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In St. Cloud, a new approach to dealing with mental health crises -- in jail and out

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Jonathon Archuletta at the Coordinated Care Services clinic in St. Cloud.
Jonathon Archuletta stands in front of a wall covered with words of affirmation at CentraCare Health's Coordinated Care Services clinic in St. Cloud, Minn. Once homeless, Archuletta says the program helped him on his road to recovery from drug addiction and mental illness.
Paul Middlestaedt for MPR News

A year ago, Jonathon Archuletta was addicted to methamphetamine and living in a makeshift shelter under a St. Cloud bridge.

During the two winters he spent homeless, Archuletta found places to stay warm wherever he could, often in public restrooms. He was arrested several times, usually for minor crimes like trespassing and disruptive intoxication. Once, he ended up in the hospital with an infected arm that required surgery.

Archuletta said his addiction and mental illness were spiraling out of control.

"I was just scrawny. I wouldn't sleep for days, weeks, wouldn't even see shadow people anymore," he said. "It was just full-blown."

Archuletta said an outreach nurse visited him under the bridge and offered to help, but he wasn't ready. Then, he got arrested again, this time for theft. Sitting in the Stearns County jail, Archuletta again met the nurse, who works for CentraCare Health.

She's part of a new St. Cloud program that aims to help people with mental health issues who frequently land in jail or hospital emergency rooms. A little over a year old, it's already showing promise in reducing costly jail and ER visits — and in helping people in central Minnesota who are dealing with repeated mental illness or addiction crises.

Archuletta said he was diagnosed with mental illness, including borderline personality disorder, anxiety and post-traumatic stress. The nurse got him set up with addiction treatment and mental health counseling after he got out of jail. She also helped find him a place to live.

A staff person at CentraCare Health's Coordinated Care Services clinic.
A staff person walks along a corridor at CentraCare Health's Coordinated Care Services clinic in St. Cloud, where former jail inmates can continue receiving medical, mental health and addiction treatment after they're released.
Paul Middlestaedt for MPR News

"I truly wanted change," Archuletta said. "It took jail and it took her ... I guess it built self-worth in me, that I kind of mattered."

Until recently, Archuletta was what local officials would have called a "high utilizer." He was frequently in and out of jail, the emergency room and detox unit — the most costly types of care — but never really got the help he needed.

St. Cloud police Cmdr. James Steve said his officers are called to assist people dealing with a mental health crisis about five times a day. But officers didn't have many tools at their disposal to help them.

"If you look in some of those low-level crimes like trespassing, really mental illness is in the background," he said. "We just keep putting those people in jail time and time again. And we here don't believe that maybe is the best spot for them."

Stearns County officials estimate nearly two-thirds of people in the jail on any given day have a mental illness, either diagnosed or not.

So a couple of years ago, local officials began discussing a different way to help people with mental health or addiction issues who keep showing up in jail or the ER.

A CentraCare Health program treats mental, physical health of jail inmates
Art greets visitors at the entrance of CentraCare Health's Coordinated Care Service's clinic lobby.
Paul Middlestaedt for MPR News

"It dawned on somebody that maybe, it's the same people," said Julie Ellis, the Stearns County Human Services department's community supports director. 

"And maybe, we should plan a more coordinated response. Because clearly, what we were doing wasn't working."

A new approach

So Stearns County, along with CentraCare, local law enforcement and the St. Cloud VA, formed an action team of police, human services, probation agents and mental health workers. They meet and compare notes on people in jail or in the community who might benefit from intervention.

Also on the team are health care workers from CentraCare, which began providing care in the Stearns and Benton county jails a little more than a year ago. 

CentraCare nurses see patients in the jails for physical health problems, such as hypertension and diabetes, said Katy Kirchner, who directs CentraCare's Coordinated & Correctional Care program. And they can get patients started on treatment for mental health problems while they're still in custody, and can even prescribe medication like suboxone to treat opioid withdrawal.  

Then, after they're released from jail, patients can receive follow-up treatment at a community clinic in St. Cloud.

Katy Kirchner is Coordinated Care Services director.
Coordinated Care Services director Katy Kirchner talks about the program's impact. The program is a joint effort with Stearns and Benton counties to help people who frequently end up in jail or the hospital emergency room due to mental health or substance abuse issues.
Paul Middlestaedt for MPR News

"That's a really innovative approach," Kirchner said. "It's not something jails have really done, especially in Minnesota, before."

Kirchner said they try to get people whatever help they need, including housing, healthy food or transportation. 

CentraCare hopes the program will reduce their total costs by reaching patients earlier, before they need the most expensive forms of treatment, such as emergency room care, Kirchner said. But more importantly, she said, "we're also serving the patients better."

"It's really difficult to serve patients really well when the only person they see is an ER physician that, rightly so, is only looking at their most urgent need," she said.

Ellis said a key component of the program is a state grant that allows Stearns County to help find housing and supportive services for those who need it. 

"If you have nowhere to go when you get out of jail, you're going to go back to the places you were, and you're going to have the same problems," she said.

Promising trends

Officials say it's too early to call the program a success. But so far, the data show some positive results: There's been a 25 percent drop in the number of people in St. Cloud who have been detained in jail or at the hospital as the result of a mental health or chemical dependency issue since the program began. 

Patients are encouraged to share their thoughts or an inspirational quote.
Patients are encouraged to share their thoughts or an inspirational quote on a wall at the entrance of CentraCare Health's Coordinated Care Service's clinic lobby.
Paul Middlestaedt for MPR News

Stearns County also has seen a 30 percent decrease in the number of detox stays, Ellis said.

The program is attracting some statewide interest as a possible model. Sue Abderholden, executive director of the National Alliance on Mental Illness for Minnesota, said it's "going in the right direction."

"What we want is people to get the right services at the right time," Abderholden said. "If people are ending up in the jail or the emergency room a lot, that means they're not getting the right service at the right time."

Health officials say recovery can be bumpy. Patients sometimes relapse or have setbacks. But they're hopeful this new approach has real promise for helping people in central Minnesota and elsewhere.

It's working for Archuletta. He said he's been clean for about six months. He lives at a boarding house, works out at the YMCA and writes poetry. 

Archuletta, 31, said without the program's help, he probably would be dead, or still high on the streets: "I've rewired my whole brain, through their education, and through their love and support, and their expertise."

This reporting is part of Call to Mind, the MPR initiative to foster new conversations about mental health.