Minnesota kids forced to cross the country for mental health help

News & Politics

Minnesota kids forced to cross the country for mental health help Kids with complex needs have gone to Massachusetts, Texas and other states for care. County officials say far-flung placements are costly and traumatic.

By Jessie Van Berkel

The Minnesota Star Tribune November 2, 2024 at 12:00PMMollie Meyer and her daughter embrace at their home on Oct. 8. Due to lack of space at mental health treatment facilities in Minnesota, Meyer's daughter spent around a year at the Justice Resource Institute outside of Boston. (Richard Tsong-Taatarii/The Minnesota Star Tribune)Mollie Meyer's daughter holds the family cat, Roscoe, at their home in Nicollet County on Oct. 8. (Richard Tsong-Taatarii/The Minnesota Star Tribune) Cost, workload falls on counties For a child whom Stearns County recently placed out of state, case workers checked with 302 facilities before they found one that could take the kid, said Nicholas Henderson, the county's human services director.

A county employee needs to fill out an intake packet that can be up to 45 pages just to get a child on a facility's waitlist, he said.

"We're talking 302 packets," Henderson said. "Each packet, I would say, takes at minimum 30 minutes."

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Desperate search for care reveals Minnesota's mental health crisis There's no comprehensive way to search availability at residential treatment facilities, even within Minnesota. Whether a place will accept a child often depends on a kid's needs and the facility's current population and staffing limits.

Families that hunted for places on their own said the process can be confusing and scattershot. Parents sometimes hire navigators to help them search, but said that help can come with a steep cost.

Some families have private insurance that covers some treatment costs. But county officials say the majority of kids they work with are on Medical Assistance, the state's Medicaid program. To bill Medical Assistance, the provider needs to be certified by state government, which involves a fee and inspection by Minnesota officials. Only three out-of-state youth residential treatment programs are certified. One is in Wisconsin, two are in South Dakota.

"Providers don't often go through the whole process for one youth," Hennepin County Behavioral Health Director Leah Kaiser said. "It doesn't make sense to them. And so the county ends up paying the cost of that young person's care in the out-of-state program."

When a child is placed out-of-state in Stearns County, their finance staff said it costs county taxpayers, on average, roughly $750 a day.

Counties paid, on average, $95,000 for each child in out-of-state residential treatment between 2018 and 2022, according to a Department of Human Services survey . That estimated cost doesn't factor in potential Medicaid reimbursements.

Once a month, county officials said case workers have to drive or fly to visit children. They said that travel, and the time-consuming search for appropriate treatment facilities, leave less time for other kids on the worker's caseload.

Having family members participate in a child's treatment and maintaining their connection is critical, mental health advocates said. But doing so can be difficult when a child is hundreds of miles away.

With the help of an online fundraiser and a flexible employer, Meyer was able to visit her daughter about once a month during the year she spent in Massachusetts. Each visit ended with heartache as she left her child halfway across the country.

Returning home The number of residential treatment beds in Minnesota has shrunk, and the facilities that do exist struggle to find enough staff to operate at full capacity. Treatment providers said they must determine whether they can adequately handle each child's particular needs and balance those with other kids in their care.

Kids who cannot find timely placement in Minnesota's residential mental health treatment facilities often also have an intellectual disability, aggressive or sexually problematic behaviors or a physical health condition, county workers said.

Stories of children stuck in emergency rooms and juvenile detention centers have put a spotlight on Minnesota's lack of residential treatment beds . But county officials, state lawmakers and child welfare advocates also stressed the need for more preventative resources to help kids stay in their homes and services to keep them stable after they leave a treatment center.

Minnesota has an array of intensive community-based and residential services for youth with high needs, DHS said in a statement. The agency said it continues to identify and respond to gaps and accessibility issues, which could be due to workforce shortages , low Medical Assistance reimbursement rates and a lack of uniform access to services statewide.

"There is a growing need to address systemic challenges impacting children's intensive behavioral health services and the lack of treatment options within Minnesota," DHS Assistant Commissioner Teresa Steinmetz said in a statement. "It takes every member of the system – the state, counties, Tribes, providers and community partners – working collaboratively to alleviate these challenges."

The day a child leaves a facility, services should be in place to help them live at home, such as an individualized education program, respite services for the family and a youth behavioral health worker and therapist, said Rep. Kim Hicks, DFL-Rochester, who is also a DHS employee.

Her daughter is on waitlists for several residential treatment facilities in Minnesota. As they wait for a place to let her in, Meyer said they are not getting therapy services at home.

"What it comes down to is a kiddo with complex trauma who needs a higher level of care," she said. "And as a state we're not able to provide it."

Mollie Meyer and her daughter play Uno at their home on Oct. 8. (Richard Tsong-Taatarii/The Minnesota Star Tribune) about the writer Jessie Van BerkelJessie Van Berkel is the Star Tribune's social services reporter. She writes about Minnesota's most vulnerable populations and the systems and policies that affect them. Topics she covers include disability services, mental health, addiction, poverty, elder care and child protection.

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