Brainerd hospital will no longer admit severely mentally ill to psychiatric unit

A Brainerd, Minn., hospital is going to test whether it’s possible for a medical facility to treat only the “good” patients with mental illness and avoid any sort of backlash with the policy that prevents those who are not voluntarily seeking help from being admitted to the hospital’s psychiatric unit.

Essentia Health may succeed with the new policy at St. Joseph’s Medical Center in Brainerd because the severely mentally ill have very little constituency.

The Star Tribune reports the hospital will no longer accept patients who are civilly committed to the 16-bed psychiatric unit. These are patients who are held involuntarily, usually because they represent a danger to themselves or someone else. Instead, the hospital will accept only those who have less serious mental health problems.

[Update: A spokesperson for Essentia says those who are involuntarily committed will still be treated in the emergency department and, if need be, the intensive care unit until they can be moved to another facility with the ability to provide care. But a common criticism of Minnesota’s mental health care system is that psychiatric patients are held in an ER, for example, but are not able to get access to the comprehensive care available in a psychiatric unit.]

The new policy is going to ripple through the entire Upper Midwest because often patients are sent to Brainerd because there are no psychiatric beds in other hospitals.

Still think the mental health system isn’t sick?

“It’s discriminatory and I’m not sure how they can get away with it,” said Dr. Barry Rittberg, an assistant professor of psychiatry at the University of Minnesota. “This sends a message that they only want the ‘nice’ patients, and that will make it more difficult for the other hospitals.”

And that’s a challenge for the other hospitals; the experts figure it could force other hospitals to limit access to care for people who seek it voluntarily. But what about people who are sick?

“These are real people. They aren’t chess pieces,” said Sue Abderholden, executive director of the National Alliance on Mental Illness of Minnesota. “And they don’t just go away because you won’t admit them.”

The Star Tribune report says the crisis in available care intensified after the Legislature passed a law in 2013 requiring people sitting in jail who are judged to be mentally ill to be hospitalized for help within 48 hours. It has forced hospitals to keep the mentally ill hospitalized longer because there’s nowhere to send them.

“They are in crisis and should not be denied treatment as if they are an inconvenience,” Human Services Commissioner Emily Piper said in a statement to the Star Tribune.

There’s no help on the horizon.

At a forum in Brainerd last month, Senate Majority Leader Paul Gazelka, R-Nisswa, said there’s no mental health reform effort coming during the 2018 legislative session (it’s not a budget year).

It was at that forum where Sen. Carrie Ruud, R-Breezy Point, revealed the hospital’s new policy while calling it “grassroots reform,” the Brainerd Dispatch reported.

The shift to voluntary patients will open up beds for local residents and make the hospital staff safer, since patients will want to be in the facility, Ruud said. It may also help alleviate the psychiatrist shortage by making the facility a more attractive place to work, she added.

There apparently is no good answer to the question of what happens to the people who are severely mentally ill?

  • Gary F

    Its not just a battle over mental illness patients, its all patients that require a higher grade of service.

    The new business model is to push the higher maintenance patient, no matter what the illness, higher up the system to the larger main hospitals. Whether its security or fancier machines, and the staff to do the job right, is the challenge today.

    Which diseases/illness, and to what level of care is needed, and to what level of hospital can properly address those needs, is going to be the big challenge in the future.

    • There aren’t beds at the “larger main hospitals”. That’s why they end up in Brainerd or Fargo.

      • AL287

        There are beds. At Mayo Clinic in Rochester. The Generose building was brand new when I did my psychiatric clinicals there in the 90’s.

        But John Noseworthy prefers privately insured patients over public assistance patients.

        http://www.startribune.com/mayo-ceo-s-private-insurance-preference-draws-state-scrutiny/416397343/

        Mental health parity was one of Paul Wellstone’s primary goals when he was senator and he got it done requiring insurers to cover mental diseases like any other disease process.

        • Carolie

          He started it, but didn’t get it done. It got done a while back, but parity remains largely unenforced and ignored. And if the party in the white house gets their way with healthcare it will be meaningless because mental health treatment will be removed from the “essential benefit set”, just like birth control and pregnancy.

  • Nick

    Senator Carrie Ruud is unfit to be making decisions about mental health policy in this state. Her ignorance would be laughable if it wasn’t so harmful and cruel.

    Clearly she’s never had a family member experience a mental health crisis.

    • Carrie Ruud

      Nick so easy for you to judge people that you know nothing about. At the League of Women Voters We had a thoughtful conversation and we did discuss the plan for those in crisis and many other things not represented by this author that has never spoken to me
      My younger sissy was diagnosed and misdiagnosed since she was in Kindergarten. She was what we now call Bi polar In those days there wasn’t much help at all and she bounced from crisis to crisis many times spent in the Grace unit. She led a very tough life and unfortunately passed at the early age of 50. Her name was Ginger and don’t you ever judge someone that you know nothing about – what a jerk!

      • Nick

        So your quote in the above article is accurate. You support health care rationing when it comes to those with severe mental health conditions and in the midst of mental health crises.

        And I’m the jerk?

        I guess your comment just makes my original point, underscoring how bizarre your public position is given your personal experience.

      • Laurie K.

        I understand that you feel you were judged by Nick’s post, but I would have expected more professionalism from an elected official. Has name calling become such a part of the political culture that you feel you can behave the same way outside the political arena?

  • rosswilliams

    The article says the hospital reports the changes will allow it to serve 200 additional patients who voluntarily seek help for mental health problems. Where will those people go if they can’t get care at the Brainerd hospital? The article doesn’t say.

    Our health care system is broken only for patients. Its working quite well for the people who manage it. Like many of our other institutions both public and private. The problem is that people lack any effective levers of power to create change that serves the broader public interest or even their own interests in many cases.

    • Mike

      Your comment is all too correct. All the recognized levers of power in our society are controlled by the wealthy and large corporations. One might call it oligarchy, except we reserve that term solely for Russians we don’t like (an example of how language works to reinforce the power structure).

      At some point, however, people are going to stop buying into the system, psychologically speaking. Whether that will bring about moderate change or something more radical is anyone’s guess.

      • rosswilliams

        I think people already have stopped buying in. That’s part of what elected Donald Trump. I think most people have completely abandoned the notion that we are engaged in self-government. Whether you are an investor, consumer, worker or voter, your only power is to select from choices created by the wealthy and powerful for their own benefit.

        • Mike

          Agreed. The often-ignored story of the 2016 election is how many people on the left side of the spectrum just didn’t turn out. That suits the oligarchy fine; they get to offer you an illusion of choice (democracy!), but they control the process. This is how so many things operate in our allegedly free society. It’s all Coke v. Pepsi.

          • rosswilliams

            I don’t think it was ignored, it just wasn’t part of the narrative that attributed Trump’s election to poorly educated, rural white males. That false narrative allowed a bunch of well off, white, college educated, urban men and women to pretend that it wasn’t people like them that made up the bulk of Trump’s vote.

          • Mike

            Yes, the white, rural working class has become the scapegoat for Trump’s victory, when in fact his base was much broader than that.

            However, I do think the lower turnout on the left/liberal side of the spectrum has been ignored by the Democratic Party establishment. They show no indication of having learned from their mistakes. That’s because the party fundraisers don’t want to nominate anyone genuinely advocating progressive policy. They’ve turned the party into a zombie; it exists mostly to raise money and enrich its insiders.

          • rosswilliams

            The Democratic party is the party of Harvard and Yale. Walter Mondale was its last presidential nominee that hadn’t attended one of those institutions. And Thurgood Marshall was the last Democratic appointment to the Supreme Court that hadn’t attended one of those law schools. And have you noticed the education background of the DFL Governor and Senators from Minnesota? The problem is not really a “left/liberal” problem. It is, one of insiders vs outsiders. And as Larry Summers told Elizabeth Warren (both Harvard), “Insiders don’t listen to outsiders.”

          • Thread drift.

          • rosswilliams

            Drift? More like raging current. But the reason problems like this never really get solved is that their aren’t solutions that benefit insiders.

  • Lindsey

    So, by treating those who are not in acute crisis, they will be able to treat more patients? But, the healthcare costs of those that they turn away is going to go up dramatically.

    • rosswilliams

      That is the standard successful business strategy. Make certain the costs and other burdens are shared equitably (or paid entirely by someone else) while keeping the rewards for yourself.

      • Lindsey

        The fact that healthcare is a business baffles me daily.

  • Beth-Ann Bloom

    Good thing there are lawyers and advocates who will be able to sue this “hospital” for discrimination!

  • AmiSchwab

    and what patients with other “not nice” illnesses wil be turned away next?

  • Mark A Gustafson

    I also belive it is about thier bottom line. The “72 hour hold” they get them stable out and out the door and get another bed ready. I remember my stays for three days were easy 2k plus. From top to bottom there is a problem whether in shotage of doctors, beds, fundings, or after care. I remember waiting hours for a bed to open and being transfer hours away to a bed. I view it as like a doctor saying he or she will only take on only the healthier patients and those with cancer they won’t treat.

    • kevins

      Be well.

  • Laurie K.

    Sadly, in a lot of cases those who are severely mentally ill and turned away by the health care system will wind up in our nation’s second mental health care system – the criminal justice system. Where, due mainly to their mental illness and their inability to assist with their own defense, the majority will wind up spending twice as long in prison/jail as those who are charged with identical crimes but suffer no mental illness.

    • Bonnie Barnes Slaughter

      Actually, mentally ill people under commitment in jail get a fast pass to go straight to the state hospital due to the law change in 2013.

      • Laurie K.

        Actually, no they do not:

        https://www.mprnews.org/story/2016/02/29/jailed-mentally-ill-wait-for-treatment

        “Even with the 48-hour rule, state law doesn’t limit the length of time mentally ill inmates stay in jail after they’re booked and before a commitment order is issued. The 48-hour rule kicks in after a judge issues a commitment order.”

        Additionally, many of the people in jail who are evaluated and found incompetent do not fit in the narrow confines of the legislation criteria for a commitment order.

  • REBECCA

    I am from Brainerd and was at the forum that Carrie Ruud discussed the changes happening at the Grace unit and the hospital. It was asked what would happen to those people who would not be accepted. There was not a good answer. ER or jail. The problem with the Grace unit is it was never meant to handle patients with more violent issues. The Grace unit has had an employee shortage because the conditions there have been considered dangerous. I had sat in a discussion that had touched on this subject the previous year. The staff had threatened to walk out if more security was not added. Since the state hospitals were shut down there is a shortage of beds to handle violent individuals. It needs to be adressed. We were very dissappointed to hear from Paul Gazelka that nothing is going to be done to alleviate the many problems. They are always claimimg to be fiscally conservative. Yet they would rather spend extra money housing people who need help in jail or the ER. It cost more and does nothing to help. The people sent to jail and the ER wind up right back in the same spot shortly after. I also do not find it to be instep with the religious values Senator Gazelka professes.