JEMS.com Editor s Note: Frequent fliers and mental health patients are often one in the same. For another story on EMS transports of mental health patients in Texas, click here.
ST. PAUL, Minn. -- A proposed psychiatric hospital in Woodbury, Minn., has accelerated a long-running debate in mental health care: Does Minnesota need more inpatient beds, or can it replace them with cheaper community treatments that keep people safe and stable at home?
The question has persisted nationally since federal legislation sought to deinstitutionalize mental health care 40 years ago.
But recently, it has moved to the forefront as the state's psychiatric beds have filled up and unstable patients have been left waiting in emergency rooms, medical beds and even police squad cars. And the dispute is unavoidable now that Prairie St. John's is proposing a $22 million suburban hospital with up to 144 beds.
If implementing a community-based mental health system is possible, then Prairie St. John's could take Minnesota in the wrong direction and distract attention and divert money from needed reforms. But if a true community system is only fool's gold, then turning down the bid for a new hospital would deepen the state's mental health crisis.
"People are looking very thoughtfully at this," said Sue Abderholden of the National Alliance for the Mentally Ill's Minnesota chapter. "They're saying, 'Let's really think about this in the bigger picture' and 'What do we want the mental health system to look like in 10 or 15 years?'"
A key decision on the psychiatric hospital is expected next month. It cannot be built without Legislative approval, and no vote can take place until the Minnesota Department of Health decides whether it is a public need.
Prairie St. John's proposal comes amid the first signs of progress toward a community system of care. Gov. Tim Pawlenty's 2006 mental-health-reform package leaned heavily on mental health care in schools and communities, and the Legislature in 2007 approved $34 million in new investments.
State and private health plans are funding more nontraditional forms of care, such as assertive community treatment, which is a round-the-clock program to help the mentally ill with symptoms, medication, housing, work and daily living.
A task force of east metro mental health providers and county officials met for the first time last year, with a working goal to increase access to crisis shelters and reduce the need for psychiatric beds.
"After working in this field for 30 years, this is our shot to do something different," said Kathy Knight, who directs behavioral health care for the Fairview system.
Some authorities have heard promises before, though, and see no results. Psychiatric units are still full statewide, leaving unstable patients stranded. When beds open up, typically they are far away.
Anoka County deputies often work from 4 a.m. to midnight transporting psychiatric patients to and from Prairie St. John's hospital in Fargo, said Sgt. Eric Herschberger, who directs the sheriff's transport unit.
A decade of meetings on community care hasn't changed things, he said, so maybe Prairie St. John's has the answer.
"We've spent a lot of time admiring this problem," Herschberger said.
Ambulances are overwhelmed, too, according to a November report from the Minnesota Emergency Medical Services Regulatory Board. Run times are 51 percent longer for ambulances when they're carrying mentally ill patients. Such transports increased 23 percent from 2005 to 2006.
Prairie St. John's leaders don't believe it's an either/or situation. Minnesota is 500 psychiatric beds short of the national average, according to one study. Community programs alone won't address this shortfall, said Dr. Stephen Setterberg, founder of Prairie St. John's.
"Patients can wait up to three days in an emergency room for a psychiatric bed," he said during Tuesday's state public hearing on the hospital plan. "This is clearly not the right care at the right time."
The hearing revealed the desperation of some families under the current system. One mother showed up to say that her daughter, at that moment, had been waiting for three nights for a psychiatric bed.
Nurse Jenny Johnson said it's frustrating to see patients waiting in medical beds with limited care. It's been more frustrating as a mother, because her mentally ill daughter has been denied timely care, even when she threatened to kill herself and Johnson had to call police.
"We need the help," she said.
More beds might be an easy fix, but they would fill up with patients who would then be stuck without more community housing options and treatment programs, Knight said.
"If we have more beds, it'll tide us over," she added. "What I think it will do, though, is take the energy out of the system for real change."
Knight said Fairview recently had 16 open beds but couldn't admit patients because there were no psychiatrists available to monitor them. She said a shortage of psychiatrists is the greater problem.
To compensate, she said, family doctors could change how they manage mental health care to prevent crises.
HealthEast opposes the Prairie St. John's plan, which could siphon patients and resources from hospitals that are trying to invest in changes, said Joe Clubb, HealthEast's director of behavioral health services.
Reforms won't stop if the hospital is built, though. Prairie St. John's could even cooperate with reform efforts, Clubb said. Also, local hospitals could learn from Prairie's successful recruiting of psychiatrists to Fargo.
Setterberg said that Prairie St. John's will add outpatient mental health services but that crises will occur and beds will be needed. He recalled a psychotic patient who received 150 stitches in an emergency room to close the cuts he made to his wrists and thighs. His family was told to take him home until a psychiatric bed opened.
"You don't have to be a psychiatrist," he said, "to know how dangerous that was."Jeremy Olson can be reached at firstname.lastname@example.org or 651-228-5583.