BRAINERD, Minn.—Essentia Health's decision to only allow voluntary patients in its behavioral health inpatient unit at St. Joseph's Medical Center in Brainerd has drawn noteworthy flak from the Twin Cities.
A top state official and a University of Minnesota academic both criticized the move in a Star Tribune article Thursday, Nov. 2, saying it was unfair to patients involuntarily committed by the justice system to get mental health care.
However, Dr. Pete Henry, chief medical officer of the Essentia Health System, said the decision to switch to voluntary-patients-only in September for its Grace Unit was not one Essentia took lightly.
The process took more than two years and included interviews with staff and physicians, as well the hospital board and focus groups made up of patients and community members. They went on site visits to other hospitals to see what those facilities were doing to address mental health treatment, Henry said. Essentia talked about it beforehand with the Sisters of St. Benedict, the order of Catholic nuns integral in starting the Grace Unit in 1987. Henry said the situation was so dire at the Grace Unit, the hospital was faced with a choice: it could either stop admitting involuntary patients sent there from communities across the state, or continue along with the status quo and risk having to shut down the Grace Unit altogether.
A history of violence
In addition to becoming CMO of the whole Essentia Health System, Henry has been an emergency room doctor at Brainerd for 20 years. When he first came to the Brainerd hospital, the Grace Unit was intended for local, voluntary, nonviolent patients only, and more hostile patients were treated at the nearby state-run mental health facility.
But time passed, and the state facility was shut down. Minnesota’s government gradually chipped away at in-patient treatment capacity for involuntary patients, he said. These involuntary patients may have dual diagnosis of both mental illness and chemical dependency, or they might have been charged with assault or sex crimes, Henry said.
"These people now have been removed from the state facilities and are being housed in various hospitals across the state," he said.
While this trend was taking place, Essentia noticed the presence of involuntary patients at the Grace Unit was becoming more and more inappropriate. Sex offenders were in the same part of the hospital as young girls and elderly people. Between 40 percent to 60 percent of the beds were occupied by involuntary patients.
In 2015, three people were arrested after an arson took place in the Grace Unit as part of an escape attempt from a locked hospital room. The incident forced the hospital to evacuate 38 other patients and temporarily shut down the unit.
"Our unit was never designed to co-house violent, aggressive male patients ... intermixed with a very vulnerable population of either females or elderly individuals," Henry said. "What we saw is that more and more, we were having (an) increased number of violent episodes, (an) increased number of people ... not wanting to come into our Grace Unit, not feeling that was a true healing environment."
Essentia remodeled rooms and employee work stations, putting up bulletproof glass in the nurse's station. Even with the changes, St. Joseph's still can't safely care for both committed and voluntary patients, Henry said—people who don't want to be there mixed with people who do.
"We've had staff assaulted, we've had our nurse practitioners assaulted, we've had physicians assaulted," Henry said.
The change also makes it easier for local people from the Brainerd area who have severe mental illness to voluntarily get care, Henry said. He said the critics in the Star Tribune story were conflating violent patients with patients suffering from severe mental illness. Just because a patient isn't hostile doesn't mean their mental illness isn't serious, he said.
The state's take
Department of Human Services Commissioner Emily Piper criticized Essentia's move in a written statement the Star Tribune story partially included.
"The patients that the health system has decided to turn away are some of Minnesota's most vulnerable people," Piper said. "They are in crisis and should not be denied treatment as if they are an inconvenience."
"I have heard from health care executives and seen firsthand the real strain that these highly challenging patients put on hospitals across our state. But denying them treatment will only shift the problem to other hospitals, whose emergency rooms and psychiatric units will be even more overtaxed."
Piper went on to use the slippery slope argument in saying other hospitals would do the same thing as Essentia.
"Beyond that, I worry that other hospitals, in turn, could follow Essentia's lead," she said.
Henry responded to Piper by saying hospitals across the state screened mental health patients in a similar way. In addition, it's against the law to turn away patients outright, Henry pointed out—St. Joseph's can still treat hostile patients in its emergency department. It was up to the state to increase funds and staffing to care for the most needy patients, he said.
The Essentia CEO reached out to Piper several times to meet on the Grace Unit shift before it happened, but none of those invitations were returned, Henry said.
"I don't believe that she fully understands the situation," he said. "I would be happy to have a conversation with her, as would anyone else in organization who was part of the decision-making process."
DHS also denied a request to interview Piper directly.
As to the question of whether there were state rules preventing Essentia from making the switch, a DHS spokesperson redirected the inquiry to the Department of Health.
"We've been exploring that question," an MDH spokesperson said.