Aug. 27—ROCHESTER — Olmsted County is adjusting to a shift in Mayo Clinic policy regarding patients under civil commitments.
“Mayo Clinic facilities in Minnesota have experienced a significant increase in the number of individuals brought to our emergency departments under a civil court order to be involuntarily detained, pending judicial proceedings or placement efforts,” states an Aug. 2 letter sent to the county by the health care provider. “Many of these individuals do not require hospital-level care and have the capacity to make their own decisions.”
The letter states Mayo Clinic facilities in the state will no longer hold patients solely based on a commitment order.
“We will rely on our providers’ independent clinical assessment to decide for each patient whether to admit or hold them in the hospital,” the letter states.
Civil commitment holds have typically involved mental health or substance abuse concerns, so the change adds pressure on county staff to find space in treatment centers and behavioral health facilities in an already overtaxed system.
“We have seen a significant increase in staff time required to manage individuals on civil commitment that are released from the hospital,” said Mike Boehm, a program manager in Olmsted County’s Adult and Family Services department. “Obviously, being medically stable does not mean that mental health symptoms or chemical use is not present.”
The county is responsible for individuals under court-ordered civil commitment, and it’s not uncommon for social workers and others to find ways to ensure people are safe outside a facility.
“The majority of our civil commitments aren’t placed in an institution,” Deputy County Administrator Travis Gransee said. “The majority of our civil commitments are in the community.”
Boehm said individuals who aren’t hospitalized in treatment generally receive periodic checks, which can lead to reliance on other public services and increased demands on county staff’s workload and capacity.
“In the past few weeks, we have conducted multiple safety checks on individuals, sent law enforcement out, enlisted assistance from the mobile crisis team, revoked multiple commitments who were taken to the hospital and then medically cleared to be released again back home, sometimes within a few hours,” he said, adding the number of individuals affected in recent weeks is not available because many county and nonprofit service providers are addressing the varied cases.
While the local situation is new, it’s not an uncommon policy in other parts of the state.
“We are fortunate that Mayo really helped hold folks that did not meet medical criteria,” Adult and Family Services Associate Director Amy Thompson said, pointing out the assistance has been unique among health care providers.
In a statement released Sunday, Mayo Clinic said the shift in practice is in the interest of the patients and others.
“To protect the rights, safety and well-being of our patients, staff and community, Mayo Clinic in Rochester remains in compliance with Minnesota law and only admits to the hospital patients who have medical needs that are appropriate for an inpatient care setting,” it states. “It’s not in the best interest of the individual who is involuntarily detained to remain in an inpatient hospital setting without a medical need, as it restricts them from accessing outpatient treatment and other non-hospital resources that they need.
“Unnecessary hospitalization of patients increases the strain on limited inpatient resources available to serve the community. This leads to delays in the hospital’s ability to treat those who require hospital-level care.”
The Mayo Clinic policy isn’t expected to release people needing medical care or those unable to care for themselves. The stated policy says a medical provider must determine the person:
* Has the capacity to make decisions.
* Does not pose a substantial risk of immediate physical harm to self or others.
* Does not require hospital-level care.
* Has a discharge plan in place, outlining any ongoing treatment needs.
When a patient with a civil commitment is discharged, Mayo Clinic says it notifies the patient’s county caseworker or social services agency, in accordance with best practices used by Minnesota hospitals and health systems.
“We appreciate the ongoing collaboration with Olmsted County, which will help us continue to serve our community and act in the best interest of both our patients and the individuals requiring civil commitment,” a hospital spokeswoman said in the statement.
Mayo Clinic’s concern about overwhelming resources is also seen in the county, which must find treatment or specialty care options in a state system that has a lack of capacity to meet needs, especially when it comes to people resistant to the options presented.
“More often than not, individuals who are unwilling to agree to a stay of commitment, unwilling to participate in any community options, have a violent history or (have) complex medical needs tended to stay at Mayo Clinic or another community hospital longer awaiting a placement,” he said, pointing out the length of a stay has varied from a few days to longer when treatment space is unavailable.
Gransee said Olmsted County staff works to help connect local individuals to needed mental health and chemical dependency support, adding that the work will continue amid the new challenges.
In an effort to find the best approach, he said county agencies have reached out to their counterparts in metro-area counties, which have operated under similar circumstances for years.
“We will respond as a system, and we will figure this out to the best of our ability,” he said.
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