The costs of dealing with Crow Wing County Jail inmates with mental health challenges, as state-funded treatment options become limited, were on the minds of county commissioners Tuesday.

"We used to have a state hospital, and you could place people at that state hospital for a variety of mental health concerns," Tim Houle, county administrator, told the board. "The state decided that they wanted to go to what is termed a more 'community-based model of care.'

"What we have now locally is the Community Behavioral Health Hospital, and it has about 16 beds. Now, I don't know know how many beds the state hospital had, but I'm quite confident in telling you it was significantly higher than 16 beds."

The state of Minnesota closed state hospitals and replaced them with smaller, community-based hospitals like the one in Baxter, but arguably did not build enough community-based hospitals and chose to underfund the ones it did build, according to Houle.

"As you know, in Minnesota, the behavioral health system is strained. ... The shortage of inpatient beds has had a significant impact on our jails and emergency rooms," Community Services Director Kara Terry told the board.

Houle said, "Because they are not getting treated for their mental health problems-big surprise-they may act out in ways that society defines as 'criminal behavior' and so they end up in jail. ... Essentially, we're criminalizing mental health."

Essentia Health-St. Joseph's Medical Center admits only voluntary patients into its Grace Unit for mental health care as of September. Essentia Health officials noted the facility is not designed nor staffed to care for involuntary patients, some of whom pose a danger to others.

"As noted in the Governor's Taskforce on Mental Health, the behavioral health continuum of care has never been fully developed, even when promising to do so, while closing facilities in our area," Terry said.

The board unanimously approved Tuesday an Association of Minnesota Counties mental health bonding resolution supporting state capital investments for regional behavioral health crisis program facilities and permanent supportive housing for those with behavioral health needs.

The resolution passed requests the county's support of the association's efforts in lobbying the state to loosen its purse strings to allow better treatment options of the mentally ill.

"We are not here today to blame or say that individuals are 'bad' with mental health crises," Terry said. "What we are here to say is that there is a lack of quality services to be able to provide for these folks with mental health crises."

Rather than booking people for alleged crimes, sending them to detox or admitting them to a hospital, the county also now considers assessment or triaging cases to determine if crisis services and intensive residential or mental health treatment, for example, would be better.

"Due to the shortage of acute psychiatric beds, clients must wait in jail or emergency departments until they can access a higher level of care," Terry said. "People are stuck when no services are available, or they are in the wrong type of care, which further affects the progress in treatment and recovery."

Jail staff are not trained to provide mental health treatment services and emergency departments do not have space or services to house people long term, according to Terry.

"Not only did we talk about the issues, but we also came up with three recommendations around those issues. The first one is to get some training, funding for the folks in our jail to be able to better respond to mental health consumers in the jail," Terry said.

"The second one is around providing adequate funding for the development of community-based residential alternatives to the jail for the treatment of those with serious mental health issues ... and the third is to restore state funding for county costs of treatment."

The impact of the cost shift at the Anoka Regional Treatment Center and community behavioral health centers has put an increased financial burden on counties and the funds have been allocated to the state general fund instead of the mental health needs of communities.

In 2015, the Legislature approved a cost shift that made county governments 100 percent responsible for a cost once shared with the state. That cost is derived from the care for patients at the Anoka facility who no longer meet medical criteria for facility-level care.

"The gaps in Minnesota's mental health system are not only damaging to the individuals and their families, but also result in an inefficient use of taxpayer dollars," Terry said, with Lt. Troy Schilling of the county sheriff's jail operations by her side.

"What tends to happen is they go to court and then they continue (the case) onto a different day," Schilling said of inmates facing mental health issues. "They don't have everything together because a lot of the testing takes time to schedule, to find the right professional to come in to do the testing."

Terry gave the board an example of a jail inmate booked six times-and civilly committed after the second and sixth booking-to show the financial burden the person places on the county.

"Between the state-operated services, the social services cost, the county attorney's cost and the jail costs, we estimated that the total costs would be $223,593 for this one individual. ... That's a pretty significant cost to the county and to the taxpayers," Terry said.

"Minnesota has an opportunity to improve its mental health system through permanent supportive housing and regional behavioral health crisis program facilities."