Controversy over proposed psychiatric hospital

Sara Benson is following up on the case of a 12-year-old boy who threatened to hurt himself at school the day before. Benson, a clinician with Human Services Inc. in Oakdale reaches his mother by phone.

"I just wanted to call in, and check in and see how things were going since Jean came out last night," Benson tells the mother.

HSI had sent out a "mobile crisis team" to visit the boy and his mom at their house.

The home visit -- and the follow-up phone call to discuss therapy options -- represent the kind of reform efforts that have been gaining steam in the east metro and across the state.

Many mental health care providers agree Minnesota needs to better deliver services in the form of nonprofit crisis centers and roving help teams. They're cheaper alternatives to hospitalization.

That's why some industry professionals are balking at the Prairie St. John's proposal, to build a new facility in Woodbury with nearly 150 new inpatient beds.

"I think more is not always better," said Heather Mundis, emergency services for HSI.

Mundis said she thinks a new hospital would distract the state from a mission of improving community care. Patients who are turned away from hospital emergency rooms are patients that her agency could help immediately, Mundis said.

"We often hear that people present at the hospital feeling suicidal, they wait for three hours, and they're unwilling at that point to say they're truly suicidal, even though they are," Mundis said. "They'd rather go home. It's 3 o'clock in the morning and they don't want to deal with it anymore."

"They're the types of folks who will end up going to the ER a month from that time because nothing's been resolved. No medications, no therapies, no school supports," Mundis continued.

John Ryan, special projects liaison for Prairie St. John's, has heard many of the same horror stories. But Ryan said those stories bolster the argument for the $22 million hospital that Prairie wants to build.

"When patients are showing up in the ERs, and require 150 stitches because they've lacerated their arms and their legs in a very real suicide attempt, and they're told to go home because their needs aren't serious enough to require inpatient hospitalization, I would say there's a serious need that's unmet," said Ryan.

When it comes to the question of more beds or more community care, Ryan said both are needed.

"We represent something new, innovative and different from what the Twin Cities has seen in a long time."

Some opponents of the Prairie proposal assume it will operate similar to psychiatric wards of Twin Cities hospitals, where there may be more emphasis on stabilizing a crisis rather than long-term treatment, Ryan said.

But he said Prairie will provide some of the same kind of outpatient therapy services that the community clinics offer.

"We represent something new, innovative and different from what the Twin Cities has seen in a long time," Ryan said.

Prairie St. John's plan has won support from the statewide sheriff's association, the Minnesota Psychiatric Society, the state's ombudsman for mental health, and people who have lost family members to suicide.

But one of the largest groups devoted to treating mental illness doesn't back the proposal.

The National Alliance on Mental Illness of Minnesota, or NAMI, agrees there's a crisis. But one of its concerns is how the privately funded Woodbury facility would affect the state budget.

State and federal governments typically split the costs of care for low-income adults on Medical Assistance. But if those patients go to freestanding psychiatric hospitals, they won't qualify for federal reimbursement. The state, then, would have to foot the bill, said NAMI-Minnesota's Sue Abderholden.

And then there's the state's shortage of psychiatrists. Hospital and community clinics are afraid that Prairie St. John's would lure their doctors away.

While Prairie officials say they won't recruit locally, Mark Kuppe, the CEO of Human Services Inc., says they won't have to.

"If you put in a nice hospital, and you pay a good salary, why wouldn't a psychiatrist want to go from ghetto to the high-rise?" said Kuppe.

The state Health Department doesn't think such a large hospital is needed in the Twin Cities, and the plan also faces opposition from some prominent lawmakers.

As the debate rages on, so does the crisis. On a recent day, the nearest bed for children in a psychiatric unit was in Duluth, about 140 miles away from Woodbury.

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