a job or going back to prison had no work experience to build on. Another patient with schizophrenia believed only food from vending machines was safe to eat -- ABC's social workers helped him recognize and manage that paranoia.
From the county's perspective, those people will be just fine without the center. Conducy says while she recognizes that ABC served a niche population, it's an injustice to put anyone into a category. "I'm not comfortable with labeling people mentally ill sex offenders," she said. "Those people should have the same access to individualized care that everybody else does."
According to email exchanges between county officials and ABC, Ramsey County Community Human Services told the day treatment center to start looking for alternative revenue a year ago. Since then, Jorento and contract manager Pam Sanchez have gone back and forth discussing options for keeping ABC open, none of which were possible due to the center's funding restrictions, Jorento said.