The self-medicator. The ER prisoner. The drug addict.
Courtney Lawson waited a full decade before seeking confirmation of being bipolar. After years of self medication via alcohol and a serious bout of depression, being diagnosed with a mental illness left her “terrified” due to existing stigmas.
Nils Peterson spent nearly three weeks in the emergency room at Saint Marys Hospital this summer during a psychotic breakdown. The 47-year-old Rochester man was found walking downtown by Rochester police after going off his meds and being reported missing, but the experience at Mayo Clinic left him angry and upset. He’s the latest to get caught up in a numbers game — an extreme shortage of psych beds across the state — that often leaves mental health patients without proper care during their time of need.
Tiffany Hunsley recently won two national awards for her advocacy and dedication to the mental health field. The 47-year-old Rochester woman overcame two decades of addiction — with five felonies, including manufacturing meth — to become the founder and director of Rochester’s Recovery Is Happening nonprofit organization in 2011.
All three are at various points of recovery, but each has experienced different problems with Minnesota’s mental health care. It’s become a familiar, frustrating refrain for thousands across the state as the once taboo topic has become a crisis.
“Until we’re seen as a constituency of consequence at a policy level and things start to change there, we won’t be heard,” Hunsley said.
Help is coming, if not quite soon enough for Peterson.
The Minnesota Legislature approved a record $46 million in new funding to support mental health initiatives during the 2015 session. That includes new programs co-sponsored by Sen. Carla Nelson, R-Rochester, with her Excellence in Mental Health bill.
Gov. Mark Dayton also appointed a Mental Health Task Force this spring in hopes of creating a comprehensive program that takes advantage of the state’s strong health care network. Mayo Clinic’s Bruce Sutor is among those involved in the potential overhaul, with one of the eight meetings being held next month in Rochester. Final recommendations are expected in November, at which point the Legislature will consider its options.
While Nelson bristled at Hunsley’s characterization, the Republican can’t help but applaud those who have stepped forward to put a face on a critical issue.
“I am so thankful and applaud those courageous individuals who have walked this path themselves, often overcoming barriers, and are now speaking out themselves,” Nelson said. “It’s a big problem. Big problems demand broad and bold solutions. Our system is lagging, and we need to catch up.”
Sutor: We don’t have the resources
While Dr. Sutor sympathizes with Peterson’s situation, he warns it’s become the unfortunate reality. In fact, Peterson’s 20-day stay in the local ER for mental health issues isn’t even close to the longest in Mayo Clinic history. That would be about 100 days, Sutor said.
Sutor said the lack of psychiatric beds is more complicated than it sounds, noting Mayo Clinic can’t simply “build our way out of this problem.” The problem has been compounded by the lack of appropriate housing for mental health patients to transition away from hospital care after they’ve become stable.
In fact, a study commissioned by the Minnesota Hospital Association released last month says 19 percent of psychiatric bed stays across 20 Minnesota hospitals were deemed “avoidable” had other housing been available. That equates to 48,000 days per year or 132 per day, according to the Wilder Foundation, the St. Paul-based organization that conducted the study.
While those stable patients are unnecessarily held, Sutor says up to 100 mental health patients across the state are awaiting psychiatric care in the ER. The waiting list dictates the next in line gets sent to the next available bed — even if that means traveling from the Iron Range to Rochester, hundreds of miles from friends and family. Processing delays also slow the system.
Peterson equates his extended ER visit to “being in a jail cell.”
“What happened was really bad, and it really needs to be fixed,” said Peterson, a former nurse who has been committed 12 times in his 22-year struggle with mental illness. “I can tell you from a patient’s perspective, the system is broken.”
Sutor and the 18-person task force have been charged with creating a statewide plan to address what’s become a mental health crisis.
“Imagine you have a 15-year-old kid you’re concerned about and you find out they have a bed four days later in Duluth,” Sutor said. “What are parents supposed to do with that? This is happening statewide.
“I would bet at any given time there would be 30, 50 or even triple digits in hospital beds around the state waiting for a psychiatric bed. If we had the infrastructure in the communities, if we had access to appropriate housing, if we had more prescribers … but we don’t. All of these factors have come together that have really strained our system.”
Those delays can prove deadly. Though Peterson quickly stabilized while back on his regular medication, he remained hospitalized for 20 days before a psychiatric bed became available at a facility in St. Peter.
Others aren’t always so lucky, Hunsley said, noting the limited “window of opportunity” available for some patients.
“They’re ready for help now, not in two to six weeks,” Hunsley said. “Then we read about them as a heroin overdose in the newspaper.”
‘I was terrified’
Lawson’s diagnosis with bipolar disorder was a life-changing experience that ultimately paved the way for her to become the executive director of Rochester’s National Alliance on Mental Illness, or NAMI.
After a full decade of navigating through debilitating panic attacks, skipping work to self-medicate with alcohol and, eventually, a serious case of depression, she finally sought help for her mental health. The diagnosis of bipolar started her road to recovery.
Her background in mental health made the long wait especially frustrating, in part because her reluctance to seek help sooner was caused by the damaging stigma surrounding mental health conditions.
“I was terrified,” Lawson said of first being diagnosed. “I thought I would be put in a straitjacket, whisked out of the doctor’s office and put in an institution and never heard from again. This is what I thought … and I had a background in public health. It was really a frightening experience — and that’s obviously not what happened — but it was about a year before I started feeling stabilized. At least I’m on this journey to recovery.”
The rocky start to Lawson’s journey prompted her to join NAMI as a volunteer in 2010. She ascended to the leadership position two years later and has spent the last four years sharing her story. She hopes her experience can help educate and bring awareness to an underserved population that’s faced difficulty being seen and heard.
More than 200,000 adults and 75,000 children in Minnesota live with mental illness, according to the latest numbers from the Minnesota Department of Health. Similar to Lawson, the average person waits 10 years before seeking treatment after the first symptoms emerge.
Many will celebrate September as National Recovery Month while one in five people across the country suffer from mental illness. Up to 90 percent of those who seek treatment report “significant reduction of symptoms and improved quality of life,” according to Minnesota Department of Human Services.
Those numbers prompted DHS Commissioner Emily Piper to call this a “critical moment for our health care system in Minnesota” in response to Gov. Dayton creating the mental health task force in April.
“Too many Minnesotans are going far too long without accessing the mental health care they need,” Gov. Dayton said.
“Those denials damage their overall health, their job opportunities and their access to safe, affordable housing. This task force will provide the expertise and leadership necessary to address these serious challenges statewide. I look forward to receiving and acting upon their recommendations.”
Mayo Clinic, Olmsted Medical Center and Olmsted County Public Health pooled their resources in 2013 to conduct the first community needs assessment, which identified mental health as one of five local health priorities. That led to local law enforcement receiving additional training as part of the crisis intervention team.
Results from the second needs assessment are due for release next month, as part of the three-year cycle. Mental health is expected to remain a top priority.
“It’s really helped elevate (mental health) to the point where people see this as being important,” Lawson said of the local collaboration.
“Nobody has the magic bullet”
Rep. Tina Liebling, D-Rochester, is intimately familiar with the ongoing challenges in the mental health community, but she’s among those frustrated by the state’s inability to tackle what she describes as “a complex problem.”
She’s served as chair of the Health and Human Services Policy Committee, while also joining the Zumbro Valley Health Center Board of Directors in 2013; the Rochester-based program dropped “mental” from its official name in 2014 as a way to become more inclusive.
Liebling will be among those monitoring Gov. Dayton’s task force closely in hopes the ideas that emerge can be implemented promptly. She recognizes the lack of hospital beds being an issue but contends that increased resources would reduce those needs by “preventing the critically ill from getting to that point.”
She also drew a parallel of the mental health crisis to the state’s rising suicide rate, which the Minnesota Department of Health says reached a record high in 2015. Minnesota’s suicide rate hit 13.1 per 100,000 residents, reflecting a 6 percent increase from 2014. The suicide rate was just 8.6 in 2000.
Liebling expressed concern that untreated mental health issues are being compounded by drug and alcohol abuse, often as a coping mechanism.
“Policymakers are very concerned about these issues,” Liebling said. “The problem is it’s not like someone has the answer. These are very complex issues and what works for someone doesn’t work for someone else. Nobody has the magic bullet.”
Liebling actually took that metaphor one step further, pushing for more gun control as a way to curb suicide rates. MDH noted in its recent report that self-inflicted gunshot wounds were the most common method of suicide in 2015.
A new Mayo Clinic study, released just this week, may have confirmed Liebling’s fears.
Mayo Clinic psychiatrist J. Michael Bostwick published a study in the American Journal of Psychiatry that shows the fatality rate of first-time suicide attempts is 60 percent, which is significantly higher than the previously reported rate of about 37 percent.
Those results were derived from studying attempted suicides in Olmsted County from 1986 to 2007 involving 555 males and 935 females, as tracked by the Rochester Epidemiology Project. The use of firearms was determined to be the root cause of the 60 percent increase.
“A large part of the reason that such a high proportion of the total suicides occurred on first attempt can be attributed to firearm usage,” Dr. Bostwick said. “The results show that it is 140 times more likely for firearms to cause suicide, compared to all other methods. That means nearly three-fourths of all deaths at first suicide attempt were caused by using firearms. This shows that guns are, unfortunately, but not surprisingly, remarkably effective.”
Dr. Bostwick’s research concludes immediate psychiatric care is required after suicide attempts, and the first year following such an attempt represents “a critical window” for care.
Minnesota’s current system can make that difficult, Liebling said.
“Funding is just a part of it,” Liebling said. “What we need to do is find a system that’s a lot more seamless. What we’re hearing now is that the system isn’t broken because we don’t even have a system. We really need to address that.”
While Liebling admits to being “really anxious” to see what solutions Gov. Dayton’s task force proposes, these could be life-or-death situations for many across the state. After navigating through the state’s disjointed system, Lawson, Hunsley and Peterson are among those with first-hand experience who are demanding reform.
“We are ensuring that people with mental illness have a voice at the table when policy decisions are being made,” Lawson said.