Here's How To Create A Stronger Mental Health Care System

By Sue Abderholden, Minnesota Reformer

December 2, 2025

I retired last month after leading NAMI Minnesota for 24 years and working on disability and mental health issues for over 40 years.

A mentor of mine always reminded me that when we look ahead and see all the work we need to do, we need to look behind us and see how far we have come.

When I was in graduate school in the late 70’s, institutions were the primary providers of mental health care. The limited community services that were available were largely funded through grants from the state and counties.

In short, there was no mental health system.

Our system isn’t broken; we have spent the past few decades building the foundation of a system.

There is now a wide array of community services for both children and adults that provide treatments and support and vary in intensity. This is largely due to a shift in 2006 to move services to Medicaid and MinnesotaCare and the subsequent passage of mental health parity laws. These are health care services and should be paid for by health insurance.

The importance of housing, employment and education were not forgotten, and these important parts of our system also received increased funding.

Ensuring that people are trained on mental health issues — teachers, police, etc. — was also important to ensure early identification and to decriminalize mental illnesses.

Despite this progress, we continue to not meet the needs of people with mental illnesses and their families.

The difference now, versus 30 years ago, is that we know what works — we know the solutions.

Here’s how to move forward on building our mental health system.

• Invest in early intervention and engagement. As with any health care condition, early identification and treatment yields the best outcomes. The government has not fully funded early episode of psychosis programs despite the evidence that it prevents young people from developing a disabling condition. There is only one small grant program, which started this fall, that tries to engage people in treatment voluntarily instead of waiting until there is a full-blown crisis. Since 50% of mental illnesses develop by age 14, fully funding our children’s mental health system is important, and programs such as school-linked mental health eliminate barriers by going to where the children are. Routine mental health screenings are sometimes conducted, but there isn’t consistent follow-up.
• Create a robust and diverse workforce. There is a workforce shortage across the state, and our current mental health workforce lacks diversity. There are several programs designed to address the barriers — loan forgiveness, paying for supervision, paying for BIPOC mental health professionals to become supervisors — but the funding doesn’t match the requests. Creating a mental health and substance use disorder workforce office within the Department of Health would direct attention to this issue and support the wide array of people needed in our mental health system, including peer and family peer specialists. We also need a different level of case managers to ensure that people with more experience are assigned to people under commitment.
• Pay the true costs of providing treatment and supports. Low payment rates — especially under Medicaid, which is the largest payer for mental health care — make it difficult to expand services. Rates don’t come close to covering the actual costs. Increase the rates, end the Medicaid policy that won’t pay for care in psych-only facilities with more than 16 beds, and require more services to be paid for under private insurance (enforce parity!).
• Separate out children’s mental health from child protection. While some progress has been made, families should not have to go through the child protection system to access residential care. It’s an incredible burden for them to have to do this, threatens their employment, and delays access to needed care.
• Create a unified mental health crisis system. When people complain about the number of people with mental illnesses in our jails, we need to ask who brought them there. We need to have a mental health response to a mental health crisis. 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. We are seeing an increasing number of police departments establish their own teams or co-responder models. This leads to confusion, especially now with “988” the suicide and crisis hotline, raising important questions like, who does what? And, does HIPAA cover data collected by city teams? Additionally, ever since the deadly use of force law changed, many police have been unwilling to transport people to the hospital unless the person willingly enters the vehicle. While there isn’t research on this, we surmise that more people may be ending up in jail because they were not brought to the hospital. Lastly, stop trying to develop separate crisis centers. Everyone goes to the hospital emergency department when there is an emergency, so build psychiatric emergency department within existing EDs.
• Pay attention to the social determinants of health. We know that housing, employment and social connections are important to a person’s recovery. Yet funding is very limited. Restrictions on the use of the Medicaid waivers —no more than 25% of the people in a building can be on a waiver — and reliance on “group homes” (four bed homes) offer little choice and insufficient support to people with the most serious mental illnesses. Employment provides a reason to get up in the morning, but the only employment program for people with serious mental illnesses has limited funding. While clubhouses and community support programs help break the isolation so many people with serious mental illnesses experience, not every county offers this program.

We could do a myriad of other things to build our mental health system. But I think back to President John Kennedy’s quote as he urged our country to close the institutions and to return people to their own communities with the “open warmth of community concern and capability.”

He added: “It is to be hoped that within a few years the combination of increased mental health insurance coverage, added state and local support, and the redirection of state resources from state mental institutions will help achieve our goal of having community-centered mental health services readily accessible to all.”

That was more than 60 years ago, but I still cling to hope that we can continue to build our mental health system and provide effective and compassionate care and support.

The Minnesota Reformer is an independent, nonprofit news organization dedicated to keeping Minnesotans informed and unearthing stories other outlets can’t or won’t tell.