Here's why mental health advocates oppose a new St. Paul specialty hospital

Mar. 3—Despite widespread agreement that Minnesota needs more capacity to treat people with mental illness, a new 144-bed hospital proposed for St. Paul faces opposition from advocates and an uncertain path through the Legislature.

Several mental health advocates testified against the plans last week at the House health policy committee, which heard a proposal to waive the state's moratorium on building new hospitals. The freeze is in place to ensure any new facilities will be sustainable long-term.

Fairview Health Services and its partner Acadia Healthcare need approval from the Legislature to build the new specialized facility, with a price tag of as much as $65 million, on the site of what is now Bethesda Hospital, just north of the State Capitol. Fairview Health Services is part of the M Health Fairview system and is the area's largest provider of mental health beds.

"I want to make it clear, we want more beds, but beds that are in a regular hospital with an emergency room," Sue Abderholden, executive director of the National Alliance on Mental Illness, or NAMI, of Minnesota, told lawmakers at a recent hearing.

Abderholden and other mental health advocates worry the specialty hospital that Fairview hopes to build with Acadia Healthcare won't cater to the groups representing the most persistent need for care: the homeless, people with other serious medical conditions and those with low incomes on public assistance.

Advocates worry about how services will be impacted when St. Joseph's Hospital winds down mental health services later this year. There are 1,331 mental health beds across Minnesota and more than half are in the Twin Cities metro.

There's also concern that federal rules about Medicaid reimbursement and larger mental health facilities could mean the state is responsible for covering the cost of longer-term care for patients without private insurance.

"It's the model they are proposing. Having a stand-alone facility raises a lot of issues," Abderholden added in an interview, saying, ideally, there would be more mental health bed capacity at existing hospitals.

"If we are going to invest all this money in to our mental health system, let's do it the right way," she said.

The committee also received written testimony from several area health care groups, including HealthPartners, which operates Regions Hospital and its mental health unit. Those groups expressed concerns about gaps in care and the overall impact the new facility would have on the existing system.

Additionally, Shannah C. Mulvihill, executive director of Mental Health Minnesota, wrote in opposition to the proposal, despite acknowledging a "crisis" shortage of inpatient mental health beds.

SPECIALIZED CARE

Leaders of Fairview Health Services and Acadia Healthcare say opponents have misconstrued how the new facility will operate. They say the new hospital will continue their organization's charity care mission and will be open to everyone.

"No patient will be denied care at the new hospital based on insurance or their ability to pay," said Beth Heinz, M Health Fairview's mental health and addiction service executive.

Heinz added that the facility was designed for a new approach to treatment with patients' safety and dignity in mind and it would be a "home-like" setting. Rather than the typical institutional hospital, the proposed facility would also include things like gyms, outdoor spaces and restaurant-like food service.

"It is very different than a traditional hospital," she said. "The whole mind and body is taken into account."

Richard Levine, a M Health Fairview psychiatrist, says that approach has proven to be a more successful way of treating mental illness.

"All of those pieces — being able to go outside, being able to exercise — are tried and true ways to improve mental health," he said, adding that it was hard to offer those types of amenities in a traditional hospital. "Instead of integrating mental health into a medical setting, we are integrating medical into a mental health setting."

While the new facility will not include an emergency room or an intensive care unit, there will be primary care doctors on staff along with psychiatrists and other clinicians. Jeffrey Woods, Acadia Healthcare operations group president, said the new hospital should be able to treat all but the most serious medical conditions along with addressing mental health.

"We have a complex and comprehensive ability to take care of the whole person," Woods said. "If they require ICU level of care or a surgical level of care as a primary reason for their admission, then they are generally better served in an acute general hospital."

CONCERNS ABOUT ACADIA, CLOSURES, STAFFING

Members of the Minnesota Nurses Association, which represents about 80 percent of the nurses working in hospitals statewide, said in testimony to the House health committee that Acadia had what they considered a questionable track record. They also raised concerns about staffing and maintaining current treatment capacity in the short-term.

Nurses said Acadia Healthcare, which serves about 70,000 patients a day and more than 200 facilities in 32 states, has faced allegations of abuse of staff and patients, paid a $17 million Medicaid fraud settlement and was accused of misleading investors.

Daniel Clute, a nurse at St. Joseph's Hospital, where only about half the available 100 mental health beds are operating because of staff shortages, said Fairview's recent history of mergers, closures and moving services was troubling. He noted that the beds at St. Joe's would be closed later this year and the new facility will not open until 2023.

Clute added that Acadia's for-profit designation and past issues raise even more questions and may discourage nurses from working there.

"Let me tell you, nurses will do their research and they will be reluctant to take jobs," Clute said. "You can have the nicest facility in the world, but you still need to staff it."

Chelsea Schafter, a nurse at Fairview Riverside, expressed concern over moving some of the beds currently at St. Joe's to her hospital. She says staffing is always a challenge and can lead to unsafe working conditions.

"I do not remember a time where we have been fully staffed," Schafter wrote to the committee. "The burnout we are experiencing is real. We are helping people during some of their darkest, most difficult days."

Fairview's Heinz noted that once the proposed facility was built, there would be a net increase in mental health beds. She said Acadia was chosen as the partner for the project after an exhaustive search.

The new hospital would be operated by Acadia, but Fairview providers would work there and oversight would be split between Acadia and Fairview.

"We had a very thorough vetting process," Heinz said. " I feel very confident we will be providing world class service and high-quality care with Acadia as a partner."

Acadia's Woods defended the organization's track record.

"We have a very low incidence of adverse events in our hospitals," Woods said. "When you measure the quality data and outcomes data of our hospitals against the industry and the national averages, we are at or better than all of them."

AN UNCERTAIN PATH

In order for the project to move forward the state Legislature needs to approve an exemption to the state's moratorium on new hospitals. Rep. John Huot, DFL-Rosemount, the chief sponsor of a bill to authorize the new construction, underscored the need for more mental health treatment.

"A location to serve the metro and surrounding region will create more access and ensure more people can get the safe and quality care they need," Huot said.

But Rep. Tina Liebling, DFL-Rochester, said plans for the project technically were not submitted early enough for the Legislature to take action this session. Typically, requests are subject to a six-month public review process.

"It is quite distressing to me to see how late these things are being submitted," Liebling said. "This will not be the end of the conversation."

Fairview first filed paperwork about the project in November and followed up in December. That happened as soon as Acadia was decided on as a partner, Heinz said.

Any delay from the Legislature would mean the new facility would not open as planned in 2023.

"I think there is an urgent need in the community," Woods said. "That is not going to lessen."