September 12, 2022
The Minnesota Department of Health (MDH) found that construction of a new free-standing mental health hospital in Saint Paul is in progress. public interest due to a lack of mental health inpatient beds. Despite this conclusion, MDH acknowledged significant concerns with the new facility as proposed.
Fairview Health Services and Acadia Healthcare have partnered to finance and operate a new 144-bed licensed facility at the site of the former Bethesda Hospital in St. Paul. In part, the new hospital is intended to replace services formerly provided by Fairview Health Services at St. Joseph’s Hospital, according to the proposal.
MDH has determined that the project is in the public interest as it provides additional inpatient mental health beds amid a bed capacity crisis. However, as MDH’s analysis shows, the new stand-alone mental health hospital will not replace the comprehensive services previously offered at St. Joseph’s Hospital, which Fairview Health Services closed in July. There will remain significant gaps in inpatient care after the establishment of the facility that other providers will need to fill. For example, the new facility does not have an emergency department to receive patients in mental health crisis, and since it does not offer a full range of medical care, it will serve only a subset of mental health patients. In addition, the facility is expected to operate under a smaller staffing model than the norm nationally and in Minnesota. Similar concerns were also raised in public comments on the proposal.
“The public review of this proposal demonstrates the great need for additional mental health beds in Minnesota,” Minnesota Health Commissioner Jan Malcolm said. “As we seek to address the acute shortage we face, we hope this review highlights the need for policy makers, healthcare organisations, mental healthcare providers, employers and insurers, and patients to work on solutions to fully address the mental health of the state. Needs.”
As part of the review process, MDH reached out to mental health stakeholders and the public through submissions, letters, and a public meeting held on June 9 to gather comments and feedback. In total, MDH received 67 written public comments from a variety of perspectives, including four other health systems operating in the region, ten community/social service organizations, 27 providers, two unions, and 24 patients. and their family members.
- Most comments acknowledged the need for additional mental health beds.
- Among those supporting the proposal, commentators recognized Fairview Health Services as a trusted community partner and expressed a belief that the new facility would help underserved populations.
- Among those who did not support the proposal, the most common concern was that the facility would not serve all patients in need, due to limited medical capacity and limited access without an emergency department. Other concerns included questions about the quality of health care provided by Acadia Healthcare nationwide; the plan to have fewer nursing staff than other comparable units in the state; and the extent to which the facility would accept transfers from outside of Fairview Health Services.
Two main concerns highlighted by the review are that the hospital will serve only a subset of the patient population based on diagnosis and potentially lower care needs, and that the hospital’s staffing plan he proposed hospital is much leaner than other inpatient mental health units in Minnesota. The review also found that most of the increase in patients due to the closure of the emergency department and beds at St. Joseph’s Hospital had already been absorbed by surrounding hospitals, although it exerts pressure on emergency rooms and inpatient mental health units.
In finding the project in the public interest, a key element was the recognition that the Minnesota Legislature expects continued careful consideration of how the new facility will impact care delivery and the economy. inpatient mental health services in the community. Under this legislation (Minnesota Session Laws of 2022 Regular Session Chapter 99), MDH was tasked with monitoring patient and payer mix, transfers, and patient flow for inpatient mental health care in the state.
In addition to granting the conditional exception in 2022, the Minnesota Legislature made other changes to the moratorium on hospital construction (Minnesota Statutes, Section 144.551). An important element is creating a process to establish additional inpatient mental health capacity without public interest review. This process includes additional monitoring activity and reporting on the impact of any increased mental health capacity for inpatients in 2027.
Documents associated with the public interest review, including the initial proposal, questions MDH posed to Fairview Health System and Acadia and their responses are available online at MDH Public Interest Review – Fairview Health Services and Acadia Healthcare .