Beltrami County looking at mental health transport options
BEMIDJI -- A Beltrami County Board-led task force was charged Tuesday with finding alternatives to transport mental health patients once the Sheriff's Department stops doing so on Jan. 1.
"We can't as a county keep this service going," County Board Chairman Jim Lucachick said Tuesday as commissioners and medical and social services providers discussed alternatives.
Sheriff Phil Hodapp said his officers will no longer transport mental health patients to treatment facilities starting Jan. 1. In a cost-cutting move, eliminating especially night transfers by deputies will cut $30,000 in overtime costs.
The providers tried to help, with Stellher Human Services offering to kick in $2,500, Upper Mississippi Mental Health Center $4,000 and North Country Regional Hospital $10,000.
But Hodapp said he's already lost part-time staff and would not be able to resume the service without hiring additional staff -- at a time when the County Board's policy is to not fill vacancies.
"We don't have the staff available at night to do this," Hodapp said at a meeting which included about 25 people.
Mental transports involve patients placed on a 72-hour hold and need transport to a facility. Many of the cases involve children who are depressed, suicidal, have violent tendencies or who are a threat to their family.
The North Country Regional Hospital Emergency Department, since January, has handled 502 mental health cases, with 59 pediatric, 37 geriatric and 406 adults, said Tim Hall, NCRH director of nursing.
Pediatric transports are the most important and most expensive, he said. "Most are under a 72-hour court-supported hold, and law enforcement takes care of that so well."
All of the pediatric cases involve transports out of town to Fargo, Duluth or Grand Forks, he said. Of the 147 adults transferred to a distant facility, six went to Wadena, four to Brainerd, three to Fergus Falls and to Baxter, two to Thief River Falls and Alexandria and one to Fargo.
Staff can be adjusted to do transports early in the day, Hodapp said, but not at night without overtime among an already smaller staff.
Bemidji has no place to hold pediatric mental health patients, Hall said, so they must be transported elsewhere no matter what time of day.
Problematic is federal law that mandate that when a patient is restrained, a physician must reauthorize the hold every four hours for an adult, two hours for ages 9 to 16 and every hour for a child under age 9, Hall said.
Law enforcement is preferred, but there may be other alternatives, Hall said.
"Law enforcement has been a huge benefit for us," Hall said. "They can manage a legal hold, are always available and have safe vehicles. North Country Regional Hospital will offer some dollars but we can't afford the whole thing."
Dr. Bob Rutka, NCRH vice president of medial affairs, said NCRH figures about the third of the night-time transfers come from the hospital, so it is willing to front $10,000.
Larry Ellingson of Stellher Human Services said he hopes his agency can contribute $2,500 from a child crisis grant. Stellher does a lot of pediatric counseling, he said. "We want to do preventive care to head off admission to residential treatment."
A spokesman for the Upper Mississippi Mental Health Center said the center would use a similar crisis grant for adults to offer $4,000.
Hodapp, however, maintains that nothing in state law obligations the county to provide such transport services.
"I believe it is the obligation of the Sheriff's Office ," Hall said. "I still do even after reading the statute."
Aside from the Sheriff's Department not being able to staff the night hours despite the new money, there is no guarantee the money will continue.
"We can do this temporarily but we need a funding stream to sustain this in perpetuity," said Commissioner Joe Vene.
Will Weaver, retired Bemidji State University English professor, is involved with a new taxi venture in Bemidji and said it is interested in providing a private service.
Still, said Lucachick, the question remains of how such a service would be paid. Mental health services are treated differently, and often are not reimbursable by the state or private insurance.
"The key is getting reimbursement," said Lucachick. "Who's going to pay that bill? We need legislation that mental health services are covered as part of insurance."
Commissioner Quentin Fairbanks said the $16,500 is a start and should help keep the service going past Jan. 1 until a task force can come up with alternatives.
Lucachick suggested using the new taxi service for low-risk transports, local ambulances for medium-risk transports and the Sheriff's Department for high-risk transports.
The task force, which will include providers, ambulance representatives, the new taxi service and Commissioners Lucachick and Vene, will meet 7:30 a.m. Tuesday at NCRH.