Increasing civil commitment for the service resistant mentally ill and chemically dependent in Minnesota

Historical approach to mental illness and chemical dependency

Up through the 1960’s, Minnesota, like much of the nation, had developed a significant state hospital structure where some 16,000 patients were involuntarily held and treated across a system of 11 institutions – often referred to as asylums. Patients were committed as either mentally ill, chemically dependent or “mentally retarded” (now referred to as developmentally disabled). Many became wards of the state, some remaining confined in the asylums indefinitely.

That level of civil commitment was rightfully condemned.

President Kennedy signed the last significant legislation of his Presidency, known as the Community Mental Health Act of 1963 just days before his assassination. The Act sought to de-institutionalize those with mental illness and developmental disabilities and treat them in community settings.

In 1967 the Minnesota Legislature passed the Hospitalization and Commitment Act, which sought to overhaul and modernize involuntary commitment procedures and protect patient due process, building on the philosophy of de-institutionalization.

Then, in 1982 another legislative overhaul of the statutes governing civil commitment was completed. The Minnesota Commitment Act of 1982 officially ended indefinite commitments for most individuals, specified commitments based on the exact cause of disability, and required strict court findings that a person’s condition posed a likelihood of physical harm.

By 1984 the number of state hospitals had been reduced to eight (8) and the total population reduced to 4,000 patients, of which 2,182 were being treated for “mental retardation.” The remaining 1800 patients were being treated for mental illness or chemical dependency (MI/CD) – a cohort that had accounted for over 10,000 of the 16,000 patients just 20 years earlier.

In 2026, the number of MI/CD patients civilly committed to the state for treatment is down to about 270 – This cohort is served by just one state hospital – the Anoka Metro Regional Treatment Center (AMRTC) – and a series of other Community Behavioral Health Hospitals (CBHH’s) and Intensive Residential Treatment Services facilities (IRTS).

The only beds considered “secure” are the 96 beds in AMRTC, which are generally filled by justice involved individuals who have been committed there for purposes of restoring them to competency so they can face trial on criminal matters. (The 270 patient total excludes those committed under the Mentally Ill and Dangerous category often associated with violent criminal activity).

In 2026, there are virtually no developmentally disabled patients being held and treated in traditional “state hospitals” – rather the few developmentally disabled patients that are civilly committed each year are now predominantly treated in community-based group home settings.  

Reform has gone too far

The rate of civil commitment for the MI/CD cohort has gone from 303/100,000 in 1960, to 46/100,000 in 1984, to just 4.6/100,000 in 2026. According to the Treatment Advocacy Center, Minnesota ranks 49^th out of 50 in MI/CD state hospital civil commitment bed capacity.

The pendulum has swung too far leaving critical gaps in service for the toughest cases – service resistant MI/CD individuals who occupy today’s homeless encampments.

Failing to properly care for this cohort not only destroys their futures but also destroys neighborhoods as cities neglect their responsibilities to protect public spaces for all citizens.

Homeless encampments

There is a misguided narrative that activists have successfully created about homeless encampments – that they are the result of unaffordable housing and/or poverty. This narrative has led to the failed “housing first” and “harm reduction” responses to homeless encampments.

The fact is in Minnesota there are enough shelters and subsidized housing options available to accommodate everyone living in encampments. However, their addictions, coupled with the permissive environment and instant access to drugs that encampments offer, is a lure too attractive for many to pass up – leading to the inevitable inability to care for one’s basic necessities like shelter and food.

The encampments have also been taken over by street gangs who have recognized the value in having a territory that is both stocked with a constant stream of addicts and treated as a “no go zone” for law enforcement. The gangs profit from this human tragedy, exploiting the encampment occupants by feeding their habits and using them for human trafficking.

Adjacent neighborhoods suffer greatly. Mounds of trash and human waste fill the area. Discarded needles, open air drug use, robberies and assaults, thefts, and harassment are all commonplace in and around encampments. The environment creates a livability crisis for area residents and decimates local businesses. 

The path used by a city to recover from a homeless encampment is far more arduous than the path used to reject the existence of encampments. Encampments violate the social contract by ceding public spaces to addicts, and cities have the responsibility of preventing their existence.     

Fortunately, policy makers around the country are recognizing this problem and taking steps to address it by updating laws relevant to civil commitment. Increasing the use of this valuable tool is not only prudent, but it’s far more compassionate than allowing people who are hopelessly addicted to drugs to decompensate on our streets, sidewalks, and parks in the name of “personal autonomy.”

No one is advocating for a return to warehousing thousands of MI/CD patients indefinitely in state asylums. However, there is a responsible and compassionate level and duration of secure treatment under civil commitment. Regrettably, Minnesota is falling far short of that as evidenced by ever present homeless encampments.

Movement to increase civil commitment

Blue states like California, Oregon, and New York and red states like Texas and Utah are leading the way toward increasing the use of civil commitment as a means to help service resistant individuals populating homeless encampments.  These states have amended their laws to broaden definitions of danger to self and others and have begun taking more firm stances against the abuse of public spaces represented by encampments. Together these moves have focused on involuntary secure treatment, rather than a continuation of the failed policies that enabled the encampments and associated human tragedy to exist.

The federal government has also moved to incentivize this policy shift through the White House’s Executive Order, “Ending Crime and Disorder on America’s Streets.”  The order explicitly prioritizes federal discretionary grants for states and municipalities that enforce public camping bans and expand civil commitment laws.

Finally, nationally based policy organizations such as the Cicero Institute have also championed this change in policy through research and advocacy.

Minnesotan’s support change

In a recent poll taken on behalf of Center of the American Experiment, Minnesotans supported by a 2 to 1 margin the state “returning to providing more care in structured institutional settings” than continuing to emphasize “treatment in the least restrictive community-based setting.”

This result represents the sentiment of many who believe our mental health and chemical dependency treatment systems have left too many people without the care they deserve. As a result, these people cycle needlessly through emergency room visits, jail bookings, and a tragic existence living on the streets.

The path forward

Minnesota policy makers need to urgently begin our transition away from the failed “housing first” and “harm reduction” models and toward a “treatment first” model.

Steps to facilitate this transition include:

1. Expanding state hospital system capacity. This includes not only secure treatment beds, but step-down community-based beds to facilitate continued progress that begins in the secure setting. The optimal capacity rate for secure treatment beds is 50/100,000. While the increase is significantly higher than our current capacity of about 5/100,000, the benefits of this investment would include reducing the number of MI/CD who become justice involved, those who use emergency medical services, and those harming themselves and our communities by populating homeless encampments.

• Reforming Commitment Standards: Re-evaluate “least restrictive care” and “danger to self/others” thresholds that currently serve as prohibitors to involuntary civil commitment.
• Addressing Encampments: Target encampments as environments that thwart recovery and render “housing first” and other “harm reduction” strategies ineffective. Reject the practice of allowing “urban camping.”
• Recognizing the unique challenges and opportunities for intervention involving those suffering co-occurring mental illness and chemical dependency leading to unsheltered homelessness.
• Aligning with the federal government’s Substance Abuse and Mental Health Services Administration (SAMHSA) strategic priorities.

Takeaway

In the 1960’s Minnesota followed the nation by moving away from a state hospital system that had held thousands of mentally ill and chemically dependent individuals in asylums for indefinite periods of time. The intent was admirable, but the effort went too far by valuing “personal autonomy” above all else.

Over time Minnesota has gutted its state hospital system capacity. Minnesota now ranks among the states with the least state hospital civil commitment bed capacity.

As a result, Minnesota is failing its most vulnerable citizens – those MI/CD individuals who are harming themselves and our communities by resisting services and violating the social contract by living in public spaces. 

It is time for Minnesota policy makers to adopt compassionate strategies that value increasing the use of civil commitment in secure treatment settings for the most severe and service resistant MI/CD individuals.