(Source: Star Tribune) 

The fate of a new 144-bed psychiatric hospital at the Bethesda campus in St. Paul rests with the Minnesota Department of Health (MDH). The controversial proposal has been the subject of much debate. 

In a typical process, MDH advises state lawmakers as to whether to waive a construction moratorium and allow hospitals to be built. This time legislators reversed the process — making a deadline vote at the end of the 2022 session to allow the hospital. But that is only if MDH Commissioner Jan Malcolm approves. 

The switch adds weight to the department’s public interest review, which included a hearing in mid-June at which dozens of people argued whether the $62 million project by Acadia Healthcare and Fairview Health Services should be allowed. 

It also gives final say to a state agency that opposed the last standalone psychiatric hospital proposed for the Twin Cities. 

Nobody disputes that psychiatric hospitals are full and that people in mental crises are left waiting in emergency rooms. Minnesota was among five states in the 2020 National Mental Health Services Survey with inpatient psychiatric bed usage rates above 130 percent. Only 28 of 1,535 adult beds were available in mid-June, according to the Minnesota Hospital Association. None was in the Twin Cities. Six were in Fargo. 

“We’ve had numerous families tell us they’ve just stopped trying go to the ER, because they’ve had such long waits,” said Liz Franklin, associate director of behavioral health services for CLUES, a Latino nonprofit agency in St. Paul. 

Adding beds is one solution, but that expands the most expensive level of mental health care and passes costs to Minnesotans. The concern of excess hospital capacity is why the state’s moratorium exists. 

The alternative is more outpatient and crisis response services, which in theory are cheaper and reduce the need for inpatient care. That rationale convinced the health department in 2008 to oppose a plan by a company now known as PrairieCare to build a psychiatric hospital for adults and children in Woodbury. 

Circumstances haven’t improved. Suicides in Minnesota increased from 598 in 2008 to 830 in 2019, according to the Centers for Disease Control and Prevention. Suicides declined to 758 in 2020, but anxiety and depression rose during the pandemic. 

A predictive model in November found that Minnesota is one of 12 states with insufficient psychiatric inpatient capacity — even with adequate outpatient care. 

A new hospital would offer a more healing environment with focused mental health and substance abuse expertise at a cheaper cost than a general hospital, said Laura Reed, Fairview’s chief operating officer. “[It is] an example of the innovation required to meet the urgent health care need that we have seen grow over the last two years.” 

The National Alliance on Mental Illness opposes a standalone hospital without an emergency room because of its potential to cherry-pick insured or lower-intensity patients. 

Fairview countered that 69 percent of its psychiatric admissions involve patients on Medicaid or other government programs, and that this rate won’t change with the new hospital. 

Fairview’s Bethesda campus was being shut down in 2020 as a long-term acute care hospital when it was made into a COVID-only hospital and then a homeless shelter. Building there requires additional approval from the Capitol Area Architectural and Planning Board.