Direct Care and Treatment officials on Monday told the Minnesota Senate Human Services Committee that recruiting and retaining staff and a lack of community step-down placements are constraining the agency's ability to admit and discharge patients, and senators debated governance changes in Senate File 626, which was introduced the same day.

"Direct Care and Treatment is a highly specialized behavioral health care system," said Carrie Brownis, legislative director for Direct Care and Treatment, describing DCT as "the only behavioral health care system of its kind, scope, and size in Minnesota." Brownis told the committee DCT serves about 12,000 patients and clients annually and has about 5,000 full- and part-time staff.

The presentation and committee discussion focused on three related pressures: staffing shortages and overtime-driven burnout; rising demand and constrained treatment capacity; and delayed discharges because of limited community-based options. "Recruiting, retaining staff is our top priority for the foreseeable future," Brownis said. She reported DCT has hired new staff but still has a substantial number of unfilled direct-care positions and that roughly 85% of DCT's operating budget supports staffing.

Dan Storkamp, operations director for Direct Care and Treatment, told the panel that DCT has tried to expand capacity within existing facilities: the agency doubled the child and adolescent behavioral health hospital in Wilmer from eight to 16 beds, reopened the Ironwood unit at the Saint Peter forensic mental health program, and is repurposing a Saint Peter care program to add 16 more forensic beds. He said the agency's waiting list is roughly 300 people.

"We could talk about adding more beds to DCT, but we can't build our way out of this situation," Storkamp said, describing the system-level gaps he said the committee would need to address across inpatient, secure and community services to prevent pipeline backlogs.

County officials and prosecutors told senators the shortage of available community placements has left jails and hospitals holding people who have been civilly committed or found incompetent to proceed. Michelle Aldean, Otter Tail County attorney, described examples she said illustrated the effects of limited bed capacity, including long waits in local jails, repeated petitions for discharge, and cases in which she said the county disagrees with recommendations to release people from state programs.

"Some of the changes, of course, with the lack of beds has significantly impacted our work," Aldean said, urging the Legislature to prioritize funding to increase bed capacity and community supports.

Legislative background and governance: Senators discussed Senate File 626, introduced Jan. 27, which would change DCT's governance model. Under the law passed last session, DCT is to operate with an executive board; SF 626 would instead make DCT a traditional state agency led by a commissioner accountable to the governor. Sponsor Senator Rasmussen said the bill would restore a commissioner model because DCT is a large, complex agency and a part-time board that is only required by statute to meet four times a year, he said, does not provide the oversight he believes is necessary.

"Direct Care and Treatment has about 5,000 employees. They have more than a $1,000,000,000 biennial budget, and they serve more than 12,000 patients a year," Rasmussen said in committee. "A board structure for this type of agency is simply unheard of in Minnesota."

Other senators said they were divided. Senator Maquade said she is wary of creating a governance structure that could invite political pressure into clinical care decisions. "I would never want the health care of individual people to be politically pressured to a commissioner," Maquade said. Other members urged clearer lines of accountability while also emphasizing the need for stronger community services and more beds, not only governance change.

Committee staff and DCT officials said several implementation items are already in motion. Storkamp described work to stand up DCT as a separate entity: an executive board required by statute was formed and has met; DCT's transition teams include 47 work groups with project managers that DCT expects to complete by the July 1 statutory deadline. The agency also described a multi-year rollout of a new electronic health record: phase one included eight new modules, three enhanced modules and 37 new workflows.

Senators asked for follow-up data. The committee was told the priority admissions review panel will deliver its report to the Legislature on Feb. 15; that report and additional budget documents would be brought back to committee for a fuller budget presentation at a later date. The sponsor acknowledged SF 626 had been introduced that day and that the committee was only taking it up for discussion; no hearing or formal action on the bill took place Monday.

The committee also heard a brief statement from Matt Freeman, executive director for the Minnesota Association of County Social Service Administrators, who noted that a statutory change that narrowed the timeline for admissions (the so-called "48-hour rule" language) will revert unless the Legislature acts; he told members the sunset in current language is scheduled to occur on July 1 if not changed.

The Human Services Committee did not vote on SF 626 Monday. Committee members scheduled follow-up items including the priority admissions review panel report and a future DCT budget presentation. The committee adjourned "without formal action" on the bill and related governance language.

Ending: Committee members said they will continue the conversation, and several asked DCT and staff to return with more detailed facility-level capacity data and budget projections; the priority admissions review panel report due Feb. 15 was identified as the next key deliverable for lawmakers.