substance use disorders, and intellectual disabilities. Public and private providers have built an array of community-based services designed to support resilience and recovery by ensuring that people receive the appropriate services at the right time and in the right place. Minnesota’s state-provided services have changed significantly during the past two decades, with the closing of large institutions, the re-deployment of institutional staff, and the creation of state-run
community-based services to eliminate or reduce significant gaps in the service system. This section describes the public-private service system as it exists today, using the service categories introduced in the previous section.
A. Mental Health and Substance Use Disorder Service Providers in Minnesota
The health care delivery system is exceedingly complex and includes: providers, funders,
insurers and payers, suppliers, education/research institutions, and government. All of these play roles in the care of people in the target population.
1. Providers
The mental health Minnesota has hundreds of public and providers of mental health and substance use disorder services:42
Specialty mental health and substance use disorder services providers: Psychiatrists, psychiatric nurse practitioners, psychologists, and social workers in public and private practice; community mental health centers and outpatient clinics; residential treatment and rehabilitation centers; psychiatric hospitals; and psychiatric units of general hospitals.
General medical and primary care providers: Primary care doctors, nurse
practitioners, and nurses often provide mental health services as part of their physical medicine practices in private clinics, community health centers, and hospitals.
Human services providers: Minnesota has a huge network of social service providers who assist clients with direct mental health services as well as support services including housing, education, employment, food supports, family counseling, etc. Mental health and substance use disorder services are also sometimes provided in schools, community centers, spiritual centers, jails, and prisons.
42 These categories are borrowed from Mental Health: A Report of the Surgeon General (Rockville, MD: U.S.
Department of Health and Human Services, 1999), accessed on December 2, 2013 at http://mentalhealth.about.com/
cs/comprehensivesites/l/blsgc6s1.htm.
Voluntary and community networks: Minnesota has an especially vibrant network of volunteer- and peer-run organizations that support people with mental illnesses and substance use disorders.
In addition to these providers of mental health and substance use disorder services are other providers of preventive and auxiliary services, including: public health departments, dental clinics, surgery centers, pharmacies, and hospices.
2. Funders/Insurers/Payers
Mental health and substance use disorder services are paid for by employers (through employee health insurance plans), state and federal agencies, and individuals who directly purchase such services or purchase their own health insurance. A little over half (54 percent) of Minnesota’s health care spending in 2011 was through private health insurance, out-of-pocket, and other private spending; the other half was through government-supported health insurance plans—
Medicare, Medical Assistance and MinnesotaCare, and Veterans Affairs.43 Several other non-profit health insurance plans also serve people in the target population, including Blue Cross Blue Shield/Blue Plus of Minnesota, HealthPartners, Medica, Metropolitan Health Plan, PreferredOne, Sanford Health Plan, and UCare.
3. Suppliers
The health care industry is supported by a wide variety of suppliers of goods and services used in health care, including equipment, information technology software and hardware, consulting services, and pharmaceuticals. For mental health and substance use disorder services, pharmaceutical companies are significant suppliers.
4. Research/Education
Research and education organizations not only supply information and guidance on treatment approaches, they also help train the professionals that staff Minnesota’s mental health and substance use disorder treatment providers. These include medical and dental schools, nursing and physical therapy programs, professional certification programs, and schools of public health.
There are also national/federal organizations with education and research roles, most importantly the National Institute of Mental Health and the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services.
5. Professional Associations and Advocacy Groups
Minnesota has a robust advocacy community that represents consumers, providers, insurers, and government agencies active in the mental health and substance use disorder service system.
43 Minnesota Health Care Spending and Projections, 2011 (Saint Paul: Minnesota Department of Health, December, 2013), 5.
Table 8 lists some of the organizations most active in the policy issues raised in this report.
Many of these have national counterparts.
Government Consumer Advocates Provider Associations
Association of Minnesota
American Indian Mental Health Advisory Council Governor's Council on Disabilities
Mental Health Association of Minnesota Mental Health Consumer/Survivor Network
Minnesota Association for Children’s Mental Health Minnesota Association for the Treatment of Sexual
Abusers
Minnesota Association of Resources for Recovery and Mental Health
Minnesota Brain Injury Alliance Minnesota Disability Law Center
Minnesota Office of the Ombudsman for Mental Health and Developmental Disabilities
Minnesota Sex Offender Re-entry Project
Minnesota State Advisory Council on Mental Health National Alliance on Mental Illness - MN
The ARC of Minnesota
Table 8: Associations and Advocacy Organizations Active in the Mental Health and Substance Use Disorder System
6. Government
There are at least one hundred federal, state, regional, county, and tribal agencies that play a role in shaping the mental health and substance use disorder services in Minnesota. At the federal level, the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) leads public health efforts to reduce the impact of mental health and substance use disorders in communities. State agencies include the Department of Human Services, the Department of Health, the Department of Education, and the Department of Public Safety.
Unlike other states that have assigned responsibility for mental health to regional entities or centralized it at the state level, Minnesota has designated each county of the state as a local mental health authority that plans, develops policy, and allocates resources for mental health services. This state-supervised, county-administered structure affords the opportunity for significant local input into policies and service provision, including through local advisory councils facilitated by counties. The state’s counties are coordinated regionally through sixteen Adult Mental Health Initiatives, each of which receives funding from the state to assess needs, facilitate cooperation among policy-makers and providers, and undertake projects to improve the regional service system.
Minnesota’s American Indian tribes also play a role in the mental health and substance use disorder services for their members. Tribes are developing extensive culturally-specific services;
the Leech Lake Band of Ojibwe, for example, has increased its staff from less than 5 mental health and substance use disorder workers in 2011 to more than 35 staff today (including
practitioners and clinicians). Tribal providers are able to bill Medical Assistance for 100 percent federal reimbursement of costs (with no state match), which is supporting an expansion of services on several reservations in Minnesota. In addition to service provision, the Red Lake Band of Chippewa Indians and the White Earth Band of Ojibwe have the legal authority to make civil commitments to the Commissioner of DHS (in addition to counties’ authority), another important role.