State deals with lack of resources for mental health

by Yelena Kibasova

People suffering from mental illness continue to struggle through Minnesota’s complex mental health care system.

Hospitals also are struggling to provide adequate care because of a shortage of beds, a lack of psychiatrists and inadequate funding. But there is hope that Gov. Tim Pawlenty’s $109 million mental health proposal will pave a clearer path for patients.

There is a constant shortage of beds in mental health facilities, with hospitals taking in more patients daily than they can accommodate.

Hennepin County Medical Center fills all of its 87 beds with an estimated 90 patients checking in daily, said Janet Andrews, a psychiatrist and medical director of the center’s Acute Psychiatric Services.

Andrews said some patients have to wait in chairs or the hospital staff has to lay mattresses on the floor to accommodate patients. The hospital also sends its overflow patients to the emergency department. This limits beds for other types of patients.

University Medical Center, Fairview, has 98 adult inpatient psychiatric beds and 18 adolescent beds that are filled daily.

But Pat Murphy, program director of behavioral services at Fairview, said the problem isn’t so much the number of beds as it is the number of inpatient psychiatrists.

“It’s a nationwide shortage of psychiatrists; it’s kind of a two-pronged deal,” she said. Not only is there a bed shortage, but also often there aren’t enough doctors to attend to those beds, she said.

Murphy said more professionals are going into outpatient psychiatry versus inpatient possibly because of the working conditions.

“It’s hard work,” she said. “Would you rather work in an office Ö or would you like to make rounds every day?”

Sharon Autio, director of mental health services at the Minnesota Department of Human Services, said the state is looking at how it can better utilize the psychiatrists it has.

She said the state is working to use psychiatrists as consultants to other medical professionals. They are using technology such as video conferencing to confer with those physicians.

“It would allow for Ö nonpsychiatrists to get consultation from psychiatry by the use of this technology,” Autio said.

The state also is working to give psychiatrists more reimbursement for the services they provide, which will increase recruitment in the profession, she said.

But the mental health system appears to have even more quirks. Andrews said the shortage of beds is also a result of state hospital closings.

“The state Department of Human Services has made some decisions about how they plan to provide mental health care,” she said.

Patients who need long-term care typically are sent

to state hospitals. Because of the closures, patients have fewer places to go for long-term treatment. Therefore, the state basically has set up a “revolving door situation,” Andrews said.

“We have sent people as far as Fargo,” Andrews said. “We do this on virtually a daily basis.”

This removes patients from their support system because it takes them out of their community, she said.

Andrews said Hennepin County Medical Center assesses all people who come in. If the patients are imminent dangers to themselves or others, or are not able to take care of themselves because of a psychiatric condition, they need to stay at a hospital.

The mental health system has moved away from asylums to less restrictive environments since the 1970s and ’80s, Andrews said. But her concern is that the pendulum has swung too far.

“We need to come back to the center ground so that we provide the appropriate level of care for the individual patient,” she said.

Andrews said the bed shortage has been going on for at least two years. She said it’s only in the past three or four months that it reached such a critical level. This is caused by the state hospital closures.

“There will be literally no long-term care facility,” Andrews said. “(Patients) are backing up in community hospitals.”

But Autio said the state is not closing state hospitals, but instead replacing them.

“We are vacating some of the old campuses and developing 16-bed, inpatient units closer to people’s homes in their community,” she said.

She said the state does not plan to vacate the facilities until the new community behavioral health hospitals are in place.

Autio said there have been some changes in the adult mental health care system that may be causing some of the accessibility problems.

“I think people are still learning how to access some of these newer services, and I think that that’s also maybe impacting a little bit in terms of referral patterns,” she said.

The proposed funding will go toward expanding crisis services across the state that would provide earlier intervention.

The state also will develop an online monitoring system for local hospitals.

“There may be beds that people are not aware of,” she said. “You’d go onto the Web and find out what services are available and where there are openings.”

Andrews hopes money will be properly allocated.

“It has really reached a critical mass effect,” Andrews said. “It’s really to the point where it’s dangerous what’s happening – we are overwhelmed.”

Autio said that if the proposal makes it through the Legislature, Minnesota’s mental health system will experience changes by the end of the year.