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Study: One in five mental health patients misplaced in Minnesota hospitals

DULUTH, Minn. -- Nearly one out of five patients in mental health units at Minnesota hospitals could be better served elsewhere. So says a study released Thursday by the Minnesota Hospital Association. The finding is significant at a time when th...

DULUTH, Minn. -- Nearly one out of five patients in mental health units at Minnesota hospitals could be better served elsewhere.

So says a study released Thursday by the Minnesota Hospital Association.

The finding is significant at a time when the state’s hospitals are overrun with mental health and behavioral health patients.

“We’ve seen a mental health and behavioral health crisis building over the last decade or more with a shortage of beds,” said Dr. Gary Peterson, chief medical officer at St. Luke’s hospital in Duluth. “We’ve seen this coming for quite a while.”

The study looked at the mental health units of 20 hospitals from March 15 through April 30 of this year. Of the 32,520 days spent in mental health beds during that time, the study’s authors identified 6,052 - or 18.6 percent - as “potentially avoidable.”

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Both St. Luke’s hospital and Essentia Health Duluth participated in the study.

Ideally, patients in a crisis situation can be stabilized in a hospital’s mental health unit for a few days, said Evan Janson, nurse manager for the psychiatric unit at St. Luke’s. If they then require longer-term treatment, they can be transferred to a facility equipped for that purpose.

But there’s a problem, said Dr. Peter Henry, chief medical officer for the Essentia Health system: “They don’t have an appropriate facility to go to.”

That’s because Minnesota’s specialized inpatient mental health facilities also are taxed to capacity, Henry said.

Hospital care is more expensive than care in long-term facilities, Peterson said, meaning health care dollars are misspent when mental health patients are kept in hospitals because there’s no alternative.

The 22 beds in the St. Luke’s psychiatric unit are full 70 to 95 percent of the time, Janson estimated, and when there is a vacancy, it’s filled soon. Patients have remained in the unit for upwards of 200 days, he said.

“We become a holding center,” Janson said. “They stay here for weeks or months at a time in a setting that really doesn’t meet their needs.”

Minnesota keeps a statewide registry of mental health patients so that if a bed opens anywhere in the state, the hospital has to accept the next patient in line. That can result in a patient being treated far from home even if there is a mental health unit in or near his hometown.

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At Essentia Health-St. Joseph’s Medical Center in Brainerd, where Henry is based, 52 percent of the patients in the mental health unit are from outside of the hospital’s five-county coverage area, he said.

“Our patients are being sent to Hastings (Minn.) and patients from Hastings are being sent here,” Henry said. “It doesn’t make sense.”

When patients in the St. Luke’s unit are from other communities, “you’re always worried about how are you going to get the patient back home,” Janson said. “Do they have a ride?”

The hospital association’s study actually understates the problem, Henry said, because it doesn’t include mental health patients who are being treated in hospital units other than the mental health sections because of a lack of space. At St. Joseph’s, mental health patients have been held in the intensive care unit or in the emergency room - one for as long as 13 days.

St. Luke’s doesn’t hold mental health patients in the ER, Peterson said, but it has placed them on medical floors when there was no room in the psychiatric unit.

The problem isn’t being ignored. In Duluth, the Amberwing Center for Youth and Family Well-Being opened in September 2012 as an outpatient mental health treatment facility for children and young adults. The 12-bed Birch Tree Center, which typically provides three to five days of care for adults in a crisis situation, is in its second year of operation. A consortium of agencies last spring proposed establishing a “triage center” for individuals in a mental health crises.

The state also has taken steps, Henry said, bolstering funding for the Anoka Metro Regional Treatment Center and the Minnesota Security Hospital in St. Peter and expanding the capacity of the seven smaller community behavioral health hospitals.

“Recent funding is a move in the right direction,” Henry said. “It’s our opinion at Essentia that it’s woefully inadequate, that it doesn’t come close to meeting the current needs.”

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The hospital association hasn’t placed a dollar amount on what it would take to reach adequate capacity, he said. But given the costs of inappropriately housing patients with long-term mental health needs now, he said, “I think it’s probably not as much of an investment.”

Gov. Mark Dayton established a task force on mental health in April and seemed to put his emphasis on prevention and spotting and treating mental illnesses earlier.

“We are fully supportive of that,” Henry said. “But that solution is a long-term solution. It doesn’t deal with the acute crisis over the next several years. … This is an immediate crisis.”

Related Topics: HEALTHESSENTIA HEALTH
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