WILLMAR -- Service contracts approved by the Kandiyohi County Board of Commissioners indicate a gap in mental health services still exists.
Mary Kjolsing, director of the Rice Hospital mental health unit, said a shortage of psychiatrists has meant a reduction in care in places like the county jail and the prison in Appleton.
Commissioner Richard Larson said jails have turned into "holding areas" for people with mental illness.
Jay Kieft, director of Kandiyohi County Family Services, said it's a "disgrace" when psychiatric episodes are "de-escalated in the back seat of a squad car."
Kjolsing said a shortage of mental health providers, especially psychiatrists, has made it difficult to provide appropriate care to inmates. She said, however, a nurse practitioner is expected to be hired that will help ease that burden locally by assisting people on an outpatient basis.
She also said there appears to be an increase in medical students studying psychiatry, which could help meet needs in the future.
"The mental health business changes every day," she said. "It's changing again."
Kjolsing told the commissioners on Tuesday that the eight-bed mental health unit at Rice Hospital has been experiencing a decrease in the census, especially in clients from outside the hospital's catchment area.
Last year, she said, about 12 percent of the patients were not local residents. This year it's down to 2 percent. An increased number of mental health beds in the metro area could be the reason why, she said.
Kjolsing said it is very difficult to recruit psychiatrists to rural communities when there are high job demands in the Twin Cities.
The demand for professionals is especially acute for children with mental illness who happen to live in rural Minnesota.
George Dubie, director of Greater Minnesota Family Services, told the commissioners that it can take four to six months for a child to be scheduled to see a psychiatrist.
"That's a long time for a child to wait," he said. "We find it very challenging."
Sandy Schlosser, an advocate for individuals with disabilities, said she drives from Willmar to Hutchinson to take family members who are disabled and have mental illness to see psychiatrists.
Kjolsing said communities like Hutchinson have a much easier time recruiting child psychiatrists because of their proximity to the Twin Cities. She said the psychiatrists who work in Hutchinson live in metro communities.
The contract with Rice and the Greater Minnesota Family Services shelter included no change in the rates. Greater Minnesota Family Services provides services for at-risk youth. Rice is one provider of mental health services for county clients.
Several other contracts the county approved for services for individuals with disabilities included a 2.58 percent reduction in rates that were mandated because of state budget cuts.
Because it's difficult to cut services to meet mandates, Schlosser said she was concerned the reductions would be a burden to the providers who will have to cut salaries to employees.
Commissioner Richard Falk said everyone has to "share" the burden of state reductions.
Schlosser said she understands that, but said it was important for the community to be aware of how those cuts were affecting people.