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Mental Health Legislative Network of Minnesota
201 Legislative Issues
2016
For additional copies or if you have questions, please contact NAMI Minnesota at
651-645-2948, 1-888-NAMI HELPS
or the Mental Health Association of Minnesota at 651-493-6634, 1-800-862-1799.
Mental Health Legislative Network
2016
The Mental Health Legislative Network (MHLN) is a broad coalition that advocates for a
statewide mental health system that is of high quality, accessible and has stable funding. The
organizations in the MHLN all work together to create visibility on mental health issues, act as a
clearinghouse on public policy issues and to pool our knowledge, resources and strengths to
create change.
This booklet was prepared to provide important information to legislators and other elected
officials on how to improve the lives of children and adults with mental illnesses and their
families and how to build Minnesota’s mental health system.
The following organizations are members of the Mental Health Legislative Network:
Amherst H. Wilder Foundation
Barbara Schneider Foundation
Canvas Health
Catholic Charities
Central MN Mental Health Center
Children's Hospitals and Clinics of
Minnesota
Community Involvement Programs
Emily Program Foundation
Fraser
Goodwill/Easter Seals
Guild Incorporated
Lutheran Social Service of Minnesota
Mature Voices of Minnesota
Mental Health Minnesota
Mental Health Providers Association of
Minnesota
Minnesota Association of Community
Mental Health Programs
Minnesota Autism Center
Minnesota Council of Child Caring
Agencies
Minnesota Disability Law Center
Mid-Minnesota Legal Aid
Minnesota Psychiatric Society
Minnesota Psychological Association
Minnesota Recovery Connection
Minnesota Society for Clinical Social Work
Minnesota Coalition of Licensed Social
Workers
Minnesota Organization on Fetal Alcohol
Syndrome
NAMI Minnesota
National Association of Social Work,
Minnesota Chapter
Northeast Youth and Family Services
People Incorporated Mental Health Services
RESOURCE
The Office of Ombudsman for Mental
Health/Developmental Disabilities
Touchstone Mental Health
Vail Place
Wellness in the Woods
If you have questions about the Mental Health Legislative Network or about policies related to
the mental health system, please feel free to contact NAMI Minnesota at 651-645-2948 or the
Mental Health Minnesota at 651-493-6634. These two organizations co-chair the Mental Health
Legislative Network.
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Mental Illnesses
Mental illnesses are medical conditions that disrupt a person's thinking, feeling, mood, ability to
relate to others and daily functioning. Mental illnesses affect about one in five people in a given
year. People affected more seriously by mental illness number about 1 in 17. There is a
continuum, with good mental health on one end and serious mental illnesses on the other end.
Examples of serious mental illnesses include major depression, schizophrenia, bipolar disorder,
obsessive compulsive disorder (OCD), generalized anxiety disorder, panic disorder, posttraumatic stress disorder (PTSD), eating disorders and borderline personality disorder.
Mental illnesses can affect persons of any age, race, religion, political party or income. Mental
illnesses are treatable. Most people diagnosed with a serious mental illness can get better with
effective treatment and supports. Medication alone is not enough. Therapy, support, good diet,
exercise, stable housing, meaningful activities (school, work, volunteering) all help people
recover.
Some people need access to basic mental health treatment. Others need mental health support
services such as case management (and/or care coordination) to assist them in locating and
maintaining mental health and social services. Still others need more intensive, flexible services
to help them live in the community.
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Table of Contents
Mental Illnesses..............................................................................................................................2
Table of Contents...........................................................................................................................3
2015 Legislative Accomplishments...............................................................................................4
Key Issues for the 2016 Legislative Session.................................................................................6
Detailed Issues for the 2016 Legislative Session..........................................................................7
Adult Mental Health......................................................................................................................7
Supporting Parents with Mental Illnesses............................................................................7
Minnesota Security Hospital and AMRTC Renovations.....................................................7
Employment.........................................................................................................................8
Patient Flow.........................................................................................................................9
Clarifying and Strengthening Integrated Dual Diagnosis Treatment Policy.......................9
Mental Health...............................................................................................................................10
Excellence in Mental Health Act.......................................................................................10
Prior Authorization............................................................................................................11
Mental Health Workforce Shortages.................................................................................12
Mental Health Parity..........................................................................................................13
Assertive Community Treatment (ACT)...........................................................................13
First Episode Psychosis Programs.....................................................................................13
Duty to Warn......................................................................................................................14
Children’s Mental Health............................................................................................................16
Improve Access to Mental Health Care for Children........................................................16
Transitional Services for Youth.........................................................................................16
Early Childhood Consultation............................................................................................17
Transportation to Day Treatment.......................................................................................17
Evidence-based Multigenerational Treatments..................................................................18
Hennepin County FASD Pilot Project...............................................................................18
Education......................................................................................................................................20
Use of Seclusion and Restraints.........................................................................................20
Continuing Education on Suicide Prevention....................................................................20
Criminal Justice...........................................................................................................................21
Mental Health Training for Police Officers.......................................................................21
Segregation and Isolation in Prison...................................................................................21
Non-Formulary Medications..............................................................................................22
Police Body Cameras.........................................................................................................22
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2015 Legislative Session Accomplishments
The 2015 legislative session was a landmark year for Minnesota’s mental health system. More
than $50 million in new funding was appropriated, the largest increase in our state’s history.
Investments were made to a number of key mental health services for both children and adults
and their families across the continuum.
Crisis and Suicide Prevention
Crisis services received $8.57 million in funding to expand 24/7 access to mobile crisis teams
and increase the number of crisis homes. An additional $449,000 was appropriated to expand the
suicide prevention programs under the Department of Health; a nearly 54% increase in funding.
Suicide grants will be expanded to train school staff, peace officers, firefighters, EMTs,
paramedics, primary care providers and others. Evidence-based postvention training can also be
funded in order to provide technical assistance to communities after a suicide in order to prevent
clusters and contagion.
The commissioner, in consultation with stakeholders, will submit a report to the legislature that
includes a detailed plan identifying methods to improve the timeliness, usefulness, and quality of
suicide-related data to help identify the scope of the suicide problem, identify high-risk groups,
set priority prevention activities, and monitor the effects of the suicide prevention programming.
The report will include how to improve injury coding, how to obtain and release data in a timely
manner, and how to support the use of psychological autopsies.
The program called Text4Life, which targets youth who tend to text rather than make a phone
call, received an additional $1 million for the biennium.
Mental Health Intensive Services
Significant funding increases were made to expand Assertive Community Treatment (ACT)
teams and stabilize mental health intensive services such as Intensive Residential Treatment
Services (IRTS) and crisis beds, and to conduct an analysis and develop recommendations on
how to better fund these services. New funding was allocated for First Episode Psychosis (FEP)
programs so that young people experiencing their first psychotic episode are provided with
intensive services so they do not become disabled by their mental illness.
To help with the hospital backlog, 15 new beds opened at the Anoka Metro Regional Treatment
Center (AMRTC) and 150 new intensive residential beds for children (PRTFs) will open in the
coming years. A new care coordination model called behavioral health homes will also receive
funding beginning in July 2016.
The legislature appropriated $2 million for Beltrami County to plan and develop a
comprehensive mental health program that will serve individuals who are under arrest or subject
to arrest, who are experiencing a mental health crisis, under a transport hold, or are in immediate
need of mental health crisis services.
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Supportive Housing and Homelessness
The Bridges housing program, which provides rental assistance for people with mental illnesses
who are eligible for Section 8 housing, was increased by $2.5 million a year. Supportive housing
grants for people with mental illnesses increased by $4.654 million this biennium and will
increase next biennium by $6.146 million. An additional $2 million was appropriated for the
homeless youth act and an additional $2 million to increase services and supports to people
experiencing long-term homelessness.
Mental Health Services
The Minnesota Telemedicine Act was passed which basically requires parity under health plans
and Medical Assistance for health care services provided by telemedicine or in-person, including
payment rates and co-payments or deductibles.
Nonprofit organizations providing resources and referrals for culturally specific mental health
services to Southeast Asian veterans who do not qualify for services available to veterans
formally discharged from the U.S. armed forces received grant money as well.
Children
Respite care grants are increased by $847,000 for the next biennium, which should allow many
more families to access respite care for their child with a mental illness. Grants will be available
in FY 2018 to children’s mental health and family services collaboratives for training on adverse
childhood experiences (ACEs) with the goal being to reduce the number of adverse childhood
experiences and increase resiliency. Funding increased for a program started in 2014 that gives
grants to community mental health centers to provide care to children and young adults under the
age of 21 who are uninsured.
The Minnesota Model of School-based Diversion for students with co-occurring disorders in
three schools received appropriations for the second year of the biennium and each year of the
next biennium. The model assists schools and their partners in becoming more selective about
making referrals to the juvenile justice system and helping them develop alternatives to
addressing these types of incidents.
Mental Health Workforce
Over $5 million in funding was made available for the rural loan forgiveness program expansion
to include mental health professionals. $3 million for the biennium is appropriated to the
Commissioner of Health to expand the primary care residency program. This includes psychiatry
and sets aside four slots for psychiatry residents.
Peer specialists can now be a case manager associate and the commissioner of human services,
with input from stakeholders, will also study and report on how peer specialists are used in the
mental health system. In assessing the use of certified peer specialists in hospital settings and
IRTS, the commissioner shall make recommendations on how to obtain reimbursement for
wraparound services by these specialists and warm handoffs to community services that facilitate
the successful transition of persons with mental illness to the next level of care.
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Key Issues for the 2016 Legislative Session
The key policy objectives of the Mental Health Legislative Network to continue to build on our
mental health system and address the current needs are:
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Eliminating barriers that prevent children, adults and families from accessing treatment
and support, and reducing emergency room use and hospital backlogs.
Ensuring people living with mental illnesses have informed choices about their housing
and employment options and helping them obtain homes and jobs that meet their needs.
Addressing mental health workforce shortages.
Enforcing and clarifying the breadth of services under mental health parity.
Increasing funding for early intervention and evidence-based practices such as First
Episode Psychosis (FEP) programs and multigenerational treatments.
Improving mental health services for children and youth by refining current programs and
appropriating funding to schools for consultation with experts to help children with
complex needs and for staff training on mental health and suicide prevention.
Reducing inappropriate use of the criminal and juvenile justice systems for children and
adults with mental illnesses.
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Detailed Issues for the 2016 Legislative Session
Adult Mental Health
Supporting Parents with Mental Illnesses
Issue: Families participating in the Minnesota Family Investment Program (MFIP) excludes
families on child-only MFIP from receiving subsidized child care.
Background: Families, who are on child-only MFIP, who are deemed disabled and are on
Supplemental Security Income (SSI) /Social Security Disability Insurance (SSDI), do not have
access to child care. It is very difficult for a parent to engage in treatment without dependable
and quality child care. A person may need intensive treatment that could potentially involve
attending treatment daily during a week to properly address and fully manage mental health
symptoms. Parents should not have to choose between caring for their children and addressing
their mental health needs.
A number of well supported studies, such as the Adverse Childhood Experiences (ACEs) study,
identify that having a parent with a mental illness is a risk factor for poor quality of life in the
future. Parents who have access to subsidized child care can access mental health treatment and
children can have a stable adult in their lives.
Policy Recommendation:
 Expand child care assistance to families who have a child under the age of six and are on
child-only MFIP.
Minnesota Security Hospital and AMRTC Renovations
Issue: The Minnesota Security Hospital facility has poor sightlines and lacks space and other
aspects that promote a safe and therapeutic environment. Anoka Metro Regional Treatment
Center (AMRTC) is in need of renovations to improve patient and staff safety.
Background: In 2014, Governor Dayton approved Minnesota’s bonding bill which included
funding for the first phase for remodeling of the Minnesota Security Hospital. The proposed
building project creates more space for individuals receiving treatment and will allow staff to
place them in different units according to the level of supervision they need. The project as a
whole will effectively split the campus into two distinct areas and move the forensics program to
the upper half, freeing up space for on the lower campus for Minnesota Sex Offender Program
(MSOP).
The governor’s 2016 capital budget recommends funding to renovate AMRTC to improve
patient and staff safety and ensure staff are equipped to serve challenging patients. Changes
include installing a facility-wide camera system that will allow monitoring from a central
location and at each unit’s nursing station, help deter acts of violence and property damage, and
assist with investigations. It will also involve installation of personal duress alarm system sensors
throughout patient care areas, and provide small transmitters to be carried by staff to provide
faster emergency response.
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Policy Recommendations:
 Pass the MSH bonding request during the next legislative session in order to complete
phase two of the renovations.
 Pass the AMRTC bonding request during the next legislative session to fund renovations.
 Reinstate community advisory council on direct care and treatment.
Employment
Issue: Persons with mental illnesses have the highest unemployment rate and yet employment is
an evidence-based practice, meaning it helps people recover. Programs that are designed
specifically for persons with mental illnesses are underfunded and serve a limited amount of
people.
Background: One of the best steps in recovery from a mental illness is a job. However, the
unemployment rate for individuals receiving public mental health services is nearly 80 percent
nationwide. In Minnesota, this rate is 86 percent despite the fact that at least 60 percent want to
work. People living with mental illnesses face a number of barriers to finding and keeping a job.
They often face stigma and discrimination when applying for jobs and may face other obstacles
such as losing health insurance coverage for their mental health treatment and medications or
lack of transportation. In addition, few receive the supported employment opportunities shown to
be effective for people with mental illnesses.
Individual Placement and Support (IPS) Supported Employment is an evidence-based practice
that integrates employment services with mental health services. There are seven core principles:
consumer choice, integrated services, competitive employment in regular work settings, place
and train, personalized follow-on support, personal preferences, and benefits counseling. IPS
programs are three times more likely to help people find employment than other vocational
programs.
During the 2013 Legislative Session, Minnesota lawmakers made a number of important changes
to the law governing supported employment programs for people with mental illnesses to reflect
the evidenced-based model of Individual Placement and Support (IPS). Changes were also made
to Minnesota’s Adult Mental Health Act to underscore the importance of competitive
employment and to encourage counties to fund IPS programs. In the 2015 special session IPS
employment received an additional $1 million a year to continue the projects that were converted
to IPS last year. The next step is to provide on-going funding and to increase the number of IPS
programs to help all Minnesotans with a mental illness who want to work find a meaningful and
well-paying job and make sure DEED programs know how to help.
Policy Recommendations:
 Require the commissioner of DEED to, in consultation with stakeholders, identify
barriers that people with mental illnesses face in obtaining employment, identify all
current programs that could assist people with mental illnesses in obtaining employment
and submit a detailed plan to the legislature.
 Expand IPS Supported Employment with the goal of statewide coverage.
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Patient Flow
Issue: People are waiting in the emergency room for a bed and in community hospitals to get
into Anoka Metro Regional Treatment Center (AMRTC) or an Intensive Residential Treatment
Services (IRTS) facility; over 50% of people at AMRTC, do not need that level of care and are
waiting to transition into the community.
Background: The Treatment Advocacy Center’s 2013 report attributes the negative impact to
our nation’s hospital emergency departments, law enforcement agencies, jails and prisons to the
closure of state psychiatric beds. Note that for the purposes of this report, “public psychiatric
beds” are defined as beds run by state governments. 2010 data from the study show that
Minnesota had the fewest beds (3.9 per 100,000 individuals). The state of Mississippi ranked
number one in the nation with the highest number of beds (39 per 100,000 individuals).
In actuality, in Minnesota there are 1,124 inpatient community mental health beds statewide: 960
for adults, 164 for children/adolescents in community hospitals. There are also 646 available
beds at Intensive Residential Treatment (IRTS) and crisis facilities and seven 16-bed Community
Behavioral Health Hospitals. When community and state run beds are added together it is
significantly greater than what is reported in the Treatment Advocacy Center report.
Minnesota needs to create more Urgent Mental Health Care Centers, such as the one in St. Paul,
provide rapid access to treatment when it is needed in a very cost effective way. We also need to
increase support for psychiatric ED services, which can offer a faster hand-off when police bring
someone into the ED; crisis teams; crisis homes; and more supportive housing for people to
transition out of AMRTC.
Policy Recommendations:
 Address the “flow issues” that are backing up our emergency rooms, hospitals and Anoka
Metro Regional Treatment Center (AMRTC).
 Establish Community Competency Restoration Programs (CRPs).
Clarifying and Strengthening Integrated Dual Diagnosis Treatment Policy
Issue: Current statutory language regarding protocol for screening, assessment and follow up
under the area of Integrated Dual Diagnosis Treatment is somewhat confusing and lacks clear
direction.
Background: The current legislative language requires all individuals who perform chemical
dependency assessments or mental health diagnostic assessments to use screening tools approved
by the commissioner in order to identify whether an individual who is the subject of the
assessment screens positive for co-occurring mental health or chemical dependency disorders.
This language limits the ability of qualified mental health professionals to use alternative high
quality diagnostic assessment processes and lacks clear direction for what is to be done with the
assessment results once they are completed.
Policy Recommendation:
 Pass legislation that clarifies the process and tools that are to be used when performing
assessments with individuals with potential co-occurring disorders.
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Mental Health
Excellence in Mental Health Act
Issue: Navigating the mental health and substance use disorder systems can be difficult.
Typically, a person with a mental illness will need to contact several different agencies to obtain
a different level of care and rarely can someone obtain both mental health and substance use
disorder treatment through the same agency. The Excellence Act will improve the way
Minnesotans access mental health and addiction treatment. The state will build on its past
investment in building community based mental health services by requiring certified clinics to
provide access to all levels of community based mental health and substance use services, as well
as care coordination across the spectrum of health care. It will also create a new payment system
to sustainably fund the delivery of the array of services by providing a reimbursement rate that
supports the cost of doing business.
In addition, the Excellence Act requires CCBHCs to engage in partnerships with a variety of
health system partners (e.g. hospitals, VA centers, and more). This emphasis on partnerships is a
move toward the health care world of the future: systems that work together to achieve concrete
health outcomes and high-value care. These partnerships will also increase the likelihood that
care will be received before a person enters into crisis, lessening the burden on families,
emergency rooms, and law enforcement.
Background: In 2014, Congress passed legislation that included provisions for the Excellence in
Mental Health Act, the single largest investment in community behavioral health in over 50
years. The purpose of the demonstration program is to increase access to community mental
health and substance use treatment services and improve funding for them under Medicaid. A
key component is to define a “Certified Community Behavioral Health Clinic” (CCBHC) and
ensure that they provide an array of intensive, individually focused, evidence-based screening,
assessment, diagnostics, treatment, prevention, and wellness services to serve individuals with
serious mental illness and substance use disorders.
Minnesota received a planning grant to begin the process of creating a comprehensive set of
mental health and addiction outpatient services to be provided by CCBHCs. Of the states that
received a planning grant (24 states total), eight will be selected as demonstration states and will
receive funding and a higher federal match under the Medicaid program to administer a two-year
pilot program.
Policy Recommendation:
 Support legislation needed to carry out the reforms for the Excellence in Mental Health
Act including:
1) Create criteria and standards for Certified Behavioral Health Clinics. Standards
will require that clinics provide directly a broad array of services to children and
adults including; 24 hour crisis management, outpatient services, primary care
coordination and person centered treatment planning.
2) Establish a Prospective Payment System (PPS). This is a cost-based clinic specific
rate that covers all eligible services provided by a CCBHC.
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3) Secure the state’s share of Medicaid payments for CCBHC’s during the
demonstration program. During the demonstration program states will receive an
enhanced federal match for Medicaid services.
Prior Authorization
Issue: Individuals experience barriers to obtaining prescribed best-choice medication due to prior
authorization regulations.
Background: Finding the right medication and treatment for a mental illness can be difficult.
Adherence to a treatment plan can be even more difficult. Research has shown that when an
individual with a mental illness is engaged in developing the treatment plan and when there is
shared decision making, the outcomes are better. The individual and their physician should work
together to determine a best-choice medication based upon treatment goals and risk of sideeffects.
Step therapy, where you must start with typically the cheapest and oldest medication and must
“fail” before trying another medication, does not allow for best practices in terms of treatment
engagement nor does it allow the physician to recommend which medication may work best
based on a number of items including research and family history. Some side effects are more
tolerable than others which means it is critical that the individual be involved in the decision
making. Mental illnesses have a genetic component. If a family member has, for example,
depression and has found a medication that works well, it may be appropriate for another family
member to try that medication first.
Controlling costs through fail-first approaches conflicts with most clinical treatment guidelines
for mental illnesses. By limiting the array of medication options to people with mental illnesses,
both physicians and individuals are forced to compromise their treatment decisions. While
studies may show that there is relatively little difference in the effectiveness of a class of
medication, these studies provide no information on discontinuation of medications or intolerable
side effects or failure to adequately control symptoms. These “cost saving measures” often place
people with mental illnesses at risk of poor outcomes such as psychiatric decompensation and rehospitalization, with little evidence that they save money or improve quality of care over the
long-term.
An individual may also have to change a medication that has been working for them should they
decide to switch to an insurance plan that better meets their needs. People should not be limited
to certain health care insurance plans for fear they might lose access to their prescribed
medication.
Often, a person with a mental illness will have to fail on one or more medications before they are
allowed access to the medication they would have tried as an initial treatment. It is poor clinical
care to delay the start of effective treatment and expose a person with mental illness to increased
risks.
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Policy Recommendation:
 Ensure that prior authorization laws do not interfere with people obtaining the most
effective medication including eliminating step therapy and requiring people to change
medication when changing plans.
Mental Health Workforce Shortages
Issue: There are not enough mental health practitioners and professionals to meet the needs of
the children and adults requiring mental health services.
Background: Psychiatry, psychology, clinical social work, psychiatric nursing, marriage and
family therapy and professional clinical counseling are considered the “core” mental health
professions. For many years, Minnesota has experienced a shortage of providers of mental
health services. This shortage has been felt most profoundly in the rural areas of the state. There
is also an ongoing-shortage of culturally competent and culturally specific providers.
Of Minnesota’s 11 geographic regions, 9 have been designated by the Health Resources and
Services Administration (HRSA) as mental health shortage areas. As more people seek mental
health treatment and as we work to expand access to mental health services across the state, there
is a great urgency to increase the supply of community mental health professionals.
Another concern is reimbursement rates for mental health services that have not kept pace with
other health care services or health care inflation. Over the past ten years there have been
inconsistent increases amounting to minor increases for mental health service when averaged
over time.
The 2013 legislature passed a bill requiring Minnesota State Colleges and Universities (MnSCU)
to hold a mental health summit and develop a comprehensive plan to increase the number of
qualified people working at all levels of our mental health system, ensure appropriate
coursework and training and create a more culturally diverse mental health workforce. In 2015
the Mental Health Workforce released the report with recommendations to address workforce
shortages by increasing the number of qualified people working at all levels of our mental health
system, ensure appropriate coursework and training for mental health professionals and create a
more culturally diverse mental health workforce.
Policy Recommendations:
 Ensure access to affordable supervisory hours for mental health certification and
licensure.
 Reduce barriers to mental health workers obtaining supervision hours required to be a
mental health practitioner.
 Expand rural mental health degree programs for psychiatric nurse practitioners, social
workers and mental health workers.
 Reform mental health licensing boards to add minimum requirements for continuing
education on cultural competency and elimination of bias.
 Require mental health licensing boards to develop community supervision standards and
agree to shared supervision requirements.
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Mental Health Parity
Issue: Mental health services are not covered by insurance in the same way as other health
services.
Background: The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a
federal law aimed at preventing group health plans and health insurance agencies that provide
mental health or substance use disorder services from imposing less favorable limitations on
those services than on medical services. There is also language in Minnesota law regarding
parity.
Parity is also an issue when it comes to long term disability claims. A person with a medical
condition can receive long term disability benefits indefinitely while a person with a mental
health condition is limited to two years of benefits.
Policy Recommendations:
 Require parity for the breadth of mental health treatment including Intensive Residential
Treatment Services (IRTS), Adult Rehabilitative Mental Health Services (ARMHS) and
Children’s Therapeutic Services and Supports (CTSS).
 Require parity in long term disability insurance for people with mental illnesses.
Assertive Community Treatment (ACT)
Issue: Statewide standards need to be established for Assertive community treatment (ACT) in
order to assure consistency and quality.
Background: Assertive community treatment (ACT) is an intensive, comprehensive, nonresidential rehabilitative mental health service team model. ACT services are:
 Directed to individuals with a serious mental illness who require intensive services
 Offered on a time-unlimited basis and available 24 hours per day, 7 days per week,
365 days per year
 Provided by multidisciplinary, qualified staff who have the capacity to provide most
mental health services necessary to meet the person's needs, using a total team
approach
These teams have been highly successful in supporting individuals with complex needs to live in
the community and avoid hospitalizations and jails. We need more ACT teams in Minnesota and
the Department of Human Services in collaboration with stakeholders is developing ACT
standards in order to ensure quality.
Policy Recommendations:
 Create standards of Assertive Community Treatment (ACT) teams.
 Fund more ACT teams.
First Episode Psychosis Programs
Issue: There are limited programs and services available for people experiencing their first
psychotic episode. The results are adverse outcomes and disability caused by their untreated
mental illness.
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Background: Individuals experiencing their first psychotic or manic episode are not receiving
the intensive treatment they need to foster recovery. On average a person waits 74 weeks to
receive treatment. Our mental health system has relied on a “fail-first” model of care that
essentially requires people experiencing psychosis to be hospitalized or be committed multiple
times before they can access intensive treatment and supports. This costs our system a great deal
and costs the individual even more. There is compelling evidence that intensive early
intervention can foster recovery and prevent adverse outcomes frequently associated with
untreated psychosis.
In 2009, NIMH launched the Recovery After an Initial Schizophrenia Episode (RAISE) initiative
to determine the best approaches for providing coordinated care to people experiencing first
episode psychosis. This model uses a collaborative, recovery-oriented approach resembling the
Assertive Community Treatment (ACT) model of community-based care because it combines
evidence-based services into an effective package. Components include cognitive behavioral
therapy (CBT), supported employment and education, case management, family
psychoeducation, peer and family supports, and low dosage medications. It emphasizes shared
decision-making with the recipient of services taking an active role in determining treatment
preferences and recovery goals.
To address the need in Minnesota we estimate that eight teams would be needed and each would
serve 30 young people at one time. People stay with the team an average of two to three years.
Each team, based on calculations used in New York, would cost roughly $250,000, in addition to
reimbursement by insurance.
During the 2015 legislative session funding of $260,000, in addition to the ten percent from the
federal mental health block grant, was made available to create evidence-based interventions for
youth at risk of developing and experiencing a first episode of psychosis. The project will offer
coordinated specialty care including case management, psychotherapy, psychoeducation, support
for families, cognitive remediation, and supported employment and/or education. These
programs provide intensive treatment right away for someone experiencing symptoms of
psychosis.
Policy Recommendation:
 Increase the number of first episode psychosis (FEP) programs so that young people
experiencing their first psychotic or first manic episode receive intensive treatment.
Duty to Warn
Issue: Current Minnesota statute only covers certain licensees under duty to warn and liability.
Background: Minnesota statute defines duty to warn as the duty to predict, warn of, or take
reasonable precautions to provide protection from violent behavior when a client or other person
has communicated to the licensee a specific, serious threat of physical violence against a
specific, clearly identified or identifiable potential victim. If a duty to warn arises, the duty is
discharged by the licensee if “reasonable efforts” (communicating the serious, specific threat to
the potential victim and if unable to make contact with the potential victim, communicating the
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serious, specific threat to the law enforcement agency closest to the potential victim or the
client.) are made to communicate the threat. The liability standard and limitation on liability
covers a “licensee”, but no other mental health providers.
Policy Recommendation:
 Expand duty to warn statute to include licensed alcohol and drug counselors (LADCs),
mental health practitioners and mental health professionals and not just licensed mental
health professional.
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Children’s Mental Health
Improve Access to Mental Health Care for Children
Issue: Expand School-linked Mental Health (SLMH) Care Grants
Background: Many children with mental illnesses struggle in school. Without access to
treatment and support, children with mental illnesses often have trouble academically and
socially and are far more likely to drop out. Since 2007, grants have been made to community
mental health providers to collaborate with schools to provide mental health treatment to
children. This program has produced wonderful outcomes and has reduced barriers to access
such as transportation, insurance coverage, and finding providers.
School-linked mental health grants were so successful that the legislature increased funding
100% in 2013. Roughly half of students served through these grants had never received mental
health services before, and of those students, about half of them had a serious mental illness.
Despite the progress in expanding to more schools and districts, we are not yet meeting the needs
of children all across the state.
This program works hand-in-hand with school support personnel such as school nurses, school
psychologists, school social workers and school counselors. Efforts must be made to ensure that
there are sufficient school support personnel to help those children who do not have a mental
health diagnosis.
Policy Recommendations:
 Increase funding for school-linked mental health grants. We want to ensure that every
district has at least one school with school-linked mental health services and to ensure
services in schools with high percentages of children living in poverty.
 Increase funding for school support personnel. We need to make sure that there are
sufficient numbers of these important personnel in our schools.
Transitional Services for Youth
Issue: As they transition to adulthood, youth face decisions that can be negatively impacted by
symptoms of mental illnesses. Accessible and collaborative services are needed in order to
support more positive outcomes for Minnesota’s children, youth and families.
Background: Children and youth with mental illnesses experience unique challenges and often
lack positive guidance and support. There is a substantial need for appropriate services and
support for youth who are aging out of children’s mental health services and going into adult
mental health services. In addition, mental health providers often operate separate from one
another and in some areas in Minnesota access to all mental health services can be limited.
The Transition to Independence Process (TIP) model is an evidence-based practice for improving
outcomes for youth. The TIP model prepares youth for their transition into adulthood, engaging
them in their own futures planning process and providing supports and mental health services.
TIP can be managed by a variety of mental health providers including case managers and
Assertive Community Treatment (ACT) teams.
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Policy Recommendations:
 Fund demonstration project to assist transition-aged youth and young adults with mental
illnesses in making a successful transition into adulthood using the Transition to
Independence Process (TIP) model and evaluate the effectiveness.
Early Childhood Consultation
Issue: Child care providers and educators do not have the necessary training or skills to
adequately support children with mental health needs. Children are getting kicked out of child
care instead of receiving the supports and treatment they need.
Background: Since 2007, Minnesota has invested in building infrastructure to address early
childhood mental health through grants to support and develop the availability of and access to
developmentally and culturally appropriate services for young children. These infrastructure
grants are used to strengthen infrastructure and support developmentally and culturally
appropriate services for young children.
Early childhood mental health consultation grants support having a mental health professional,
with knowledge and experience in early childhood, provide training and regular onsite
consultation to staff serving high risk and low-income families, as well as referrals to clinical
services for parents and children struggling with mental health conditions. Early childhood
mental health consultation would have three main components:
 On-site mental health consultation and support for child care agency staff. Mental health
agencies will also work directly with families as appropriate.
 Referral for children and their families who need mental health services.
 Training for child care staff in child development; trauma/resilience; working with
families who have their own have mental health issues; and skills to better support the
emotional health and development of children they work with. These trainings would be
built into the Parent Aware ratings of participating child care agencies.
Policy Recommendations:
 Appropriate funds for early childhood mental health consultation grants.
Transportation to Day Treatment
Issue: Children and families experience barriers to accessing treatment due to lack of funding for
transportation.
Background: Since 2009, schools, treatment providers and advocates have been meeting to
address the problems related to education and care and treatment programs. There are several
issues. One is the lack of transportation. Some districts refuse to provide transportation to a
particular day treatment program – even if that program provides the best treatment to meet that
child’s needs. Some districts have created “day treatment” programs in name only. They are
segregated programs that do not provide the active treatment component required by DHS. Day
and residential programs need the schools to provide the education piece and yet there is little
collaboration as to the type of teachers that would work most effectively in these settings. Added
to this is that these children are not receiving a full day of education due to their mental health
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treatment needs, and yet few are offered extended year (summer school) programming, leaving
them further and further behind in school.
A hearing was held in the Minnesota Senate in 2014 to raise awareness of the problems. A bill
has been introduced twice to address the problems.
Transportation to a treatment program should be based on the recommendations of a mental
health professional not the ease of school district. Some programs provide a specific type of
therapy that is needed by the child to recover and learn. This decision should be based on the
child’s needs not transportation convenience. Another way to decrease costs to the school is to
increase the amount that is paid for a family member to transport the student, which currently
does not pay when the child is not in the car, meaning that the parent is making four trips a day
but only being paid for two. There are also problems with transporting children from foster care
to their previous school district and transporting youth to ALCs.
Policy Recommendation:
 Require transportation to day treatment for a child who has a mental illness.
Evidence-based Multigenerational Treatments
Issue: Multigenerational mental health treatment and services are not included under the
Minnesota statute for children’s mental health grants.
Background: Multigenerational treatments are an evidence-based practice designed to increase
supportive and responsive caregiving of parents with serious mental illness and to conduct an
independent evaluation of the effectiveness of these interventions. Research has shown that
many parents who have a serious mental illness also have a child with mental health challenges
and this model seeks to address the needs of both the parent and their children in an integrated
fashion.
Policy Recommendation:
 Appropriate funding to develop the capacity of providers to deliver evidence-based
multigenerational treatments designed to increase supportive and responsive caregiving
of parents with mental illnesses.
Hennepin County FASD Pilot Project
Issue: During their transition period, youth with Fetal Alcohol Spectrum Disorders (FASD) face
multiple challenges. Not enough is known about how what services, supports, programs and
strategies are needed to achieve optimal outcomes. Accessible and collaborative services are
needed in order to support more positive outcomes for this population. Without appropriate
supports, this population is particularly at risk for a variety of adverse outcomes.
Background: Youth ages 12-26 who have been prenatally exposed to alcohol (and may or may
not have the diagnosis on the FASD spectrum) face unique challenges. Because this medical
diagnosis does not fit neatly in developmental disability service track, in the mental health
service track, and is excluded from brain injury services, it is apparent that the current service
delivery model falls short for this population. FASD is a spectrum and so each individual who
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has been impacted often needs a unique collection of services and supports to achieve greater
independence and success.
Individuals with an FASD require funding and appropriate services that recognize the existence
of a permanent brain based disability. Affected individuals have limited cause and effect
reasoning and lack an understanding that actions have consequences making traditional
interventions ineffective. In addition, because it is an "invisible" disability, assumptions about
their behavior may be completely false and counterproductive.
Hennepin County, along with the Minnesota Organization on Fetal Alcohol Syndrome (MOFAS)
and key stakeholders are committed to developing a pilot program that will identify
comprehensive, multi-system transition services needed by youth living with FASD with the
goal of substantially improving life outcomes.
Policy Recommendation:
 Improve transitional services for youth with FASD by developing a pilot project for
young adults who are in need of supports such as specialized case management,
supportive housing, and supportive employment.
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Education
Use of Seclusion and Restraints
Issue: The use of seclusion and restraints in the schools needs to continue to be reduced. A
statewide policy on effective alternatives to suspension needs to be developed. School staff need
training on alternatives.
Background: On August 1, 2011 a law went into effect limiting how schools could use seclusion
and restraints on special education students and could only be used in an emergency by trained
staff. The schools are also required to keep documentation, review data and inform parents.
While progress has been made in reducing the use of these procedures, more must be done. In
2014 the legislature appropriated $250,000 to help school districts reduce the use of prone
restraints, especially for those students who have experienced a high use of prone restraints. The
annual report to the legislature found that just a few children account for a high percentage of the
use of seclusion and restraints pointing to the need for districts to bring in experts to help them
figure out how to meet the child’s needs.
Policy Recommendations:
 Appropriate funding to reimburse school districts for experts to reduce the use of
seclusion and restraints on students with complex needs.
 Amend current statute to include that children in kindergarten through third grade are not
suspended and a discipline policy on effective alternatives to suspension is created.
 Fund staff training for intermediate districts and co-ops.
Continuing Education on Suicide Prevention
Issue: The list of topics for in-depth training for teachers does not include suicide prevention
training that is approved as a best practice.
Background: Under current law, teachers must receive continuing education about
understanding the key warning signs of early-onset mental illness in children and adolescents as
part of their re-licensure. This was passed back in 2003 and Minnesota was the first state in the
country to require this type of training. Other states have followed in our footsteps
In 2013 the law was changed to allow teachers who have taken an initial course on early warning
signs of mental illnesses in children to, during subsequent licensure renewal periods, take
courses that provide a more in-depth understanding of students' mental illness such as on trauma,
accommodations for students' mental illness, parents' role in addressing students' mental illness,
Fetal Alcohol Spectrum Disorders, Autism, de-escalation methods and Minnesota’s law
governing the use of seclusion and restraints in schools.
Policy Recommendation:
 Require teachers to receive at least one hour of continuing education on suicide
prevention.
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Criminal Justice
Mental Health Training for Police Officers
Issue: State law does not require police officers to have training or continuing education on skills
related to working with people with mental illnesses.
Background: Training for police officers on mental illnesses and dealing with a mental health
crisis often results in better outcomes for the individual and prevents someone from going to jail.
While some community colleges have begun including coursework on mental illnesses for
people studying law enforcement, many police officers have little training. The “gold standard”
for police training is called Crisis Intervention Team Training (CIT), which is a 40-hour class
that provides intensive training for police (and now in Minnesota prison staff) on mental illnesses
and crisis response. Police forces need funding to afford the training and especially for smaller
forces for paying for substitutes while an officer is at training.
Policy Recommendations:
 Require police training for officers to learn skills to appropriately handle mental health
crisis situations and be more effective when working with people with mental illnesses.
 Require the Peace Officer Standards and Training (POST) Board, in collaboration with
the commissioner of the Department of Human Services and other mental health
stakeholder, to create a list of approved training courses to instruct peace officers in the
techniques of responding to a mental health crisis.
 Require MNSCU CIT training as a part of law enforcement curriculum.
Segregation and Isolation in Prison
Issue: Segregation and isolation have negative impact on a person’s mental health. Given the
high rate of people will mental illnesses in prison, the use of segregation and isolation prevents
that person from receiving adequate treatment when there is limited treatment in the first place.
Background: Minnesota Administrative Rule defines segregation in two ways: administrative
and disciplinary. 2911.0200 Subp. 2 “Administrative segregation” means the status of an inmate
prone to escape, prone to assault staff or other inmates, or likely to need protection from other
inmates or self, an inmate with a mental illness or a developmental disability who is in need of
special care, or an inmate on medical isolation or infirmary status. 2911.0200 Subp. 29
"Disciplinary segregation" means the status assigned an inmate following a hearing in which the
inmate was found in violation of a facility rule or state or federal law or the status assigned an
inmate before a hearing when segregating the inmate is determined to be necessary in order to
reasonably ensure the security of the facility.
There is research to support the psychological stress and strain that result from the use of
disciplinary and administrative segregation and isolation in prisons especially for persons with
mental illnesses. Individuals who are held in solitary confinement spend nearly every hour of the
day in a small windowless cell with no contact with others. The use of segregation and isolation
is also extremely expensive and counterproductive if the hope is to support rehabilitation back
into the community.
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Policy Recommendation:
 Place time limits and oversight on the use of segregation and isolation in prison, and the
use of administrative segregation to protect against medication theft and vulnerability.
Non-Formulary Medications
Issue: Jails follow a formulary and are not required to provide a person who is detained with the
exact psychotropic medications they are prescribed.
Background: Maintaining healthcare costs in jails claims a large portion of the correctional
budget. Correctional facility health care costs continue to rise due to factors including an aging
population, distance from health care providers or facilities, and a high occurrence of mental
illnesses. In order to cut costs, many facilities contract with an external health care company to
control costs. These companies often have extremely limited formularies, or approved drug lists.
A formulary typically contains only the most cost effective version of a medication. Jail
physicians may only prescribe medications from this list, regardless of medications the inmate is
currently taking or may have utilized in the past and changing a person’s psychotropic
medication while they are in jail is simply not a good idea.
In the state of Minnesota, incoming offenders have their current medications switched to
formulary-approved medications by jail physicians. This may appear to be an effective money
saving strategy, but limiting and switching a person’s psychotropic medication is extremely
detrimental to their mental and physical health. If a person gets approval for a non-formulary
medication while in jail, Minnesota has no supplemental protocols in place while waiting for the
medication to be approved. If a non-formulary medication were to be approved, the inmate
would still be temporarily switched to a different medication. Even a short-term change in
medication can cause significant setbacks to a person’s mental health.
Policy Recommendation:
 Pass legislation requiring a county of regional jail to provide a prisoner who has a valid
prescription for a psychotropic medication the same psychotropic medication while
incarcerated. Any medication changes must follow standards of community practice.
Police Body Cameras
Issue: The use of body cameras by police raises privacy concerns for people experiencing a
mental health crisis and imposes a barrier to accessing emergency services.
Background: The use of body cameras by police is increasing in Minnesota and across the
country. Their use is beneficial in terms of transparency and accountability by police. Their use
is problematic in terms of personal privacy. The concern is that recordings of people
experiencing a mental health crisis could become public without the individual’s consent. The
individual could face repercussions that could negatively impact their life. People with mental
illnesses are not the only ones concerned about privacy. A video recording is very different from
a police report and includes images that are more sensitive. People should not feel uncomfortable
calling police or 911 when needed for fear of being videotaped.
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Policy Recommendations:
 Establish clear policies on when cameras can be used and retention periods should be
clear and only tapes that are flagged should be kept.
 Establish disciplinary actions when a police officer fails to record or interferes with a
camera inappropriately.
 Require law enforcement to inform people that an incident involving them has been
recorded and that they have a right to confidentiality and access to the tape.
 Public disclosure of the tapes should only be done with the written consent of the person
especially in situations where there is no indication of police misconduct.
 Redaction of people’s faces should be used when feasible and should be noted.
 The person, their attorney or advocate, should always have access to the recording and be
able to “flag” it just as an officer can. An internal or external investigation can have
access to the tapes.
For more information contact NAMI Minnesota at 651-645-2948 or [email protected] or
the Mental Health Minnesota at 651-493-6634
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