Delays in government contracts have pushed ambulatory mental health crisis services into limbo

Minnesota’s mobile crisis system for responding to people with mental health emergencies is in limbo, due to bureaucratic delays at the state agency responsible for overseeing the service.

Across the state, local agencies that respond For people experiencing suicidal thoughts and other mental health crises, services are being disrupted because the Minnesota Department of Human Services (DHS) has failed to provide tens of millions of dollars in grant contracts that help cover the cost of a life-saving program.

Mental health providers say timely delivery of grant contracts is crucial. Without them, they cannot pay for the 24-hour call centers and mobile crisis teams that travel to homes, schools, hospitals and other places to provide counseling and resolve conflicts non-violently.

Mobile teams work in every county and filling a crucial gap in the health care system, to help those who are often incapacitated by mental illness from visiting a clinic or seeking professional help. They also reduce burdens on local law enforcement, which are often ill-equipped to handle mental health emergencies.

However, crisis responders have been operating in a financial bind since late December, when it was Division of behavioral health At the Department of Homeland Security notified them of the delay in completing their contracts. The agency noted that drafts of their award contracts would not be ready until the end of January – which service providers say is more than a month late.

As a result, crisis responders have been placed in the exceptional position of having to provide safety net service without contracts or assurances that they will be paid.

“It’s frustrating and disheartening because this is a vital service that we can’t just stop,” said Ashley Kgos, CEO of Woodland Centers, a Willmar nonprofit that provides mobile crisis services in seven counties. “It’s not like we can say, ‘Sorry, we don’t have a contract so we can’t take your calls. ‘ We are their lifeline.”

Homeland Security officials declined an interview request. But in written remarks, Assistant Commissioner Eric Gromdahl said contract delays stemmed from leadership transitions, employee turnover, and a shift in contract management processes. He said mobile crisis providers can continue to provide services, although they will not be paid until the grant contracts are finalized. He said the agency does not expect delays in payments to service providers because contracts must be ready by the time first-quarter invoices are received.

Grumdahl, who supervises Division of behavioral healthsaid the contract delays related to the launch of a new contract management system — a “one-time transitional effect” — that would streamline contract renewals across the agency.

“These rapid response teams play a vital role in assessing individuals, resolving crises, and connecting people to needed services,” Gromdahl said in a statement. “Ensuring that these services continue without interruption is critical to the State of Minnesota and an important priority for DHS.”

Crisis responders say they have been kept informed of the causes of contract delays, which have already disrupted service.

Some providers have suspended hiring staff to fill vacancies in call centers and crisis response teams, which means they can’t respond quickly to emergencies and many personal calls. Others hold back on marketing and expansion plans until they know they’ll get their money’s worth, according to the Association of Mental Health Providers.

He said, “When agencies have to scramble to put together contingency plans for delayed or broken contracts and reimburse for public programs, people have to divert them away from their other areas of work to compensate. This takes attention, resources and capabilities away from our systems.” Gene Lee Palin, CEO of Minnesota Association of Community Mental Health Programswhich represents 34 mental health providers.

Budget difficulty

The contract delays reflect long-standing problems within the behavioral health department, which in recent years has been plagued by pervasive problems handling grants.

In March 2021, A.J Found the Legislative Auditor’s Office The department has handed out tens of millions in grants to mental health and substance abuse services for nearly three years without adequate oversight. The legislative auditor has identified problems at nearly every step of the grant application process, from failure to document potential conflicts of interest to inadequate evaluation of grant recipients. In late 2019, the division, too I got shot For its role in overpaying Indian tribes for addiction treatment services.

Human Services Commissioner Judy Harpstead has repeatedly pledged support for the agency’s finances and rolled out a series of measures to improve the grantmaking process.

“Make no mistake, there is a basic expectation from state agencies that contracts be completed and delivered on time,” said Sen. John Hoffman, DFL-Champlin, who chairs the Senate Human Services Committee. He undertook to look into the reason for the delay.

“If you don’t fund mobile crisis teams, people are going to die,” Hoffman said. “I don’t want people to die.”

Mobile crisis teams, who are often the first responders to mental health emergencies, receive a high volume of calls. In 2020, they responded to more than 16,000 incidents statewide, including about 13,400 face-to-face visits with people in crisis.

The Department of Homeland Security estimates that $41.2 million in government grants is available to mobile crisis service providers over the next two years—about one-third less than what the providers have requested.

Even before the contract was delayed, service providers struggled with tight budgets and increased demand.

Mobile crisis programs are expensive because they must keep trained staff on call 24 hours a day, seven days a week. In rural areas, respondents sometimes travel more than 100 miles each way to make house calls. Sometimes, they will spend hours with someone who is experiencing a psychological crisis – helping to calm their anxiety and accessing psychiatric care.

Shona Rittmeyer, CEO of Alluma, Inc. It operates a mobile crisis call center serving eight counties in northwest Minnesota. “Often, crisis services are the gateway to getting mental health services.”

The 10-person crisis team at the nonprofit Human Development Center (HDC) in Duluth responds to more than 100 calls a month in southern St. Louis County. The team meets people in crisis at fast food restaurants, highways, hospitals, homeless shelters, and even cars.

Sometimes, the response to a crisis can involve stabilizing a stressful family environment. HDC crisis responders cleaned houses, cooked meals and helped children with homework when their parents were too distressed to care for them, said Courtney Buchholz, nurse and community coordinator at HDC.

With the help of government grants, Buchholz said, the agency is able to speed up the process of getting people into psychiatric care, often arranging appointments within 48 hours rather than the usual wait of several months.

“It is a very big blessing for our people that people have access to treatment quickly when they are faced with such an urgent need,” she said. “Because that is when they are often the most willing to help.”

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