Closure of another rural in-patient psychiatric ward leads to public hearing

CATHY WURZER: This evening at 6 o'clock, there will be a public hearing on the closure of an inpatient psychiatric ward in Central Minnesota. Lakewood Health System plans to close its 10-bed unit in its hospital in the small town of Staples. Now, it's the latest loss of rural health care services. And hospitals and clinics are already struggling to keep up with the demand. The state reports 80% of counties are experiencing a shortage of mental health care.

A 2021 report by an industry publication found Minnesota ranks last in the nation in psychiatric beds per capita. Many patients have fallen into that gap and wind up stuck in emergency rooms for weeks, even months, without access to more specific care. Joining us right now to talk about this situation is Sue Abderholden, the executive director of the National Alliance on Mental Illness Minnesota Chapter, NAMI Minnesota. Sue, how have you been?

SUE ABDERHOLDEN: Good, Cathy. Thanks for having me on.

CATHY WURZER: Good. I'm glad to hear your voice. Thank you. Say, what's the situation in Staples? What's happening there?

SUE ABDERHOLDEN: Well, like many hospitals across the state, the Medicaid payment rates are just much, much lower than cost. And so they're just not able to keep it open, along with staffing shortages as well.

CATHY WURZER: Now, this is part of a larger trend that seems quite concerning. I'm thinking about, well, there's the closure of St. Joseph's. North Memorial closed inpatient care. Other areas that you've heard about in Minnesota that are cutting back on mental health care?

SUE ABDERHOLDEN: Southdale closed their unit as well. The hospital in Fergus Falls closed their unit. We've lost about 888 children's residential facility beds. So we are seeing a lot of closures. One thing I do want to point out, though, the study that you referenced was really about state-operated beds and not community hospital beds.

CATHY WURZER: OK.

SUE ABDERHOLDEN: And Minnesota, unlike some other states, particularly in the South, has moved most of our acute care to community hospital beds instead of state-operated beds.

CATHY WURZER: I'm wondering, the need is so great out there, is it not? Where are folks going if these inpatient units are closing?

SUE ABDERHOLDEN: Well, I think it's really a tough thing. One of the things that we don't do well is intervening early. So are there more things that [AUDIO OUT] to prevent people from needing to go to the emergency room or needing a hospital bed. And I don't think we're doing a good job of that. When I look at right now the waitlist for even getting in to see a therapist, it can be months. And so we're just letting people, frankly, struggle with their mental health during that time. And then it often leads to a crisis.

CATHY WURZER: We had a story in the newscast just a few minutes ago about the state of Minnesota cracking down on United Health allegedly because of mental health parity law violations. And evidently, United Health as an insurer is tougher on granting mental health care claims. Is that also a problem here, where you have insurers that are just not coming to the table and approving claims?

SUE ABDERHOLDEN: Yes. Mental health parity is still a dream, despite the fact that our recent law was passed in 2008. And we see this all the time. And we have report after report after report that comes out showing that mental health has narrower networks, we pay mental health services a lot less, there's more prior authorization and more denial of claims. And so we've put up incredible barriers for people to access mental health treatment.

I am glad that last session, they did create an office of mental health parity enforcement within the Department of Commerce. And this will allow us, frankly, to put more resources to actually enforcing mental health parity.

CATHY WURZER: I'm glad you brought up the legislative session last year. But there's also this session that ends in less than a week. I know there are a couple of bills you're following closely. What are they?

SUE ABDERHOLDEN: Mainly, we're trying to look at funding for our mental health system. So last session, they did provide a 3% increase to mental health providers. But they said, well, we want to wait to see what the rates report says. So they did come back this session with the rates [AUDIO OUT] grossly underpay many, many mental health services, which is why it's so difficult, right, for providers to find people to actually do the work. But of course, this year, there isn't as much money. So we are trying to get as much money as we can into increasing rates.

But there are also some grant programs that we're going to face a deep cliff. One of them being our school-linked mental health grants, which is a very popular, very effective program where mental health providers co-locate in the schools so that we can really reach kids where they're at and eliminate barriers for families, such as transportation and taking off of work. So that's one of the things.

One of the other things is that the hardest part of my job is when I have families call me and they say they can see their loved one is getting worse, the symptoms are getting stronger. And when they call the county, the county says, well, unless they're a danger to themselves or others and they'll take treatment voluntarily, there's nothing we can do.

And so we have language that would actually create a grant program where we could go out and actually try to engage that person into treatment, a peer specialist, something like that, and follow along for 90 days. We could also help the family know about suicide prevention, how to talk to your loved one when they're hearing voices or have delusional thoughts. And we really think we could intervene much earlier than we're able to do right now.

CATHY WURZER: But, of course, Sue, we've been talking about the lack of inpatient beds. Are you looking at outpatient treatment then in something like that?

SUE ABDERHOLDEN: Definitely outpatient treatment. The Senate actually has some funding for inpatient mental health services, a couple of million dollars to help when you have high Medicaid claims. But we really need to come in next session, although I know there isn't necessarily going to be a lot of money next session either, and really address the rates for our mental health services. You were right in saying that the needs are greatly increased. And we have to figure out a way to meet them.

CATHY WURZER: What are other states doing that Minnesota might want to look to? Any other models that look interesting?

SUE ABDERHOLDEN: I think everyone is struggling with this, to be honest, Cathy. Some states really rely just on state-operated programs, which is not something that we want to do. I mean, Eisenhower had one of the largest [AUDIO OUT] of all the presidents. And one of the things he said in that report is that every hospital should have an inpatient psych unit so people can get care closer to home. And with telehealth these days, too, I think we could do better.

One of the things that we do that other states don't do is have residential treatment facilities. So we have about 60 of them across the state of Minnesota for adults. They're called IRTs, Intensive Residential Treatment. And it really is a good place for people to step down when they need longer term care. And again, those are going to be closer to their communities.

Other states have a few more first episode of psychosis programs. But to be honest, we're usually still in the top 10 of services that we provide compared to other states. There's no other state I would move to, to be honest. We're still doing better than most. And that's disheartening in some ways.

CATHY WURZER: Well, Sue, I'm glad you joined us to talk about what's happening out there. I appreciate it. Good to talk with you. Thank you.

SUE ABDERHOLDEN: Thanks, Cathy.

CATHY WURZER: Sue Abderholden's been with us. She's the executive director of the National Alliance on Mental Illness Minnesota.