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Robertson asks county board to explore more options for mentally ill

"Justice for all" are the last three words spoken in the pledge of allegiance to the Stars and Stripes.

Judge Sally Ireland Robertson spoke those words twice last week at a meeting of the Wadena County Board of Commissioners. The first time in unison with others as the meeting began. The second time to make a point about an injustice in Wadena County and in other Minnesota counties.

Robertson, who retired last Thursday after a 22-year career as a district judge, detailed a jailed individual's recent ordeal inside the confines of the Wadena County Jail. Suffering from severe mental illness and without medication, the person resorted to bizarre behavior.

"We had a person sitting in our jail for over a week before that person could be placed and prior to that, with our knowledge, he was in the Hubbard County Jail," Robertson told the board.

The person was placed in the Wadena County Jail on a non-criminal matter by order of the court. Robertson told the board no planning was done for his placement when he was released from the Hubbard County Jail and no planning could be finished during the week he was in Wadena.

Robertson pointed out that state statute requires all counties to have a contract with a mental care provider. While Clay, Becker and Otter Tail Counties are known to have these contracts, the only arrangement she was aware Wadena County had was one with Safe Harbor in Brainerd - a facility that cared for people suffering from depression and other non-acute mental illnesses.

The person's extended detention in the Wadena County jail was considered necessary because freeing him would be dangerous for him and for others. Other Minnesota counties have been known to put the mentally ill out on the street after the 24-hour period.

Wadena County Human Services director Tanya Leskey said the 24-hour rule is only supposed to be used as a last resort. She added that after a county has someone confined for more than 24 hours, the county is legally liable.

County Attorney Kyra Ladd also weighed in on the discussion.

"There are two issues here," Wadena County Attorney Kyra Ladd told the board. Ladd said one issue is what to do with the individual between the time they are identified as someone in crisis and the time they can be committed.

"We need to put them somewhere," Ladd said.

The other issue, in Ladd's opinion, is the bed space.

"No one seems to be having trouble on the detain orders, where kind of the resounding problem seems to come in is when they are committed. Finding that bed space seems to be the larger issue," Ladd said.

Good intentions are not hard to find when it comes to helping the mentally ill but Ladd has her own ideas about a solution and offered them Monday in an interview with the Pioneer Journal.

"Ultimately, it boils down to money," Ladd said.

The Wadena County Sheriff's Office is also interested in finding solutions. Chief Deputy Joe Schoon said Monday that he believes it is more than a county or state problem. After closing big treatment facilities in cities like Fergus Falls and Brainerd in favor of smaller, more accessible facilities, the state, and even the nation, has found itself with a huge headache.

"It's a national problem," Schoon said. "It seems like the system is broken. They can't get the help they need."

Leskey pointed out that Wadena County had contracts with Sanford and Prairie St. John in Fargo. While she did not disagree with Robertson that a problem exists, she said contracts do not guarantee a mentally ill person being held by a county will be accepted into a care facility.

Leskey said these providers have "loopholes" which allow them to legally refuse service to counties wishing to commit the mentally ill.

"Facilities still have the right to refuse admission based on their licensing requirements and if they have beds," Leskey said.

The state has been working on this problem since 2016 when the Governor's Task Force on Mental Health was formed. Leskey said it is well recognized there is a shortage of inpatient psychiatric care.

"There is a lot of red tape to get through sometimes to get people to the right provider and there are a lot of complicating factors," Leskey said.

Robertson found she was not alone in her frustration.

"In reference to the situation Judge Robertson brought up, my agency actually had made 32 different contacts trying to find admission," Leskey said. "I think there is a lot of advocation that could be done around legal statuses because there is a difference between availability of placement based on a person's legal status. That is another limitation, a person's legal status."

Tri-County Health Care Chief Administrator Joel Beiswenger was invited to attend the board meeting by Board Chairman Sheldon Monson and offered his own insights.

Beiswenger made it clear that Tri-County is not set up to provide acute inpatient care.

"Our role is to medically clear them and be sure they are medically stable for whatever is the next placement," Beiswenger said.

Beiswenger talked about two of the situations that Tri-County has found itself in because bed space is not available. In the first case, an individual spent 21 days in Tri-County's inpatient unit waiting for placement. Beiswenger added that stays of such length are not unheard of at other hospitals. The lesson learned from the three-week session was that patients are deprioritized once they are moved from a hospital's emergency room to inpatient care.

There is a perception they are being cared for at a basic level," Beiswenger said.

"What we learned is that we do not move them from our emergency department to our inpatient unit."

The second involved a stay of seven days in Tri-County's emergency department by a person suffering from acute mental illness. Beiswenger said the E.R. staff found ways to cope but he considered it close to the care a jail would provide.

"Tri-County is not a mental health facility and at this point, we do not have plans to become a mental health facility," Beiswenger said.

While expediting the placement of people with acute mental illness in the proper care facility is the goal, it is not one easily realized.

"The only person you can really push hard at accepting is state-operated services and again they have to be under the appropriate legal status to push that," Leskey said.

Robertson requested the board pass a motion for further exploration of more detailed host contracts that would allow the county to place people in crisis and avoid an extended stretch in the county jail

"I am just very concerned about it. I would not want any of us to have relatives in that jail cell," Robertson said. "We all know it is a statewide problem but it is also a local problem and we have to address it."

Commissioner Bill Stearns suggested an ad hoc committee be formed to look into the matter and key representatives. Monson asked Robertson to serve on the committee and she agreed.

"We as a society need to do better and we as a county can do better," Robertson said.