Late last summer, the story of a 10-year-old boy with autism and severe mental illness who’d spent seven months boarding in a Carver County emergency department awaiting mental health treatment made national headlines. Providers around the state knew something had to be done to improve access to mental health care in Minnesota.
In response, a group of providers, hospital administrators and public health experts set up a weekly group call with the purpose of making change happen. What they quickly realized was that they needed to create a system to better match patients with available mental health care, said Todd Archbold, chief executive officer of Prairie Care, a Twin Cities-based provider of residential and outpatient mental health treatment for adolescents, young adults and families, who was on the calls.
Archbold recalled one discussion about an aggressive 13-year-old in foster care who needed treatment. Mental health providers shared the number and kinds of inpatient beds they had available, often to the surprise of hospital administrators, he said. “They were saying, ‘There are available mental beds out there and there’s this 13-year-old stuck in my hospital for two weeks? What’s happening?’”
The first phone calls were “awkward and wonderful at the same time,” Archbold said. And things started getting done.
“Suddenly there was this coming together of two communities who hadn’t worked together intentionally before,” Archbold said. “We were learning to talk the same language. It evolved into a real grassroots effort. People were showing up to help. There were very compassionate-but-frustrated providers saying, ‘This is awful. We have to carve out time from our day to make something happen.’”
[image_caption]Todd Archbold[/image_caption]
This “beautiful and simple” system, Archbold said, is a key improvement: “We’ve had 100 kids who have been connected to care who previously would’ve sat in ERs or been discharged back to home while waiting for another crisis to occur,” he said. “We’ve saving lives. We’re getting kids and families out of ERs.”
This new matching system is one of several changes that have been taking place over the last few years to make Minnesota’s mental health care system more accessible and open to people around the state. While many Minnesotans in mental health crisis still struggle to find the help they need, insiders say that in many key areas, progress is being made.
Sue Abderholden, executive director of NAMI Minnesota, pointed to a number of changes made in latest legislative session that were designed to help Minnesotans more easily get the mental health care they desire, even if there’s still more work to be done.
“People always want to know the one thing we can do to make things better for people with mental illness,” Abderholden said. “The truth is it is not one thing. It is multiple things.”
‘Value-stream’ process, outpatient expansion
One thing Allina Health has been trying to change is how to serve people with mental health needs who arrive in the system’s 12 emergency departments, said Joe Clubb, Allina’s vice president of mental health and addiction services.
“We recognized that we were overwhelmed with the number of patients that needed mental health care,” Clubb said. “We’d had significant wait times for mental health care.”
Since recognizing the problem five years ago, Allina staff started tracking all of the steps that happened from when a patient in mental health crisis entered an Allina ED to when they finally got treatment for their concern. Clubb said the process revealed gaps and repeated steps that slowed the process for patients and made the experience of getting mental health care feel frustrating and exhausting.
[image_caption]Joe Clubb[/image_caption]
Rather than following the old model, Clubb said, where the patient comes into the ED and waits hours to see a nurse, then a physician then a mental health professional, Allina emergency staff now conduct a team assessment: “When a person in mental health crisis comes into our ED, we do an overhead page. The team comes together. We assess the situation, and then determine how best to treat the patient.”
Another approach that Allina has taken to mental health care is moving more patients away from inpatient hospitalization and into day-hospital programs. These programs, which typically require participants to spend a significant part of their daytime hours in group and individual therapy while allowing them to spend nights in their own home, have proven to be less expensive and just as successful for many people with mental illness, Clubb said. “We’ve recognized that inpatient care is not always the best option for people.”
With that conviction in mind, Clubb added, “We have significantly expanded our partial hospitalization and day treatment programs and our outpatient addiction programs. We’ve built more options for patients at Allina that are alternatives to going to an inpatient bed.”
While some people need inpatient care, Clubb said the outpatient experience is less disruptive while still being impactful in the treatment of mental illness. Allina now has more mental health patients in their day hospital programs than in their inpatient hospitals. “We have 250 inpatient mental health beds,” Clubb said. “We’ve decided to maintain that number, not decrease or grow it, and then grow the heck out of our day hospital programs.”
Allina behavioral health leaders have leaned heavily into this approach, with a 30% increase in outpatient programs in 2021 and 15% more in 2022. Today Allina offers outpatient mental health slots for some 750 children and adults across the state, in the Twin Cities and in Faribault, Cambridge and Hastings. “We are trying to bring those services to where people live so they don’t have to travel long distances,” Clubb said.
New care options available
Another health system that’s undergone drastic changes In the past few years is M Health Fairview. Some moves — like the closure of St. Joseph’s Hospital in downtown St. Paul and its addiction treatment Unit 2700 — caused controversy. Others — like repurposing the hospital as a Community Health and Wellness Hub — won praise.
Some more recent changes at the health care organization have helped to reduce wait times for patients in mental health distress, said Lew Zeidner, M Health Fairview vice president for mental health and addiction.
“Part of what we’ve been trying to do is reduce some of the strain of the delay and identify patient needs accurately,” Zeidner said. One strategy the organization has adopted is creating an EmPATH unit alongside the ED at M Health Fairview Southdale Hospital in Edina. The unit, designed to offer focused, alternative treatment to patients in mental health crisis, has been successful, with fewer people lingering in the system’s EDs, reducing hospital admissions, and getting the care they need in a more calming, relaxed environment.
[image_caption]Lew Zeidner[/image_caption]
“The EmPATH provides a more ideal space in which to manage a crisis, the staff are all mental health professionals and there is more time to deescalate the crisis, manage medications and connect them to the next level of care,” Zeidner said.
The COVID-19 pandemic caused a big jump in demand for ED treatment from people seeking care for their physical health, Zeidner said, but despite the chaos this caused, M Health Fairview was still able to reduce wait times for behavioral health visits: “With the EmPATH unit, we’ve been able to more accurately identify who needs outpatient vs. inpatient care and direct people to the right care.”
With a goal of easing the transition to psychiatric care, Zeidner said M Health Fairview also opened something called “a transition clinic, focused on bridging from the identification of need to the appointment with a psychiatrist.” The transition clinic, located in the Community Health and Wellness Hub in St. Paul, is open every day, he said, so behavioral health staff can help patients manage their medications, identify needed medication changes and support them until they get an official appointment with a psychiatrist or are referred for partial hospitalization.
For cases that don’t originate in the ED, most of M Health Fairview’s clinics now have mental health providers on staff, so primary care physicians can easily help their patients build connections for care.
Having easy access to a mental health professional allows “primary care docs to make an introduction on the spot, or to drop in and say, ‘I’m working with this person. They seem to struggle with anxiety or sadness while they were here today. Can you help them make connections for mental health care?’” Making early identification and treatment of mental illness convenient can help to nip a problem in the bud, before it reaches a point where a patient and their family feels they have no other option but to head to an ED.
Sometimes when a person is admitted to the hospital for another issue, like a surgery or a birth, physicians or other caregivers notice a mental health issue that needs attention. Zeidner said M Health Fairview has recently created a consult liaison service, where clinicians can identify symptoms of potential crisis and intervene by making connections to mental health providers during the course of treatment.
“We’re having clinicians ready to see patients while they are already in the hospital so they can clearly identify symptoms and intervene early so patients can be treated before the situation becomes a crisis,” Zeidner said.
At the same time that Minnesota politicians are legalizing weed and psychedelics. Brilliant.
Somehow, one cannot ignore the suspicion this newfound focus on mental health ties in neatly with Minnesota’s new “red flag” law.
I wonder if any of the dozens of model citizens that show up to HCMC for treatment of their gunshot wounds each month will be beneficiaries of this wonderful new system.