Human services leaders say Minnesota is in a mental-health crisis, complicating efforts to manage behavioral health facilities.

Closure plans for certain locations have been avoided, but staff want comprehensive improvements to the care system.

The Department of Human Services recently floated plans to close two addiction treatment centers, and repurpose one of them for more patients with serious mental-health needs.

New funding will keep one building open, but the other will still be revamped for patients who are there by court order.

Lynn Butcher, who works for one of the DHS programs as a quality officer for forensic mental health services out of St. Peter, said she feels there are solutions that aren't being emphasized.

"What's happening right now is, people are not getting an early intervention," said Butcher, "they're not getting the support that they need, and they end up into our jail system."

She said those patient needs are putting more pressure on the broader system, creating these facility debates, along with safety and quality of care concerns for staff.

Butcher said bolstering early intervention programs, such as school counseling, could help.

DHS officials say they understand these concerns, but must to respond to an urgent need with limited options.

Butcher, who is also a member of the Minnesota Association of Professional Employees, said she worries about worsening staff turnover if some workers are shifted from their current roles.

"People go into this work because it's the work they want to do," said Butcher. "And it's one thing to provide substance use treatment to folks who need it - it's another to, you know, work with mentally ill and dangerous people."

The department describes the current approach as a short-term solution to a long-term problem, noting the Legislature is calling on the agency to explore how it can strengthen addiction care down the road.

A report is due by mid-January of next year.

It's been about a year since the official end of the COVID public health emergency - which has led to a significant drop in Medicaid enrollments and a rise in uninsured individuals in Colorado.

This poses challenges for community mental health centers, like the Jefferson Center for Mental Health, where the rate of Medicaid enrollee decline has surpassed earlier predictions. It has remained below pre-pandemic levels since January.

Dr. Kiara Kuenzler, president and CEO of the Jefferson Center for Mental Health, said it's now facing a daunting $6 million shortfall.

"The people that we're serving are just in extreme stress, struggling to deal with regaining health-care benefits. That impacts not only their access to behavioral health care, but all of their health-care needs," she said.

The nonprofit KFF recognizes the need for behavioral health at an all-time high in its 2023 Colorado fact sheet - identifying more people than ever reporting mental health and substance use challenges.

Kara Johnson-Hufford, Colorado Behavioral Health Care Council CEO, emphasized the urgent need for support for these clinics. She noted a projected shortfall of $24 million to $29 million for these centers overall could mean a risk of reduced services, longer wait times and compromised care.

She added many individuals who have lost Medicaid coverage and now have private insurance are also seeking treatment less frequently - or discontinuing it altogether - due to co-pays and deductibles.

"More people than ever are now going without insurance. No longer qualifying for Medicaid, but cannot afford private insurance - or they may be giving up on Medicaid altogether because of the emotional toll of the enrollment process just being too great," she continued.

Johnson-Hufford predicted if reimbursement mechanisms don't keep pace with the need, programs will close. Despite efforts to address the issue, such as helplines and complaint processes, she said the gap in funding remains a critical concern.

By Mara O'Malley for Kent State News Lab.
Broadcast version by Farah Siddiqi reporting for the Kent State-Ohio News Connection Collaboration.

According to the Ohio Department of Aging's Summary Assessment of Older Adults, deaths by suicide among adults ages 60 and older have increased by 40% in the last decade.

The spike is particularly concentrated among men aged 85 and older. At this point, the suicide rate of Ohio men age 85 and older is four times higher than the nation's overall suicide rate.

The Ohio Department of Aging has found that adults ages 60 and over have high rates of depression. Coleman Health Services, a nonprofit that provides behavioral and mental health services in 10 Ohio counties, works with some of those patients.

"It's an illness. it can be effectively treated," said Brian Welsh, chief medical officer at Coleman Health Services. "When you can't live your life they way you need to live it - because you don't get out of bed, you can't face the day and you withdraw from others or you have suicidal thoughts and you're hopeless - then you're not living the life where you need to."

Depression can be particularly hard on older adults who have experienced loss, Welsh said.

"As you get older, you start having more and more losses. Losses can be physical losses or social losses," Welsh said. "Along with that comes the physical issues that sometimes happen with decline, which could include things like mobility, arthritis, having increased issues with pain."

Coleman Health Services is also working to include more accessible services for the older population in case mobility issues are causing them to not come and seek help.

Last year, three older adults died by suicide in Portage County, said Karyn Kravetz, the associate director of the Portage County Mental Health and Recovery Board. In general, Kravetz said, they faced health challenges or chronic illnesses.

Beyond that, more than half of gun-related deaths in the U.S. are deaths by suicide, according to a Pew Research Center analysis of data from the Centers for Disease Control.

"Our last survey shows that 48% of the people in Portage County own firearms," Kravetz said. "When you have firearms in your home and you have access to lethal means, that can make that impulsive decision happen a lot faster."

The Mental Health and Recovery Board now offers a training every few weeks about signs of suicidal ideation.

"We're trying to up our suicide prevention training, to reach out to the different community groups," said Kravetz. She hopes that the more people they can train, the more people will be able to respond to those signs.

The Ohio Department of Aging worked with the Health Policy Institute of Ohio to assess the causes of the 40% spike in suicide rates among people 60 and older. The key challenges they noted were the conditions in which people live and the access they have to important resources around them.

Improving the mental health and well-being of older Ohioans requires a multifaceted approach. Older adults are also at risk of scams and elder abuse, may experience social isolation and may be vulnerable to disorders like hoarding.

Older adults sometimes feel a bond with someone who is trying to scam them and they fall into the trap due to loneliness, explained Richard Meeker, a therapist who works with Area Agency on Aging District 5. If someone calls them claiming to be from the IRS and demanding bank information, older adults may experience anxiety or panic and immediately answer instead of taking a second to consider who may be on the other end.

"We're seeing a lot of scams now being perpetrated on an emotional level with individuals," Meeker said."I talked about social isolation - if I've lost a spouse, I don't have a lot of contact with family, maybe, or friends, I'm becoming more withdrawn, I have a craving for human attention, I have someone that has shown an interest."

Empowering older adults and giving them some control back over their life is one of the most important things we can do, Meeker said. Area Agency on Aging helps to do that by providing its clients with transportation, helping them get caregivers, and getting them to come out of the house.

"We change all the time in life as decades continue to go by," Meeker said. "But one of the things that can be really impressive is, with older adults, they have the ability to adapt, to be able to overcome things. And through that adaptation they can be empowered."


Mara O'Malley wrote this article for Kent State News Lab. This collaboration is produced in association with Media in the Public Interest and funded in part by the George Gund Foundation.


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Children's advocates are pressing California lawmakers to pass a bill that would increase oversight on health plans when they deny mental health services for children. Right now, parents have to ask their health plan for a review when a child's mental health condition isn't covered by their insurance - and if service is still denied, they can ask the state for an independent medical review.

Lishaun Francis, senior director of behavioral health with the nonprofit Children Now, a sponsor of the bill, said this is a critical issue.

"This bill says if plans deny care for a Youth Mental Health Service, they have to automatically review that denial, as opposed to a parent calling and asking them to take a second look. If it is an emergency service, that review goes to the state automatically," she explained.

The California Association of Health Plans opposes the bill, arguing that the extra reviews could delay care and build more unnecessary costs into the health care system. Case stories posted on the state's Department of Managed Health Care website suggest the types of services most commonly denied by health plans include residential mental health treatment, and medication or surgery for gender dysmorphia.

Francis said when parents escalate their fight to an independent medical review, they often win.

"Almost 70% of all claims that make it to the state get overturned by the independent medical review process, which tells us a big chunk of this is something that health plans should actually be covering," she said.

Senate Bill 294 would also require the state to make public the number of independent medical review claims they receive each year, and how they were resolved. The bill has already passed the state Senate, and is now before the Assembly Committee on Health.