It was almost the last topic at the Crow Wing County Board of Commissioners meeting this week, but it was one of the first things that Chairman Paul Thiede wanted to get off his chest.

Thiede took umbrage at a state official's comment disparaging counties for arguably not doing more to take care of those with mental illness and said so at the Tuesday, July 10, meeting.

"I heard the commissioner of (the Minnesota Department of) Human Services Emily Piper make a couple of statements that I think are worth drawing attention to," he said. "One was that when Anoka treats for mental illness, the counties are not taking those people back to their facilities."

What ensued was a spirited discussion at the meeting between Thiede and County Administrator Tim Houle of long-held grievances against the state and the Anoka Metro Regional Treatment Center, which serves those with a mental illness in a campus-based setting.

"As you well know from previously, we were being charged for holding them there. Now, she said this morning we're not taking them. ... I think having the commissioner make that kind of statement to the general public is a bit misleading," Thiede said Tuesday.

"This statement kind of got to me ... because the state is not supporting us to create those facilities, and so therefore she can have the ability to say, 'The counties are not accepting them,' but kind of leave out there hanging the reason why we're not accepting them."

Mental health

Minnesota closed all but two of its large mental health hospitals by 2008. Work started on community-based services in 1976, but in 1987, the Legislature put the responsibility for developing them on the Minnesota Department of Human Services and the counties.

"Previously, it was we wanted them discharged because you were charging us an exorbitant price to keep them when they weren't being treated. Now, you're telling us we don't have the room," he said, exasperated. "Magically, we're supposed to fund the facility to care for them."

The state did not build enough community-based hospitals and chose to underfund the ones it did build, according to Houle.

Houle said of Piper's comments, "I think it is misleading. It certainly conveys that counties are not doing something that they could do."

The board approved at its Jan. 23 meeting 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 irony of this situation is we now get charged by the Anoka (Metro) Regional Treatment Center as soon as they determine that someone's stay there for a medical health crisis is no longer medically necessary," Houle said.

The Anoka Metro Regional Treatment Center is a 110-bed psychiatric hospital, divided into 25-bed units with specialized services that include treatment for those with multiple and complex conditions, mental illness and who face a criminal trial, and high levels of behavioral issues.

"I think the Legislature sort of bought into this mentality that somehow counties were responsible for the fact that patients were not getting out of Anoka ... and that counties needed to be charged in order to provide us with the correct incentive to get those patients out," Houle said.

Essentia Health-St. Joseph's Medical Center in Brainerd 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.

"The irony in my mind in all of this is that the beds that used to be available in the state of Minnesota for someone coming out of the Anoka (Metro) Regional Treatment Center was probably the local regional treatment center that no longer exists," Houle said.

"The state of Minnesota, who used to provide those beds, they close the facilities that had those beds, they have not developed a continuum of care to replace those beds with community-based care," Houle said.

Costly problem

Community Services Director Kara Terry gave the board at its Jan. 23 meeting an example of a county jail inmate booked six times-and civilly committed after the second and sixth booking-to show the financial burden that person placed 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 at the time.

About 1 in 5 adults in America-43.8 million or 18.5 percent-experiences mental illness in a given year, according to the National Alliance on Mental Illness.

"How is it that we are somehow responsible for not getting somebody out of the Anoka (Metro) Regional Treatment Center when the continuum of care for mental health services in the community has not been developed fully by DHS?" Houle asked rhetorically.

"It is sort of like the burglar blaming the homeowner for leaving their door unlocked and saying, 'It's your fault I burglarized.' It's not right, it's misleading, and it does not paint the entire picture."

The Department of Human Services is the state's largest agency, serving more than 1 million people with an annual budget of $16.2 billion and more than 6,000 employees throughout the state-and arguably has the resources to do more about the mentally ill than the county.

"It is not acceptable to say, 'We don't have any place for them to go'-we do. We'll send them back to their homes ... and when they have another acute crisis, law enforcement will get called, and because we don't have any place to put them, we put them in jail," Houle said.

"What we're doing is criminal. This state has to fix this problem with mental health services. ... It's hard to have a partnership with a partner who wants to blame you for a problem that-from my perspective at least-they created."