A new, $62 million St. Paul hospital that will serve people with mental illness is moving ahead, despite red flags raised by advocates and even the Minnesota Department of Health (MDH) itself. State officials determined in September that opening the new hospital would be in the public interest, given Minnesota’s shortage of inpatient mental health beds. 

The Fairview Health Services/Acadia Healthcare facility is granted an exemption to Minnesota’s current moratorium on hospital beds. The new 144-bed hospital is to be built in St. Paul on a site north of the capitol complex. The site has been occupied for decades by various Bethesda health care facilities. Bethesda originally opened as a community hospital in 1883. Its facilities most recently served as a Ramsey County homeless shelter, closing in the spring.  

The new hospital will have capacity for 144 beds, with 120 new beds and 24 held for future use. 

Minnesota lawmakers approved the new facility during the 2022 session, then left the final decision on the facility in MDH’s hands. 

Plans for the new hospital were announced in 2020 by Fairview. Response was mixed. Proponents point out the state’s severe shortage of beds, which means people have to wait for treatment or travel long distances for mental health services. They also cite Fairview’s long record of service in the community. 

Some mental health and health care advocates cite the potential problems with the way the hospital proposal was structured, citing the need for facilities that provide comprehensive health care. Another red flag is the involvement of Tennessee-based Acadia and problems that company has had in other states. 

Fairview has repeatedly made the case for the facility’s need, stating that “We know this crisis will not be solved by one hospital. It will take the concerted efforts of health care providers, community partners and others coming alongside local, county and state officials to ensure that we meet the needs of our patients and communities into the future.” Fairview officials called the planned facility “a significant and important step forward for our community.” 

MDH has determined that the project is in the public interest because it provides additional inpatient mental health beds in the midst of a bed capacity crisis. But the state’s analysis indicates that the new facility won’t replace the comprehensive services previously offered at St. Joseph’s, the state’s oldest hospital. That St. Paul facility was closed and reopened as a wellness center earlier this year. 

“There will be significant inpatient care gaps remaining after the establishment of the facility that other providers will need to fill,” MDH stated in a news release. “For example, the new facility lacks an emergency department for receiving patients undergoing a mental health crisis, and because it does not offer a full complement of medical care, it will only serve a subset of mental health patients. “ 

Staffing levels are another concern MDH and members of the public raised. The facility is scheduled to operate under a leaner staffing model than is the norm nationally and in Minnesota. 

“The public review of this proposal shows how much need there is for additional mental health beds in Minnesota,” said MDH Commissioner Jan Malcolm. “As we seek to address the acute shortage we are facing, we hope this review highlights the need for policy makers, health care organizations, mental health care providers, employers and insurers, and patients to work on solutions to fully meet the state’s mental health needs.” 

MDH worked with mental health care stakeholders and the public through presentations, letters and a June public meeting held to collect comments and feedback. Sixty-seven written comments revealed a variety of perspectives. Those who commented included four other regional health systems, 10 community/social services organizations, 27 providers, two unions, and 24 patients and family members. 

Many of those who commented recognized the need for additional beds and acknowledge that Fairview is a trusted health provider that would aid an underserved population. The biggest concern raised by opponents is that the new facility wouldn’t serve all patients in need, based on limited medical capabilities and limited access with no emergency department. 

Reviews found that most of the increased patient load from the closure of the emergency department and beds at St. Joseph’s Hospital had already been absorbed by surrounding hospitals, although it is placing a strain on emergency rooms and inpatient mental health units. 

For their part, state lawmakers have indicated that they expect close, ongoing scrutiny of how the new facility will impact care delivery and the economics of inpatient mental health services in the community. MDH has been directed to monitor patient and payer mix, transfers and patient flow for inpatient mental health care in the state.