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Hospitals strained by ailing mental health system

Free Press - 11/12/2017

Nov. 12--MANKATO -- An Essentia Health hospital in Brainerd was recently criticized for turning away certain patients with severe mental illnesses from its psychiatric units, but it's far from the only health center in Minnesota feeling the strain of the state's ailing mental health care system.

The controversy in Brainerd revolves around patients who've been court ordered to receive mental health care. The hospital highlighted in a recent Star Tribune story opted to only take in patients who voluntarily sought treatment to its 16-bed psychiatric unit.

With capacity at a minimum in psychiatric units, the hospital argued the civilly committed patients were taking up beds that could be used for other patients.

Hospitals in southern Minnesota have reported similar challenges, although none has gone as far as to divert certain patients in favor of others.

Bruce Sutor, clinical practice chair for psychiatry and psychology for Mayo Clinic, said even hospitals without psychiatric units are impacted by a mental health system that isn't keeping up with the needs.

"It's the case really statewide," he said. "So it's Rochester, it's Mankato, in fact it's every hospital that has an emergency department whether they have a psychiatric unit or not."

Hospitals are typically obligated to care for patients who come in reporting a mental health crisis. A 2013 law, however, also requires the state to transfer inmates found to have mental illnesses to a state psychiatric bed. The idea was these patients would be far better served in state facilities or hospitals than in jail.

The problem is there aren't enough beds at state-operated facilities to handle all these civilly committed patients, according to a 2016 Minnesota Hospital Association report on "avoidable" mental health days spent in hospitals. As much as 19 percent of bed stays at hospitals included in the study -- Mayo Clinic Health System in Mankato among them -- were found to be avoidable.

If the private hospital doesn't have a psychiatric unit, or they can't find another unit to transfer the patient, an emergency room bed is sometimes the only option -- Essentia later announced it would still treat civilly committed patients in their Brainerd ER if needed. Critics contend that, just like jails, this isn't an ideal venue to treat the patient.

Sutor and other health care officials said they see the 2013 law as just a symptom of an underlying mental health problem facing the state. It started decades back as Minnesota shifted away from larger state mental health hospitals. The state rightly stopped "warehousing" patients by closing these facilities, Sutor said, but not enough beds were added elsewhere to make up for the loss. It left a shortage of beds that still hasn't been addressed.

At Mayo Clinic Health System in Mankato, the psych unit consists of 14 beds. Other hospitals in the region with psychiatric units include Allina Health's 10 beds each at New Ulm Medical Center and Owatonna Hospital.

Sutor said Mayo's psychiatric beds are consistently 90 percent full. Paul Goering, vice president for the mental health and addiction clinical service line with Allina Health, cited the same percentage for his health care system's 300 beds statewide.

These capacity issues led the Minnesota Hospital Association and Minnesota Department of Human Services to create a mental health service locator website. When no beds are available for a patient, this resource is used to find one elsewhere. It can result in a Bemidji patient being transported to Mankato and vice versa.

"It's not uncommon that all the beds for Allina will be full and all the beds in the metro will be full, and then we do find alternates," Goering said.

Being so far away from their support systems back home raises a whole new set of issues, but it at least connects them with care.

One of the concerns surrounding St. Joseph's Medical Center in Brainerd's September decision to stop admitting certain patients to its psychiatric units was how it could further burden other hospitals.

"I have heard from health care executives and seen firsthand the real strain that these highly challenging patients put on hospitals across our state," said Emily Piper, the state's human services commissioner in a statement. "But denying them treatment will only shift the problem to other hospitals, whose emergency rooms and psychiatric units will be even more overtaxed."

She also expressed fear other hospitals might follow suit. Sutor for Mayo, and Goering for Allina, confirmed their health systems have no such plans.

"All of our facilities are committed to continuing to work with these folks," Sutor said.

No other health care systems in the state have publicly indicated otherwise. Without solutions, though, the strain won't disappear on its own.

Goering said St. Joseph's decision should be seen as another example of the troubled state of Minnesota's mental health care system. He and Sutor both serve on the governor's mental health task force.

Sutor suggested more mental health resources in schools, continued police training for dealing with people with mental illnesses, and establishing more permanent funding streams rather than five-year grants for mental health programs are among the first steps needed to fix the issue.

Goering said he just hopes the Brainerd hospital situation spurs continued focus on the problem, rather than fleeting interest.

"If this helps us garner attention and pick up momentum for gaining better services, that would be the one good outcome that could come of this," he said.

Follow Brian Arola @BrianArolaMFP.


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