A part of the problem, or a part of the cure?

Posted at 10:26 PM on January 22, 2008 by Bob Collins (3 Comments)

There are few silver linings to getting cancer in Minnesota. Here's one: You've got a better shot at getting treatment for it -- and fast -- than if you were diagnosed with a mental illness Several speakers at a public hearing on a proposal for a new mental health facility in Woodbury Tuesday night repeatedly made the comparison between the two illnesses.

"If teenagers with cancer were sent home from emergency rooms without treatment because there were no oncology beds available, we would be outraged," Dr. Stephen Setterberg of Prairie St. John's told a Department of Public Health hearing on his for-profit firm's proposal to build a 144-bed mental health facility in Woodbury. The proposal needs the approval of the Legislature because of a statewide moratorium on new hospitals.

Not a heck of a lot has changed since MPR produced its 2004 series, Bad State of Mind, chronicling the difficulty in obtaining mental health treatment in Minnesota. The chief complaint then -- a lack of beds for people needing immediate help -- is the chief complaint now. And Minnesotans need help.

(More below the fold)

But some existing hospitals think Prairie St. John's proposed cure will further erode the Minnesota mental health system. The non-profit institutions are worried that the Prairie St. John's will do a good job of meeting its promise to recruit psychiatrists and other mental health professionals by recruiting them from their already-understaffed institutions.

Kathy Knight, the administrator of behavioral services at Fairview Hospital, said the number of beds available for mental health patients isn't the problem. "We have a provider shortage," she said. Over the holidays, she said, "I had 16 beds, and no doctors. We've recruited all over the country. It's an enormous struggle and a continuing drain."

An official at Regions Hospital said an opening for a psychiatrist went unfilled for more than a year.

That's the problem the Legislature will have to face. Hospitals are concerned about retaining what few mental health professionals they have. People with loved ones in need of mental health treatment, however, could not care less about the long-range impact. They want -- and need -- help and they can't wait for politicians, hospitals, and insurance companies to fix a broken system.

Clayton of Eagan, who didn't want his last name used, had little good to say about his experience navigating the mental health system in Minnesota recently. His wife needed hospitalization. "We went to Fairview because it was the only one in town with a bed. We arrived at 9:15 a.m., admitted to the ER at 9:45. At 10:30 we began waiting for a bed upstairs. We waited until 7:30 p.m. When we got upstairs, it appeared no one was in charge. It was not clean. The staff was disorganized. Patients were strapped in, out of control. There was no way I would let my wife reside there. We arrived home at 10:30 p.m., and my insurance paid $2,600 for a day of chaos. People should be able to get help when they need it."

All Denise Rodriguez, a Twin Cities schoolteacher, knows is that the system failed her brother, who made good on his plan to kill himself last year. She said he drove to St. John's Hospital in Maplewood after deciding he wanted to live, but the hospital doesn't have a mental health facility, and when he was transferred to Regions Hospital in St. Paul, he wasn't allowed to see a doctor on the same day and, she said, he didn't get the specialized care he needed. He drank Drano and eventually killed himself. "In mental health," Rodriguez said, "you only get one chance."

Judy Johnson, of Woodbury, called the police when her daughter was threatening to kill herself. She she was told by one provider that it could take up to a year. "I was referred eventually to Prairie St. John's," she said, "and thank God."

Not all people with personal stories were embracing the idea of more options. "I have a brother in law who saw a psychiatrist," said resident Rick Dixon. "My brother in law looks worse. It doesn't work, so I wouldn't be for it."

The Department of Public Health will make a recommendation to the Legislature by the end of February. Still unclear, however, is how Prairie St. John's is going to make money and solve the problem at the same time. If hospitals could make money on mental health treatment, they'd provide more of it. If psychiatrists could get higher payments from insurance, they wouldn't move to other states.

And that's the heart of the problem. They can't.

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Comments (3)

Universal Healthcare
I think it is sad that we live in a society that doesn't take care of each other and puts the dollar before the welfare of its people. Why is there a shortage of psychiatrists and psychologists?......Money?
I think the question should be WHY do we need more psychiatrists and psychologists. WHY are there so many on anti depresants.....what has our society become that depression is so wide spread?
I know I haven't given any answers other than raise more questions but maybe the article should be more about how we care for one another-where do we place our values? Of course this is only the tip of the ICEBERG.

Posted by c | January 23, 2008 9:47 AM

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ok
here's a story:
A friend, who is a single mom worked for a builder supply company, (now closed) in Woodbury. This single mom was using Minnesotacare for her healthcare. When she was hired full time at that company, she was offered health benefits. The healthcare package offered to pay half of her premium (which amounted to a fourth of her pay check) plus it included a $4000 deductible. This was a worthless healthcare benefit for this single mom trying to make ends meet. To top it off she no longer qualified for Minnesotacare becuase her employer's package offered to pay half of her premium (a budget cut made towards Minnesotacare signed by Govoner Pawlenty back in July of 2005). This single mom tried the healthcare offered by her employer for one month but discovered she could not afford it. So her son and herself went without healthcare. This single mom was also taking anti-depressants for depression that was diagnosed 12 years prior. She thought that maybe she could just try -again-to do without the medication. Her co workers noticed that she FREQUENTLY was 10 -15 minutes late...noticed that she did not put much effort into her appearance....noticed that she would cry at work back in her office for no apparent reason. The manager and coworkers support amounted to disciplinary action taken towards her tardiness. Snide comments made by two female coworkers about her hair and lack of style and her "FASHION SENSE". One day, the manager decided that this single mom had no respect for her fellow coworkers, (huh I wonder why) and terminated her employment. The company fought her and won on not giving her unemployment on the grounds of being tardy. This single mom was stuck without income, health insurance, oh and by the way she was not receiving any child support payments either.
There's society.

Posted by c | January 23, 2008 10:22 AM

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Why is there a shortage of psychiatrists?

Yes, money. For all the crowing we do as a state as being #1 in this or #2 in that, we are bottom of the barrel when it comes to attracting and keeping mental health professionals.

Seventy of Minnesota's 87 counties meet the federal definition of "shortage" when it comes to these health care professionals. The average age of one now here is 54. It costs a LOT of money to become a psychiatrist, for example. And insurance reimbursement rates are low, too low.

There's a really good treatise on the subject here.

The questions about depression are interesting because I think we automatically assume it's something about society that leads to depression and that may be true. But just as evident is that it is a neurological disease that, as we learn more about the brain, is diagnosed more often.

The brain uses chemicals to transmit data. So it makes sense that an absence, reduction, or overload of the existing chemical is going to make a difference in how and what the brain communicates.

Prescription drugs, used properly, are intended to adjust the imbalance of a chemical the brain needs to communicate with its various innards properly.

The problem, of course, is we don't have a machine -- yet -- that can tell exactly what the problem is. Cancer? No problem. A broken bone. Easy.

With the brain, quite often a psychiatrist has to prescribe a drug and see what the effect is and if it's negative, that can be eliminated from a checklist. It's a horrible way to get an illness diagnosed, but that's how it often is done.

There are people, too, who think depression or mental illness can just be wished away. Just think happy thoughts, for example. But that presupposes that the brain -- the body's most complex organ -- can't get broken. A bone can, but a brain can't.

That's not to say a holistic view of healing isn't a good thing; it is.

And, of course, there's a stigma attached to mental illness that's at play here, too. We're slowly getting more intelligent in this area, but we're likely several generations away from getting to the point where we collectively shake our heads at the anachronistic view of things surrounding mental illness.

The man last night, for example, who said he had a brother in law and some colleagues at work who have sought help and that help -- in what form we don't know -- didn't work, so therefore he wouldn't favor the current proposal on that basis.

That obviously is his right. But do you know anyone who died from cancer? Did it occur to you to say we should have less cancer treatment because it didn't work?

Posted by Bob Collins | January 23, 2008 10:37 AM

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