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State to increase capacity for mental health care

Additional psychiatric beds will open at Minnesota's state-run mental health hospitals under a plan recently approved by the Legislature, a state news release reported.

The plan is in the early stages of implementation at the Minnesota Department of Human Services.

In response to rising demand for inpatient care, DHS will gradually bring the state's network of Community Behavioral Health Hospitals up to full operating capacity. The change—part of Gov. Mark Dayton's budget package approved earlier this year—will add another 12 psychiatric beds systemwide. In addition, 20 beds at the Anoka-Metro Regional Treatment Center will become available as patients who no longer need treatment in a hospital are treated at a new program that provides a less intensive level of care.

"Last session, I called for this essential funding to improve care and safety for patients and employees at Minnesota's Community Behavioral Health Hospitals, adding critical capacity to our state's mental health services," Dayton stated in the release.

The changes come as the Community Behavioral Health Hospitals in Alexandria, Annandale, Fergus Falls, Rochester and St. Peter celebrate 10-year anniversaries in their communities. Facilities in Baxter and Bemidji will mark that milestone in the first half of 2017.

"The shortage of psychiatric beds and community-based services statewide is a serious long-term problem," stated Human Services Commissioner Emily Piper in the release. "While this isn't a complete solution, it is a meaningful step in the right direction."

Each hospital is licensed for 16 beds, but funding from the Legislature has kept the hospitals from admitting more than 12 patients at a time. Under the new plan, facilities in Alexandria, Annandale, Baxter, Bemidji, Fergus Falls and Rochester will receive funding to operate at full strength. The CBHH in St. Peter stopped admissions Saturday and will close in early November. Its budget will be reallocated to the remaining hospitals.

Even though one facility is closing, the system's overall capacity will increase, the release stated. At the same time, a new competency restoration program slated to open in St. Peter will care for patients who do not need treatment in a hospital or secure facility. That, in turn, will free up beds at the Anoka facility for patients who need acute psychiatric care.

"The plan makes the best use of our limited resources," stated Piper in the release. "Even a modest increase in beds is a welcome relief in an over-strained system. We'll get more people into treatment sooner."

The ramp-up to full capacity will take place gradually as administrators at the CBHHs and the new Competency Restoration Program are able to recruit, hire and train new staff.

The community behavioral health hospitals were established as Minnesota moved away from a system of large regional treatment centers in favor of smaller, more patient-centered, community-based facilities. The central idea was that patients would fare better if they received treatment as close as possible to their home, community and supportive family and friends.

The model has proven effective, according to the state.

Since their inception, CBHHs have treated about 11,500 patients, the vast majority of whom tend to spend far less time in the hospital, are able to return sooner to their homes or to a facility with a less intensive level of care, and are far less likely to be readmitted to the hospital within 30 days of their discharge.

Locally, statistics on the CBHH in Baxter show the total number of patients treated is on the decline alongside the number of beds, and those patients originating from six surrounding counties has also steadily decreased.

Statistics provided by Crow Wing County show in 2011, 93 of 190 patients served in Baxter originated from Aitkin, Cass, Crow Wing, Morrison, Todd or Wadena counties. So far in 2016, seven patients of 48 served were local.

In August, employees within Crow Wing County Community Services expressed concerns with the impacts of reduced availability of beds and its financial implications for counties.

In 2015, the Legislature approved a cost shift that made Minnesota counties fully responsible for a cost once shared with the state. That cost is derived from the care for patients at the Anoka facility who no longer meet medical criteria for facility-level care.

The state-licensed psychiatric hospital is one of the facilities where Crow Wing County residents are placed when in need of hospitalization for mental health care. Once Anoka staff determine a patient no longer meets the medical need to stay at the facility, the meter starts running for the county of residence—even though, according to adult services supervisor Tami Lueck, it's often seven to 10 days before notification of the change in patient status is received.

At $1,309 per day for care, the costs add up quickly. Eight patients from Crow Wing County were receiving treatment in Anoka between July 2015 and June 2016. Of those, six were discharged for no longer meeting medical need. The quickest discharge took a week, while the longest discharge took 62 days. That lengthy discharge time alone cost county taxpayers $81,158.

More patients were headed to Anoka because of the reduced number of available beds at CBHHs, according to Lueck. Typically, she added, beds at the Anoka facility were reserved for those requiring a higher level of care or were more medically fragile.