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The 2022 session of the Minnesota Legislature didn’t exactly end in stellar fashion. With primaries looming and the general election less than six months away, the DFL-led House and the GOP-led Senate didn’t agree on much.
But as the clock approached midnight on May 22, our legislators did manage to unite behind a $93 million plan to address the state’s growing crisis in mental health care. The plan includes funding for emergency room beds for children and teens experiencing a mental health crisis; loan forgiveness for mental health professionals; grants for schools and shelters that provide mental health services; and funding for an African American mental health center in North Minneapolis.
Those all sound like solid investments – but the biggest decision made by the Legislature regarding mental health care is likely the least understood.
The same law that created the programs listed above also approved an exemption to the state’s decades-old moratorium against any project that would increase the number of licensed hospital beds in Minnesota.
If your response to the above sentence is “Um, what?” then you’re not alone. Outside of hospital administrators and elected officials, few Minnesotans likely are aware that in 1984, the state passed a law prohibiting any increase in hospital capacity – including new hospital construction – without approval by the Legislature. According to the Minnesota Department of Health, the moratorium was meant to limit “investment in excess hospital capacity.”
Given everything we heard about overcrowded hospitals during the COVID-19 pandemic, you might wonder why anyone would oppose “excess hospital capacity,” but there is a certain logic in the moratorium. If a region has too many hospital beds, the resulting rise in staffing requirements and decrease in occupancy levels can cause worker shortages, increased costs and the inability for the poor to afford hospital care.
Put more simply, one hospital that consistently operates at 85% capacity will be more efficient (and provide better care) than will two half-empty facilities. That’s why 35 states have systems in place to regulate the expansion of hospital capacity.
But the moratorium is flexible. Since 1984, the Minnesota Legislature has granted 28 exemptions to it – including the one it approved in May that will allow Fairview Health Services and Tennessee-based Acadia HealthCare to build a freestanding, $62 million 144-bed inpatient mental health facility in St. Paul.
This is a big deal, and again, it’s OK to ask, “Why would anyone oppose this project?” Private health care companies will pay for the facility, and there is universal agreement that Minnesota has an acute shortage of beds for patients who require short-term or long-term mental health treatment.
But the devil is in the details, and this week the Minnesota Department of Health raised a number of significant concerns before giving the project a rather lukewarm stamp of approval – without which the project would have been dead in the water.
Among MDH’s concerns and questions are these:
- The new facility will not have an emergency room, which means that patients who have a medical emergency during a mental health crisis will need to go elsewhere for immediate care.
- The facility will use a for-profit model, which means it will likely have a “lean” staffing model compared to other hospitals in the area.
- The new hospital could negatively impact the financial well-being of other hospitals in the region.
- Will the new hospital provide care to low-income and/or homeless patients who currently aren’t being served by other hospitals?
That last item is crucial. On any given night, roughly 20,000 Minnesotans are homeless, and nearly two-thirds of those people have some form of mental illness. When they walk into an emergency room, or when they arrive via ambulance or police car, their needs are acute, but all too often they are discharged or leave the hospital when the immediate crisis has passed – only to return, time and time again.
That cycle is bad for the patient, bad for the hospital and bad for everyone whose health care costs rise as a result of uncompensated care.
So, once the new hospital is built, the MDH will monitor it closely to determine whether it is caring for patients who are on Medicaid or who have no insurance at all. After July 31, 2027, MDH will issue a report to the Legislature regarding the facility’s quality of care and how its creation has changed access to mental health care in the region.
By that time, regardless of the facility’s performance, it will likely be too late for the state to say “Nope, we’re shutting you down.” Still, we’re optimistic that close scrutiny of a brand-new mental health facility will provide a template (as well as a list of mistakes to avoid) for future, smaller facilities in other parts of the state, because this new hospital probably won’t help people who are living in tents in Duluth or under bridges in Rochester.
This crisis was decades in the making. Minnesota began closing its state-run mental hospitals in 1978, including Rochester’s in 1984. While we won’t disagree with this shift toward smaller, less-expensive, community-based facilities, this patchwork system has not kept up with the growing demand for long-term inpatient care.
We hope that the new hospital in St. Paul will be a major step toward solving this problem, but we are reminded of a familiar adage: “Trust, but verify.”
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