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At Issue: No rooms for those in crisis

Published (3/28/2008)
By Patty Ostberg
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An emergency room visit could last hours for a mentally ill person in the middle of a crisis episode. After waiting, and waiting, the hospital might squeeze them into an available bed somewhere in the Twin Cities metropolitan area. More often, there aren’t any beds at all; and if there are, they’re probably located 60-plus miles from their home or out of state.

Data from a Department of Health report released in February shows that 2,600 patients from the Twin Cities metropolitan area traveled distances to receive psychiatric or chemical dependency care.

Some patients are even being discharged from emergency rooms despite being at high risk of harming themselves or others, simply because there are no beds, Roberta Opheim, state ombudsman for mental health and mental retardation told the House Health and Human Services Committee March 11.

“Mentally ill people deserve better than that, and they should not have to wait until they’re at death’s door to get a hospital bed,” she said.

A bill for more beds

Rep. Marsha Swails (DFL-Woodbury) sponsors HF3539 that would establish a 144-bed specialty psychiatric hospital, Prairie St. John’s, in Woodbury. Swails is convinced more beds are needed after hearing the story of a 16-year-old in her district who attempted suicide around Christmas 2006. After the teen was revived, her parents were told the closest mental health facility with open beds was in Duluth, more than two hours away from her family. They were forced to make a decision that no parent should have to make, Swails said.

The bill was approved and awaits action in the House Health Care and Human Services Finance Division. A companion bill, SF3429, sponsored by Sen. Kathy Saltzman (DFL-Woodbury), awaits action by the Senate Health, Housing, and Family Security Committee.

While HF3539 would increase the number of beds, hospital officials and doctors in the Twin Cities metropolitan area are saying it’s not more beds that are needed. Beds are at capacity because there aren’t enough psychiatrists to treat the mentally ill. Patients that are healthy enough to be released don’t have community housing or a place that will take them. A patient needing treatment can be left to wait in the hospital for days or weeks at a time.

Intermediate level care

Placing treated patients with complex health problems, such as having a mental illness and a disease like diabetes, can be especially difficult. There just aren’t enough aftercare community housing units to send these types of patients to because of continuing medical needs such as dialysis or diabetes treatment.

“Once acute care needs have been met, it’s a failure of care to delay discharge for lack of mid-level service,” said Kathy Knight, vice president of Fairview Behavioral Services. “The question is not whether the mental health system needs change, but whether 144 new beds in a for-profit hospital in Woodbury represents the change needed,” Knight said.

The Health Department report studied whether it is in the state’s interest to approve additional beds in Woodbury.

Through early intervention and the implementation of programs funded by the 2007 Legislature, more beds will eventually open. But the report acknowledges, “It will take time to transform the mental health care delivery system in ways that better serve patients.”

While hospitals plan to add 32 psychiatric beds and four chemical dependency beds in 2008, staffing these beds would directly compete with the additional beds in Woodbury.

Of Minnesota’s 87 counties, 70 are designated as Mental Health Professional Shortage Areas. According to the report, a new facility could “create additional competition for existing workforce resources.”

Funding and complex patients

The proposed new facility would be limited in its treatment of complex patients.

Of the 31,000 admissions for psychiatric care, more than 80 percent had other medical conditions. Whether those conditions would be severe enough to require hospitalization is unknown, but the new facility would not have “medical-psychiatry” units for patients with medical conditions, the report states.

Prairie St. John’s argues that there are other facilities like theirs in the state, and usually patients are medically stabilized at a hospital before being sent to psychiatric facility.

Providing care for those on public assistance would be more costly for the state because of limitations on federal reimbursement costs. Federal regulations only reimburse Medicaid fee-for-service enrollees ages 21-64.

The facility has said it will accept all patients on public assistance, but the additional cost to the state would be about $2 million per year, said John Ryan, special projects liaison for Prairie St. John’s.

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