A target number of psych beds is elusive

How many psychiatric beds does Minnesota need?

That’s an answer not even experts and lawmakers know.

Experts and advocates agree more beds are necessary to meet the ongoing rise of mental health-related emergency visits and people with severe mental illness who commit crimes, among other things. Yet it’s unclear just how many are necessary given Minnesota’s complex mental health service system.

“It’s not quite as quantitative as how many beds you need,” said Dr. Michael Trangle, a researcher

with the Health Partners Institute.

Trangle, the president of the Minnesota Psychological Association and a board member of the governor’s advisory board on mental health, led a limited study published in 2017 through the Minnesota Hospital Association to calculate how many beds were needed among 20 hospitals.

The study focused on how many days beds were in use, and how many of those days could have been avoided by providing alternative treatments for patients who didn’t need hospital-level care but weren’t safe to go home either.

The study showed about 19% of the bed days — 6,052 out of 32,520 — were potentially avoidable.

Researchers also found some of the most common reasons for those avoidable days were due to waits for hospital bed availability elsewhere, from state-run psychiatric beds in Community Behavioral Health Hospitals to chemical dependency treatment beds to residential treatment service beds to legal steps in the civil commitment process.

Trangle said that study clearly shows the flow issues the state’s mental health services have when it comes to helping patients with severe mental illness. It’s the kind of study he and other experts say the state could, and should, be doing on a regular basis.

“We need to publicly have a way to fund it, but come up with a way to permanently, whether it’s once every other year or once every three years, calculate this and not just do it once in a blue moon,” he said. “At the same time, I think we need to build a culture where that’s done transparently and reliably, and people trust the data and act on it.”

Trangle told lawmakers at a House subcommittee hearing in late January such studies would help determine whether the state or hospitals could cut back on psychiatric beds as more intermediate-level resources get funding to treat patients who don’t need hospital-level care.

Part of the issue in determining how many psychiatric beds the state needs is settling ongoing issues with standards in care.

The Treatment Advocacy Center, a national nonprofit focused on civil commitment and patients with severe mental illness, ranked Minnesota last among states in terms of access to beds per capita in a 2016 report.

State officials and advocates take issue with the center’s report as it only focuses on state-run hospital beds, excluding the psychiatric beds available in private hospitals.

Center researchers say the metric is valuable in comparing states’ ease of access to mental health resources for those who truly need it.

“Those are the beds that are last resort, for people who need longer-term care,” said Elizabeth Sinclair Hancq, director of research with the Treatment Advocacy Center.

Sinclair Hancq also pointed out state-run psychiatric beds also tend to be better regulated and subjected to more rigorous treatment standards.

Sue Abderholden of NAMI Minnesota said that focus on state government-run care is a central flaw in the center’s research.

“What other health care service does the state provide?” Abderholden said. “We don’t really want the state service to provide the only access to care.”

Abderholden said NAMI generally supports more psychiatric bed access in hospital systems as that’s where Minnesotans would typically think to go for help.

“We do not want to see freestanding crisis centers because no one knows what they are,” she said.

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