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State relying more on smaller, local psychiatric hospital services

The psychiatric health care industry in the state is beginning to move toward smaller, more patient-focused inpatient units and the state of Minnesota is backing them up.

“Several years ago, the state started talking about wanting to move away from the large, regional treatment centers and provide care closer to home for patients with a mental health illness,” said Steve Schneider, manager of the Behavioral Health Department at New Ulm Medical Center.

In order to do that, the state decided to focus on three primary initiatives:

• Maximizing the use of private centers, such as the psychiatric inpatient unit at NUMC. Last year, 10 counties in south central Minnesota contributed two-thirds of the cost of the unit upgrading from five to 10 beds, said Schneider.
• Creating Community Behavioral Health Hospitals, such as the 16-bed psychiatric hospital that recently opened in St. Peter. Another is due to open in Rochester next month. In all, there are seven such psychiatric hospitals planned to open throughout the state by the end of 2007, Schneider said.
• Supporting individuals in their own homes, in an effort to keep hospital stays short. At the time the state began this initiative, NUMC started to offer Adult Rehabilitative Mental Health Services (ARMHS). “We are one of two providers in Brown County to offer this type of service, the other being Sioux Trails Mental Health Center,” Schneider said. “There are now well over 100 providers of these services in the state. This is only funded right now through medical assistance, so there are some limitations in terms of the population we can serve.”

All these initiatives are a sign of the direction psychiatric care is going, Schneider said.

“In the past, the St. Peter Regional Treatment center covered an area all the way over to Wisconsin and down to the Iowa border – a huge area,” Schneider said. These new smaller, community-based units will have the capability of being designed the way those in the mental health profession feel they need to be, with more of a patient focus. They will also be more economical to run, Schneider said.

As the state becomes more successful in localizing psychiatric care, it will more easily accommodate family participation for the patient, Schneider said. “If the patient is a new admission, we work with the family to get their background information. We also work closely with the family upon discharge of the patient to provide information to the family and recommendations for continuing care. Family involvement is important,” Schneider said. That involvement is much more feasible when the family is located within miles of the facility, rather than on the other side of the state.

“It is also important for us to be able to identify ongoing resources for them after hospitalization,” Schneider said. “It’s just common sense that we are more familiar with the resources in our own area than we are with the resources up in the Twin Cities.”

The mental health field has been in a supply and demand crisis for some time now: too much demand and not enough supply. “Some hospitals end up keeping patients in their Emergency Departments longer than they should or putting patients on their medical/surgical units with one-on-one staff until they are able to locate an in-patient behavioral health unit with a bed available for them,” Schneider said.

This same supply and demand crisis is seen locally. At New Ulm Medical Center, statistics show the psychiatric unit has been turning away 40-120 patients a month in the first half of the year, because of bed availability. Very few of these patients who are being diverted are actually presenting to the medical center in person, Schneider said. Most are being turned away when the psychiatric unit receives a phone call, usually from the Twin Cities or Mankato, looking for an available bed.

“There are task forces up in the Twin Cities working on enhancing the community resources for these folks, including mobile crisis teams who will be able to go out to these people and help them through a crisis before hospitalization becomes necessary,” Schneider said. “They are looking at how we keep people out of the hospital – or if hospitalization is necessary, to identify that need before the person decompensates and then requires a longer length of stay.”

The state has also opened up a 10-bed unit in Mankato called a crisis center. It is not a hospital, it provides a lower level of service for those who don’t quite need hospitalization, Schneider said. It is meant to meet some of the needs of people before they get to the point of needing hospitalization.

There is also the complex problem of the shortage of psychiatrists. The problem starts with reimbursement that is provided for psychiatry services through both private and government health plans, Schneider said. “Reimbursement for mental health services is not the greatest, so we can pay to psychiatrists is often not as great as what we can pay for other medical specialties, resulting in a shortage of physicians choosing psychiatry.”

“But, there is a glimmer of hope. There is movement in the direction of improving that level of compensation. We know it will take a long time for the supply to catch up with the demand,” Schneider said. “In the meantime, there are a lot more clinical nurse specialists being trained. These are mid-level practitioners who can function very independently in the behavioral health domain. The state has recently come forward and said they would provide reimbursement for services provided by clinical nurse specialists on behavioral health units. We are hoping that medical plans will follow suit. These specially trained nurses are able to help fill the void left by not enough psychiatrists.”

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