A significant expansion of the mental health unit at HealthEast’s St. Joseph’s Hospital in downtown St. Paul will add 37 new rooms in a bid to address the shortage of psychiatric beds in the state.
HealthEast is projecting that the expanded facility — the hospital previously had 30 beds dedicated to mental health patients — will now serve some 1,500 patients annually, including those in need of geriatric and acute mental health care, specialties in particularly short supply in the East metro.
The backlog of patients this shortage creates can affect other services the hospital provides, particularly in the ER, said Brian Erickson, HealthEast interim director of mental health.
“St. Joe’s is a downtown ER with 20 beds,” he said. “There have been many times where maybe 14 of our patients in the ER are mental health patients who have been there for 3-5 days or longer waiting for safe disposition to a mental health facility. That is not good for an ER. We are not set up to provide that kind of care, and it limits what we can do for our patients who are not experiencing mental health concerns.”
This issue is not unique to St. Joseph’s, Erickson said. Many hospitals around the state regularly run into similar backlogs. Before his hospital’s expansion, the lack of available mental health beds meant that HealthEast had move many of their mental health patients to other facilities around the state and the region.
“It is not uncommon for mental health patients to be backed up in our ER and have to be diverted,” Erickson said. “Sometimes we have to divert people to Minneapolis or as far as Duluth or Rochester or Fargo. That is not good for patients or their families.”
Moving patients from one end of the state to another is expensive — and counterproductive, Erickson said. The opioid addiction crisis also contributes to an increased need for mental health services, and expanding the mental health wing at St. Joseph’s, near the hospital’s busy outpatient addiction-treatment clinic, made sense.
“Mental health and substance abuse concerns can use a lot of resources,” Erickson said. “We needed to bring services to the people, to meet them where they are so we can try to get a much better outcome for them sooner.”
Designed for healing
The expansion was designed collaboratively, with input from the hospital’s clinical care team and architects. Members of the design team visited mental health facilities around the country, taking the best of what they saw back to St. Paul to incorporate into their plans. The result is a secure environment designed to encourage healing and comfort for both patients and workers.
Nursing staff played a central role in the design process, said Maria I. Raines, HealthEast’s group director of nursing — mental health, addiction and clinical operations.
“We did a lot of work on this design,” she said. “A number of people participated in a one-week intensive, where we had our architects, our end-user staff, our construction folks and leadership all there to address the space so we could embed a series of features that would minimize disruption in the environment and promote healing.”
The resulting expansion features rooms with large windows, calming lighting and colors, all designed to reflect best practices in mental health care.
A significant design element is the way patient rooms are structured, Raines said.
“In a hospital, there is usually a lot of noise within a unit made by workers who need to get into the space,” she said. “In our design, we were able to build the unit with a ‘front-stage/back-stage’ approach, kind of like a theater. The front-stage area is designed for people who are being treated. The back-stage area is for people who are providing the supplies and services.”
The end product is an efficient space that serves everyone. “We have minimal disruption from those who need to bring things into the unit,” Raines said. “This creates a quieter environment for patients and creates a safer space for patients and workers.”
Another element of the redesign is the nursing station. Raines explained that the station counter in St. Joseph’s old mental health unit was designed in a traditional style, with a long counter separated by glass.
The long, slanted, open counter in the new unit is, Raines said, “A good example of collaboration. The way it is designed, patients feel welcome to come and talk to staff. It’s not like what we have in other units. The physical design allows for patients to still be separated from staff for safety but not by walls or glass. The older design created an, ‘Us vs. Them’ dynamic. The new design opens the environment but still increases safety for staff.”
Geriatric care expansion
The St. Joseph’s expansion includes a geriatric mental health unit designed to meet the unique needs of older patients diagnosed with mental health disorders. With the state’s aging population, the demand for this type of care is growing, but there are only a few facilities in the region that offer mental health care focused on this age group.
“When we were in the planning stages, and we discussed what population really needed added mental health services, the geriatric population kept coming up,” Raines said. “On this side of the metro there are really not a lot of beds available for older adults. Not a lot of hospital systems in the state have that specialty, and we thought we could step up and provide that service.”
Older people need specialized mental health care because their needs are different from those of adolescents or young and middle-aged adults, Erickson said.
“As patients get older, from a medical point of view they can be more sensitive to certain medications,” Erickson said. “These sensitivities can include physical problems from interactions to medications that they are already taking with medications needed for mental health problems. You need to hire staff that can recognize those interactions and understand how to treat people with complex medical histories.”
Working with older adults also requires staff who understand the signs of other kinds of common geriatric illnesses, Erickson said: “You need workers who are trained to have an awareness of the difference between early dementia or hospital confusion and serious medical interactions.”
And there are also basic issues that have to be taken into consideration when working with an older population, Erickson added.
“Sometimes older patients might be more frail and not be able to participate in all the kinds of activities we’d provide on a regular unit,” he said. “Activities need to be designed to make it safer for older patients. We can easily do that in units designed for older adults.”