Mental illness has become increasingly prevalent throughout our society. It is estimated that one in five adults already suffer from a mental health condition each year. The situation has undoubtedly worsened with twice as many adults now reportedly struggling with their mental health due to the novel coronavirus pandemic. Mental health issues are soaring at an all-time high for adults and children alike. Unfortunately, Minnesota lacks the magnitude of mental health services necessary to appropriately care for all these patients in need, resulting in numerous heartbreaking stories across the state. People in mental health crises frequently go to local emergency departments, desperately seeking help, only to find themselves languishing in emergency rooms for days, even weeks, waiting for an inpatient psychiatric bed to open. This devastating practice is known as “boarding.”
Boarding is a glaring problem, but it is really just the unintended consequence of a much larger issue. According to the Department of Health and Human Services (“HHS”), boarding “is a systems issue that manifests itself in the [emergency departments], which is a common pathway for the problem; but the real problem is about capacity in other parts of the system, adequate funding, and being able to move patients to the level of care they need.” Minnesota’s mental health system has a long history of inadequacy; though, this has not been without effort to change and improve upon the system over the last century and a half. Unfortunately, such effort has not been enough to successfully rectify the state’s futile mental health system. The system continues to fail Minnesotans every day. The state’s mental health system must be reformed to maximize its impact and positively improve psychiatric care for a greater number of patients across the spectrum.
This Article begins by describing the overall problem of boarding mental health patients in Minnesota emergency departments and the underlying problem of a statewide inpatient psychiatric bed shortage. Next, it proceeds by drawing attention to another contributing factor, which is delayed discharges from inpatient psychiatric units due to a shortage of “step-down” mental health programs. Then, this Article addresses the impact of emergency room boarding on patients, providers, and health care systems as a whole.
This Article continues by delving into the historical background of Minnesota’s mental health system. First, it discusses the history of the state psychiatric hospitals and what led to their mass closing. Next, it describes the aftermath of the state hospitals closing, including the new age of Community Behavioral Health Hospitals, the unanticipated effect of the “48-Hour Rule” on hospitals, and the misplaced blame on the state’s hospital-bed moratorium for the inadequacy of Minnesota’s mental health system.
Finally, this Article identifies a multifaceted solution to this exceedingly complex problem. It begins by addressing one state’s apparent solution to the problem of boarding psychiatric patients in emergency departments. Although this apparent solution is noteworthy, there is a critical systems issue at the forefront that must be resolved first. Therefore, this Article concludes by addressing further solutions to reform Minnesota’s mental health system at various levels of service, incentivize psychiatric bed development, and expand the mental health workforce across the state.