Plans to cut 200 full-time positions from a mental health direct care program may not adversely affect Hubbard County.
But in going leaner and meaner, the Minnesota Department of Human Services has exposed itself to questions of how a well-intentioned program became mired in bureaucracy, which torpedoed the facilities built to deliver that mental health care.
It all began in 2006, with lofty plans to restructure how mental health services were delivered. Large "institutions of mental disease," because of their funding sources, only took patients older than 65 and under 21 years of age, said Hubbard County Social Services Director Daryl Bessler.
State Operated Services stepped into the breach, building 10 smaller 16-bed psychiatric hospitals across Minnesota that would accept patients of all ages on Medical Assistance and other insurance plans.
Hubbard County patients theoretically would have been referred to the short-term acute care facilities in Wadena or Bemidji, Bessler said.
But the referral process became overly cumbersome, leading emergency room physicians to send patients to Fargo or other facilities outside the SOS system that would readily accept them, Bessler said. It sometimes would take hours to get a patient admitted to one of the community care facilities, Bessler said, while other emergency patients came in needing services - and physicians' attentions.
"Then they don't have to deal with some of the bureaucratic stuff that was going on so you develop referral patterns that, even though it might be closer to put someone in a facility in Wadena or Bemidji, if you can't get 'em in, in a reasonable period of time, you find a place that you can," Bessler said.
Those referral patterns resulted in the new facilities experiencing high vacancy rates as doctors steered clear of them.
"These facilities started out at $850 a day and now we're up to $1,411 in two years, it's gotten expensive because they have to base the cost on their admissions they anticipated," Bessler said. "Since they're not using the facilities at the level that was anticipated the rates keep going up."
Another problem with these Community Behavioral Health Hospitals was that only four of the 10 ever got certified to accept Medicare or Medicaid payments, Bessler said. Bill collection became a problem with the other facilities, he said.
Now those facilities will either be subject to cuts in personnel, because the overstaffing has become expensive, or refocusing their missions, Bessler said.
And that's where the 200 positions and $17 million in cuts to SOS factors in.
Bessler said in the overall plan, it looks like the Bemidji facility likely would accept juvenile admissions "or have some juvenile component."
The plan is to refocus the Wadena facility, too, Bessler believes, but he's not sure how.
"I think we're basically getting leaner and meaner and that's not necessarily a bad thing," he said. "I don't think people will get lost in the cracks. We're attempting to provide a service that everybody thought there was a need for, but for whatever reason, the capacity is not being utilized."
And while 200 jobs sounds like a drastic cut, it includes unfilled positions and some attrition, the state says.
Bessler hopes the plan to redesign mental health services will now be redesigned.
Three facilities will close, in Cold Spring, Eveleth and Mankato.
"I think they're going to try to work more locally with community and provide user resources to team up with, help partner with and collaborate with people to better serve people," Bessler said. "That's one of the themes I've read in materials of the state."