BAXTER-A top Minnesota official visited Baxter Tuesday to discuss the rural mental health crisis-and to decry proposed Republican budget cuts she said would gut mental health care initiatives.

Emily Piper, commissioner of the Minnesota Department of Human Services, met with local health care leaders at the Community Behavioral Health Hospital in Baxter.

The Baxter hospital is a 16-bed acute psychiatric care facility, run by DHS.

The proposed $600 million in cuts would force DHS to eliminate 200 positions at their facilities, Piper said. That includes Community Behavioral Health Hospitals like the Baxter facility.

"Every single legislator in this area voted in favor of the cuts," Piper told those at the meeting Tuesday.

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The cuts are particularly mystifying to Piper in light of the Legislature's move in 2016 to spend additional money on DHS.

"We are unsure about what justification is for this level of cut," she said.

"Particularly given the fact that the Legislature invested in these same services, same facilities, same programs, last year."

In response to the cuts, Piper has testified at the Legislature against both bills, as well as writing letters to legislators and travelling the state to emphasize DHS's importance. Asked whether Gov. Mark Dayton would veto the language that cuts DHS, Piper said it was unclear what specific language would show up to his desk, as the House and Senate bills are being worked out in conference committee.

The cuts would threaten DHS's staffing of not just the Baxter hospital, but the main state hospital at Anoka, the Minnesota Security Hospital in St. Peter (for patients who are committed), and the state sex offender hospital, Piper said. Communities need to push their legislators on the value of state mental health care, she said.

But there are aspects of the Community Behavioral Health Hospital system that draw criticism from communities that have them. When a patient needs to stay in a mental health care facility, the agency's practice is to find a bed wherever one is available, regardless of where the open spot is located.

During the meeting Tuesday, Adam Rees, Essentia Health president for the central region, seized on the fact that so many of the local beds were occupied by people who weren't from Crow Wing County.

"There's just something illogical about that," he said. "The local people who should be getting care in the local hospital, they actually end up travelling to far-off spots."

Interviewed after the meeting, Piper said that half the patients at the main state facility in Anoka were from greater Minnesota. She said that every state facility felt the shortages associated with the health care crisis, and that she didn't think there was any disparity in access between the individual state hospitals.

During the meeting, Rees said many general hospitals were creating what amounted to miniature inpatient psychiatric hospitals within their emergency rooms.

"Would any other business do something like that?" Rees asked rhetorically.

One in four Crow Wing County respondents to a recent survey said they struggle with mental illness, he said.

An Essentia Health position paper Rees pointed to said the lack of mental health care in Minnesota had reached a crisis point, and called for additional state spending to combat it.

"The number, acuity and violent behaviors of patients with mental illness has increased significantly, resulting in a statewide crisis," it said. "Although state investments have been made, there exists a critical need for additional state investment addressing acute, inpatient services. Inpatient care shortages for those with serious mental illness awaiting involuntary commit processing, and those with violent tendencies, are at historical highs and unacceptable levels."

Rees also commended the state government for increasing the capacity of the Baxter facility back to 16 beds, and praised the staff at the facility for their good work.

Dr. Shawna Kovach, Lakewood Health System Director of Psychiatric and Behavioral Health Services in Staples, said there was a general lack of awareness of the mental health field among the general public, including legislators. Despite the cuts, there's still a bill to pay, she said.

"There is a cost, plain and simple: you're going to cost the patients," she said. "And if you do it the wrong way, it's going to be more of a cost. It's going to end up on your law enforcement. It's going to end up in your emergency rooms, your highest level of care. If you do it right, put the money where it should go-these CBHHs and other residential types of facilities-you know what, you'll probably bring down that cost. Plus, you'll have more access and more appropriate levels of care and treatment."

The state-licensed psychiatric hospital at Anoka is one of the facilities where residents are placed when in need of hospitalization for mental health care. Once Anoka staff determine a patient no longer meets the medical need to stay at the facility, the meter starts running for the county of residence-even though, according to Crow Wing County adult services supervisor Tami Lueck, it's often seven to 10 days before notification of the change in patient status is received at the county.

At $1,309 per day for care, the costs add up quickly.

After the meeting Tuesday, Piper was asked if the agency was reforming the notification process. She said DHS was investing in additional case coordination. She added that a provision in Dayton's proposed budget-a provision absent from the House or Senate versions-would give $6 million to communities in order to provide transitional housing grants to help transfer out people who don't need to be in a hospital.

The money counties pay for mental health care doesn't go to mental health or even to DHS directly, Piper said-it goes into the state's general fund.

"The Legislature spends it on other things," Piper said.

Dayton's proposal would redirect some of the county payments for state mental health care away from the state general fund and toward the community grant program, she said.