Behavioral health has made strides since the 1970s, when institutions were the primary providers of care and community services were limited. Despite progress, challenges in the sector remain, from workforce shortages to reimbursement rates and a lack of prevention care, Sue Abderholden, recently retired executive director of National Alliance on Mental Illness Minnesota, wrote in a Dec. 1 op-ed for the Minnesota Reformer.
Ms. Abderholden, leader of the organization for 24 years, cited several areas on which policies should focus, including full funding for early episode psychosis programs. Only one small grant program, launched this fall, supports voluntary engagement before crisis — despite evidence of long-term benefits, she said.
With 50% of mental illnesses beginning by age 14, she also emphasized the need to fully fund children’s services, including school-linked mental health services, and ensure consistent follow-up after screenings.
Ms. Abderholden called for a more diverse workforce, noting that funding for supervision, loan forgiveness and training for professionals from diverse racial backgrounds falls short of the current demand. She also proposed creating a dedicated workforce office within the state Department of Health to support behavioral health.
Other areas for potential reform include separating children’s mental health from the child protection system, enforcing parity laws and increasing Medicaid payment rates, which she said do not reflect the true cost of care. She also urged the state of Minnesota to end the Medicaid policy that bars payment for treatment in psychiatric-only facilities with more than 16 beds.
Crisis response funding, she said, remains fragmented. “Every county is covered by a mobile mental health crisis team, yet the statewide funding is less than the budget of most of the individual cities’ police department budgets,” she wrote. Ms. Abderholden advocated for building psychiatric emergency departments within hospital emergency departments instead of launching standalone crisis centers.
Lastly, she called for funding to support social determinants of health, from housing to employment and social connections. Current funding is limited and Medicaid waiver rules — including a cap that no more than 25% of residents in a building can be on a waiver — restrict access to supportive housing. “Employment provides a reason to get up in the morning, but the only employment program for people with serious mental illnesses has limited funding,” she wrote.
