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6/9/2022 Report: NAMI Ramsey County Listening Session on Accessing Mental Health Services in Ramsey CountyRead Now May 2022 Greetings! On behalf of the National Alliance on Mental Illness (NAMI) Ramsey County, I am pleased to present this report which summarizes the findings and recommendations from our Listening Session on Accessing Mental Health Services in Ramsey County. Our report is intended to be a springboard for discussion and action to improve access to vital mental health services for those with serious mental illnesses. With timely, effective treatment and supports, we know that they can lead productive and meaningful lives. We have heard from those experiencing mental illnesses and their family members that Ramsey County must improve its services to those most in need in order to promote recovery; assist with employment; and prevent crises, homelessness, and incarceration. We have also heard that programs need to include family members as supportive partners. We highly recommend the development of an accredited clubhouse in Ramsey County through Clubhouse International. This will require partnership and investment by the public, private and nonprofit sectors. We look forward to working with county commissioners, officials, advocates, foundations, mental health professionals, people living with mental illnesses and other stakeholders to lay the groundwork for this successful model that is found in over 300 communities in 30 countries around the world. I would like to thank the following individuals who contributed to our February 10, 2022 Listening Session and to this report:
NAMI Ramsey County supports, educates and advocates for those in our community living with mental illnesses as well as for their family and friends. Please join us and help make a difference. For more information, visit: https://www.namiramseycounty.org/ Sincerely, Mindy Greiling, President NAMI Ramsey County NAMI Ramsey County Report from Listening Session on Accessing Ramsey County Mental Health Services May 2022 PURPOSE In an effort to better understand the accessibility of Ramsey County Mental Health Services, NAMI Ramsey County (National Alliance on Mental Illness) held a listening session on February 10, 2022 for people who have experience accessing such services. The goal was to gather information regarding the effectiveness as well as current shortcomings of this system through first hand accounts from clients and family caregivers. Forty two individuals attended the program. NAMI Ramsey County is sharing this summary of our findings and recommendations with county commissioners, pertinent county administrators, lawmakers, and other stakeholders in the hope that the personal stories will inform future decisions to improve mental health service accessibility – particularly for those who need it most. OVERVIEW NAMI Ramsey County planned and co-hosted the Zoom session with the Ramsey County Adult Mental Health Advisory Council. Sophia Thompson, Director of Mental Health and Adult Support for Ramsey County, presented a 30-minute description of Ramsey County Mental Health Supports and Services, which included demographic information on clients served. She also provided specific data on four programs: mental health courts, adult targeted case management (TCM), crisis teams and the new voluntary engagement program (designed in Minnesota statute to help avoid the need for civil commitment by engaging proposed patients voluntarily in needed treatment). Ramsey County is currently serving 20 individuals in mental health court and their grant allows for 40 people. The graduation rate is 45 percent. The voluntary engagement program designed to address the pressing need to help individuals who have anosognosia so do not recognize their illness is currently limited to 15 individuals. Following Ms. Thompson’s presentation, the 40 minute listening session began, moderated by NAMI Ramsey County members Kayla Murphy and Marly Yang. In total, during and after the listening session, thirteen people shared their stories.
KEY FINDINGS Ramsey County Mental Health Services fall short in serving those most in need, people with serious and persistent mental illnesses (SPMI). Those diagnosed with illnesses including schizophrenia, bipolar disorder, schizoaffective disorder and other mood disorders have the greatest need. They often have an accompanying chemical dependency dual diagnosis. Accessing available resources is hindered greatly by: bureaucratic red tape; lack of effective and preventative wraparound services; anosognosia (lack of insight, which means the ill person cannot request services themselves or many times even accept them) and navigating the criminal justice and/or civil commitment court system. In addition to those qualifying for civil commitments, many others never reach the level for civil commitment, but nonetheless have many unaddressed, urgent needs. While their situations are extremely complicated, efforts should be made to streamline and simplify the process to access services. Ramsey County espouses the availability of such services, but major roadblocks exist. Additionally, classic hallmarks of certain severe mental illnesses prevent access. The revolving door of crisis/hospitalization/restabilization for this population is unhealthy, expensive, and far less effective than establishing proactive mental health supports and wraparound services up front. The difficulty in getting help before, during and after a crisis was a common thread throughout the testimonies. Services for voluntary clients seem adequate. However, the extreme challenges discussed below exist for those with diagnoses that often include anosognosia. Seven of the eight family stories below are shockingly similar and heart-wrenching. This report highlights major service shortcomings for those most in need:
The report calls for recommended improvements for consideration and action by Ramsey County Commissioners and county agency officials in partnership with foundations, hospitals and mental health providers, those living with mental illnesses and their family members as well as other stakeholders. NAMI Ramsey County highly recommends that Ramsey County establish a local clubhouse through Clubhouse International. Through over 300 local Clubhouses in more than 30 countries around the world, Clubhouse International offers people living with mental illness opportunities for friendship, employment, housing, education and access to medical and psychiatric services in a single caring and safe environment. This social and economic inclusion reverses the alarming trends of higher suicide, hospitalization and incarceration rates associated with mental illness. MAJOR SHORTCOMINGS 1. Accessibility for Involuntary Clients Ramsey County must recognize, appreciate, address and prioritize the needs of those experiencing anosognosia and those with the most serious and persistent mental illnesses (SPMI), who, by nature of their illness, cannot recognize they are ill and consequently cannot voluntarily seek services. Anecdotal Listening Session Feedback:
2. Civil Commitment and Outpatient Treatment Civil Commitment is difficult to obtain. Those without strong family support to help navigate the complicated system will not obtain commitment and will likely be homeless. If/when commitment is finally achieved, the patient has already demonstrated substantial need and now deserves stabilization support, sustained and adequate wraparound services, and appropriate housing. Anecdotal Listening Session Feedback:
3. Cycle of Crime/Incarceration/ Mental Health Court Anecdotal Listening Session Feedback:
4. System Navigation/Paperwork Difficulty for People with SPMI Anecdotal Listening Session Feedback:
5. Lack of Wraparound Services SPMI patients require a much higher case management approach than those with less severe mental illnesses. As such, they require improved and more frequent case management. This management should include a comprehensive and sustained plan which coordinates all aspects of the case and patient needs - past, present and future anticipated needs. Anecdotal Listening Session Feedback: Targeted Case Management (TCM)
Homelessness/Housing Lack of supportive housing options is a fundamental problem.
Employment Employment services are sorely lacking for SPMI.
Other Support Service Needs
6. Emergency Services While families generally appreciated the emergency services, they expressed frustration in the following areas: Crisis Teams Anecdotal Listening Session Feedback:
Law Enforcement
Hospital Beds
7. What Happens When There is No Family to Do Everything? Parents expressed grave concern over who will care for their loved ones after they are gone. The system needs to provide a much, much higher level of care, care coordination and proactive wraparound services for those most vulnerable, specifically, those with an SPMI diagnosis or those on the path to such a diagnosis. There is also concern for such patients who currently lack supportive families. Who is caring for them? Worry about future care for their loved ones with SPMI by aging/dying parents Anecdotal Listening Session Feedback:
8. Lack of Clubhouse Model Not having a Clubhouse is a huge hole in Ramsey County’s service model. Anecdotal Listening Session Feedback:
RECOMMENDATIONS NAMI Ramsey County calls for a collaborative approach to “think outside the box” and effectively address these shortcomings by taking the following action steps:
About NAMI Ramsey County Governed by a voluntary board, NAMI Ramsey County supports, educates and advocates for those in our community who live with mental illnesses as well as for their families and friends. We are an affiliate of NAMI Minnesota and national NAMI. We are committed to diversity, equity and inclusion. For more information, visit www.namiramseycounty.org Correction 6/23/22: We updated the post to fix our mistake of listing that Ramsey County Voluntary Engagement is limited to 9 days. It now reads "up to 90 days of service." 
 NAMI Ramsey County NAMIWalks team, 2021 NAMI Ramsey County President’s Annual Meeting Report for June 2021-May 2022 Accomplishments (Fiscal Year 2021) 1. Programs:
2. Action:
3. Organization:
 Photo by Christa Rittberg In the book, It’s Kind Of A Funny Story by Ned Vizzini, the protagonist Craig went through a bout of depression. While in the hospital, he discovers that he has tentacles and anchors. His tentacles are the things that bring him down, and the anchors are a solid force in his life. Some of the tentacles are his friends and his high school, and his anchors are his family and his art. Craig worked hard to get into a high school, but after he got in, he realized the work load was too much. After the hospital, Craig decided to attend another high school. In the discussion, we discussed the stress that Craig put himself under while attending the pre-executive high school. One of our book club attendees talked about how high school is a place where people tend to not leave unless something bad happens. Craig had a friend named Nia, who was dating his best friend. The book club discussed that she had positive and negative qualities. She was on medication and helped Craig not feel alone, but she also tried to use Craig. In the book, Craig got numbers from people in the hospital, and the group talked about how he was put into an adult ward because the adolescent unit was being renovated. The book club talked about how the adults in the unit were positive influences, and Craig may have struggled in a teen unit. The club thought that the catalyst for his change was making art. In the story, Craig created art for other patients, and he found a purpose for his life. A member of our discussion group thought the book was a good description of depression, and people who hadn’t had the struggle would understand it better.
 Photo by Christa Rittberg This month in April of 2022, the book club discussed a book called Fix What You Can, by Mindy Greiling. The memoir explored a mother and father going to battle for their son. In the book, there were topics of lack of help for the younger person living with a mental illness who hadn’t committed a crime and didn’t want help. There were also issues from medication changes to legal issues and drug use due to a mental illness. Mindy Greiling was with us at the session. She discussed her writing process and what it took to write the story. She wrote about her son Jim in the book. Mindy said, “Writing is a release.” The story surrounds her son dealing with the struggles of having his life turned upside down from hearing voices and dealing with appointments, different medications and their side effects, and law enforcement. Mindy said, "its hard to get help for someone unless they are breaking the law or older." With her son, Jim, being young, it was hard to get him help. In the book, Jim dealt with bad relationships, and it is common in the lives of people living with mental illnesses to be taken advantage of and being vulnerable. The media associates people with mental illnesses as perpetrators. Members of the discussion discussed trials with mental illnesses and hospitals. One of the discussion participants identified with Jim and is going to have his mother read the book to help her deal with her isolation. Mindy discussed how her son was sent to mental illness court because he caused damage at a hospital. Mindy’s son was charged with damage at a hospital without his knowing it. The final discussion topic was that of teenagers with mental illnesses getting the help that they need. A mother of a fifteen-year-old was in the group. He is on medication, which to her is bitter-sweet. Bitter, because he needs medication, but sweet because he may get used to asking for help when he isn’t living in the home anymore. Please join us for the next NAMI Ramsey Book Club! Find more information at https://www.namiramseycounty.org/bookclub.html
 Photo by Christa Rittberg This month, the Book Club read Dr. Birds Advice for Sad Poets by Evan Roskos. In this book, James Whitman finds himself overcome with suicidal ideation, anxiety, depression, mania, and family issues such as abuse and his sister’s self-injurious behavior. The book is written for older teens, and it poses questions such as if you feel yourself struggling, would you feel comfortable reaching out? In the book club discussion, there was talk about how the teens were seen as more resourceful than the adults, as James was able to find therapy on his own to deal with the issues he was experiencing. James also found himself in an investigation about his sister Jorie’s expulsion from school. You could see James’s getting stronger and more vocal as the story went on. James finds inspiration from Walt Whitman, and sometimes uses the famous author's writing to sum up his own thoughts, such as, Dazzling and tremendous how quick the sun-rise Would kill me If I could not now and always send sun-rise out of Me Please join us for the next NAMI Ramsey Book Club! Find more information at https://www.namiramseycounty.org/bookclub.html
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