Bed shortage for inpatient psychiatric treatment impacting care and access, lawmakers hear

When someone has a heart attack, they don’t worry about whether they’ll be able to find a hospital that will treat them.

“You only worry about an open bed when you have mental illness,” Sue Abderholden, executive director of NAMI Minnesota, told the House Behavioral Health Policy Division Wednesday.

And those issues are only expected to get worse as more people struggle to cope with the effects of the COVID-19 pandemic and need more intensive care, testifiers said.

“The total capacity of inpatient beds in Minnesota is inadequate, and the distribution of those beds across geography and systems is inequitable,” said Rep. Peter Fischer (DFL-Maplewood), the division chair.

Hospital beds for inpatient psychiatric treatment are only necessary in urgent and extreme cases requiring a high level of care, and the number needed across the state could ideally be lessened through early intervention and improved access to intermediate care options — like residential treatment centers and group homes, said Dr. Michael Trangle on behalf of the Minnesota Psychiatric Society.

But that doesn’t change the fact that current availability is not sufficient to meet the population’s needs.

The state needs more beds at Anoka Metro Regional Treatment Center, in intensive residential treatment services, chemical dependency treatment, community behavioral health hospitals, and group homes — though specific needs vary by region, Trangle said. 

Jenelle Zern testified that when her 15-year-old daughter — adopted from foster care — recently had a mental health crisis, a local crisis home said they were not able to serve children or youth and couldn’t connect the family with any other resources.

The family contacted police three times, but were only able to get help moving their daughter to an emergency room after finding evidence of self-harm. Even then, it still took more than 24 hours to find an open inpatient psychiatric bed 670 miles away.

“The thing is we don’t live in a rural area … we live 10 miles north of Mankato,” Zern said.

But finding a solution is far more complicated and nuanced than simply “open up more beds.”

For one, qualified and competent medical professionals are needed in order to properly staff facilities and the state faces a shortage of mental health professionals.

“We can build as many [Intensive Residential Treatment Services] facilities and other options as we want, but if we don’t have the licensed staff to take care of people, it doesn’t do us any good,” Rep. Jamie Becker-Finn (DFL-Roseville) said.

Minnesota also has a moratorium on new hospital beds, so for new beds to be added, hospitals have to get exceptions from the state. But Minnesota doesn’t regulate what services are delivered, or at what volume, or regulate closures, State Health Economist Stefan Gildemeister said.

Moreover, current reimbursement systems for those services — especially for Medicare and Medicaid patients — can make high numbers of mental health beds financially unsustainable for hospital systems, M Health Fairview said in a written statement.

Potential bed closures at M Health Fairview’s St. Joseph’s Hospital campus in St. Paul is a source of major concern among testifiers.

“I know there’s an old adage, ‘measure twice, cut once,’” Trangle said. “I think Minnesota has been cutting all the time and not measuring at all. And then we find ourselves in a mess ... and we don’t need to, if we devoted some resources to periodically measuring … the need.”