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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." 
Dear Mayor Martin and City Council Members: On behalf of NAMI Ramsey County (National Alliance on Mental Illness), I am contacting you in strong support of your proposed ordinance on flavored tobacco. The NAMI Ramsey board believes that since flavored-tobacco encourages some people to smoke, banning it will help many people, including people with mental illnesses. People with a mental illness have a high rate of smoking and once they begin they have a harder time quitting. According to NAMI, in America, 44.3% of all cigarettes are consumed by individuals who live with mental illnesses and/or substance abuse disorders. People with schizophrenia are three to four times as likely to smoke as the general population. Smoking is known to cause heart disease, stroke and lung disease, among other medical problems. Many antipsychotic medications cause an increased risk of heart disease, so it's important that individuals living with a mental illness quit smoking. Every year, smoking kills about 200,000 people who live with mental illnesses. Also, smoking increases the breakdown of medicines in the body, so smokers often need to take higher doses to get the same results as someone who does not smoke. If a smoker quits, they can usually get the same treatment results from lower doses of psychiatric medications. We recognize that cigarette and tobacco use is a dangerous form of addiction that creates more significant health problems. People with mental illnesses have the right to be smoke free and they must be given the education and support to make healthy choices. This includes not being tempted to begin smoking in the first place through flavored tobacco. Thank you for working on this important ordinance. NAMI Ramsey also sees it as a housing issue. Most apartments are non-smoking, and we don’t want to see people with a mental illness evicted due to smoking in their apartments. Sincerely, Mindy Greiling NAMI Ramsey County President Author: NAMI RAMSEY PRESIDENT MINDY GREILINGWith editing help from the NAMI Ramsey County board. Dear Commissioner Carter: As you know, the COVID-19 pandemic exposed long-standing, significant weaknesses in the emergency and affordable housing available in Ramsey County. On behalf of NAMI Ramsey County (National Alliance on Mental Illness), we implore you to prioritize housing for people living with serious mental illnesses who have long been overrepresented--and frequently overlooked--in populations of those experiencing homelessness. All too often people living with mental illnesses are discharged from in-patient hospital care, sober living, and community care facilities to the street with no housing plan. Added to that, their behaviors, stemming from a mental illness and/or substance abuse, too frequently bar them from available shelters. As our board discussed in a recent letter to you, we urge Ramsey County to opt into the new engagement law allowing mental health workers to work with families on early intervention during the time a person living with a serious mental illness is decompensating. This is crucial to help people from losing their housing, being unnecessarily hospitalized, or worse yet, dispatched through the criminal justice system when medical treatment for a disease of the nervous system is required. Our board would gratefully discuss these and other issues related to mental illness and homelessness with you. We applaud your recent formation of county governance and steering committees to assist you in determining Ramsey County’s affordable housing response, and likewise would appreciate the opportunity to provide input from families and people with lived experiences of mental illnesses. Please share this with the county commissioners and county manager. Sincerely, Mindy Greiling President, NAMI Ramsey County Michele Gran Board Member, NAMI Ramsey County Author: NAMI ramsey board member michele granWith editing help from the NAMI Ramsey board. Dear County Commissioner: As you look ahead to a new year, NAMI Ramsey County (National Alliance on Mental Illness) hopes you are preparing to meet the needs of people with mental illnesses and their families. As you know, the stressors of the COVID-19 pandemic are increasing both the number and severity of mental illnesses for people in Ramsey County, and the M-Health Fairview system is closing the St. Joseph’s emergency room and is likely to close the entire hospital at the end of 2021. This will be a 16% decrease in the number of inpatient psychiatric beds in the metro area. It is crucial for Ramsey County to consider all options to reduce the strain on scarce inpatient psychiatric beds. Toward that end, we urge you to support a promising new law to intervene early and prevent hospitalizations for people with mental illnesses called Services for Engagement in Treatment. NAMI Minnesota joined with other key stakeholders-–including the Association of Minnesota Counties–-to pass this comprehensive update of Minnesota’s civil commitment law, including adding this new option. Services for Engagement in Treatment is voluntary for counties. Each county must opt-in to offer this intervention. We urge you to adopt this new service and prevent the unnecessary hospitalization, incarceration, or commitment of people with serious mental illnesses. This new intervention is designed to voluntarily engage a person in treatment early in the process, when someone is either exhibiting the symptoms of a serious mental illness for the first time or exhibiting the patterns or behaviors that have previously led to hospitalization, incarceration, or a civil commitment. We could give you many examples in Ramsey County where family members are told that they must watch their child or loved one decompensate until they meet the criteria for a civil commitment. Services for Engagement in Treatment is a new law to break this cycle. If Ramsey County opts in, families and others could contact pre-petition screening at the county and ask for help. Engagement services include assertive attempts to engage the individual in mental health treatment, engaging the person’s support network (family) including educating them on available services and suicide prevention, and meeting the person’s immediate needs for food, housing, medication, income, disability verification and treatment for medical conditions. Engagement services must consider a person’s personal preferences and can last for up to 90 days. Engagement services must be person-centered and can be provided to people who are in jail. Services end if the person meets the criteria for civil commitment or if the person agrees to voluntary treatment. The needs of the mental health community are increasing while the number of hospital beds is decreasing. We urge Ramsey County to do whatever it can to divert people from hospitalization. High on that list is offering Services for Engagement in Treatment to better serve people with mental illnesses. Thank you for your time and consideration. Our board would be happy to answer your questions. Sincerely, Mindy Greiling, President Board of Directors NAMI Ramsey County Author: NAMI Ramsey county boardWith guidance from NAMI Minnesota Dear Mayor Roe and City Council Members: On behalf of NAMI Ramsey (National Alliance on Mental Illness), I am contacting you in strong support of your proposed ordinance on flavored tobacco. The NAMI Ramsey board believes that since flavored-tobacco encourages some people to smoke, banning it will help many people, including people with mental illnesses. People with a mental illness have a high rate of smoking and once they begin they have a harder time quitting. According to NAMI, in America, 44.3% of all cigarettes are consumed by individuals who live with mental illnesses and/or substance abuse disorders. People with schizophrenia are three to four times as likely to smoke as the general population. Smoking is known to cause heart disease, stroke and lung disease, among other medical problems. Many antipsychotic medications cause an increased risk of heart disease, so it's important that individuals living with a mental illness quit smoking. Every year, smoking kills about 200,000 people who live with mental illnesses. Also, smoking increases the breakdown of medicines in the body, so smokers often need to take higher doses to get the same results as someone who does not smoke. If a smoker quits, they can usually get the same treatment results from lower doses of psychiatric medications. We recognize that cigarette and tobacco use is a dangerous form of addiction that creates more significant health problems. People with mental illnesses have the right to be smoke free and they must be given the education and support to make healthy choices. This includes not being tempted to begin smoking in the first place through flavored tobacco. Thank you for working on this important ordinance. NAMI Ramsey also sees it as a housing issue. Most apartments are non-smoking, and we don’t want to see people with a mental illness evicted due to smoking in their apartments. Sincerely, Mindy Greiling NAMI Ramsey County President Author: NAMI ramsey president mindy greilingWith editing help from the NAMI Ramsey County board. |
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