Board of Mental Illness reports rising holds and staffing constraints; Medicaid seen as reducing county hospital costs

Tom Wierheim and (identified in the transcript as Erin/Aaron) Johnson, from the Minnehaha County Board of Mental Illness, briefed the County Board of Commissioners on May 6 about increasing numbers of mental‑illness holds, how Qualified Mental Health Professionals (QMHPs) operate, and the budget effects of hospital days for detained individuals.

Wierheim described the board’s process: when law enforcement places a mental‑illness hold the individual is taken to a behavioral-health facility or emergency room and evaluated by a QMHP, who is paid by the county. The QMHP’s recommendation informs whether the board continues or releases the hold; continued holds result in hospital days charged to the county’s Board of Mental Illness budget. “Those hospital days then affect our budget,” Wierheim said.

Presenters said the number of holds has risen roughly 8–10% annually in recent years, mirroring local population growth. For 2025 the presented data covered only through March, with April cited as typically the busiest month; staff estimated about four to 4.5 holds per day on average, including weekends and holidays. The board has started tracking days per hold and suspects the average hold duration has increased modestly — staff reported roughly an additional day and a half per hold in the period tracked.

Commissioners asked about QMHP staffing and service delivery. Presenters said QMHPs typically hold additional jobs (e.g., hospital assessment, private practice) and cover the county on a rotating and PRN basis; recruiting and travel time between facilities are ongoing challenges. Wierheim said some QMHPs cover one to two weekends per month and others rotate to meet demand.

On budget impacts, the co‑chairs said Medicaid expansion and increased insurance coverage have helped reduce county hospital expenditures tied to mental‑illness holds. Commissioners and presenters noted that while holds may be increasing in frequency, net county costs have been dampened by improved insurance coverage among patients.

Why it matters: The Board of Mental Illness directs holds that can result in county-funded hospital days; rising hold volume and longer stays would increase county expenses absent offsetting insurance coverage or staffing changes.

Next steps: The board will continue tracking holds, days per hold, and staffing capacity; commissioners requested ongoing updates as April and subsequent months’ data become available.