North Dakota lawmakers want experts to guide plan for new State Hospital
North Dakota legislators have been studying ways to close gaps in mental health services, including a new state hospital integrated with better local treatment options
BISMARCK — Legislators studying how to fill gaps in North Dakota’s mental health system want to consult with specialist architects to help plan a new State Hospital incorporating state-of-the-art technology and design.
There is a broad consensus among officials that North Dakota’s aging State Hospital is in need of replacement by a more modern and efficient building. A consultant has recommended a new hospital with 75 to 85 adult beds, which would be smaller than the current capacity of 100 acute psychiatric beds.
Rep. Jon Nelson, R-Rugby, chairman of the Acute Psychiatric Treatment Committee, said he’d like guidance from specialists with expertise in designing psychiatric hospitals. The use of specialists was successful in building a new medical school at the University of North Dakota, he said.
“I’d like to use that example,” he said. “It was a good example of efficiency,” delivering a state-of-the-art medical school on budget.
One clear sign that the current State Hospital’s days could be numbered: a recommended $2 million appropriation to demolish several unused buildings on the campus in Jamestown, including an old dairy barn and water treatment plant.
In 2020, Rosalie Etherington, superintendent of the State Hospital, estimated a replacement would cost $150 million to $160 million, but Nelson said he doesn’t have a cost estimate. Ideally, he said, construction could start during the 2023-25 budget biennium.
“That might be a little aggressive, actually,” he said. “I hope we could make that work.”
Beyond building a new hospital, efforts continue to make behavioral health care more accessible in communities.
A key in determining what recommended improvements will be implemented likely will come from a proposed study by Legislative Management of a slew of recommendations from consultants’ reports in 2018 and this year. Legislative Management is a 17-member committee and includes leading members.
Recommendations given to the interim legislative study committee call for enabling the state’s more than 30 critical access hospitals to handle behavioral health crises by stabilizing the patient before transfer to specialized care.
That capability, if achieved, would be in addition to the availability of mental health crisis services at each of the state’s eight regional human service centers, whose teams are tasked with providing around-the-clock coverage over a 45-mile radius.
A phased-in approach, selecting critical access hospitals that can serve each region of the state, is probably the most practical way to expand behavioral health crisis services in rural areas beyond the human service centers, Nelson said.
“I’d like to see a sprinkling of it across the state,” he said. “There are some safety features that are unique to behavioral health, especially with emergency services.” The committee heard testimony from a hospital administrator that it could cost $100,000 to convert a standard medical-surgical hospital room to one equipped for mental health patients.
Another challenge to overcome: the lack of mental health professionals in critical access hospitals and counseling centers, a problem that can at least partly be addressed by expanded behavioral telehealth services.
“Everybody deserves to have access to the same care,” said Sen. Judy Lee, R-West Fargo. It will be critical to connect the State Hospital to a system of local treatment, she said.
“We don’t need a big plan for long-term hospitalization anymore,” she said. “That’s not how the treatment works.”
Instead, there’s a need for short-term residential stays to assess and stabilize patients, then provide ongoing outpatient care, Lee said.
Legislators are expected to consider proposals to streamline licensing to make it easier for credentialed mental health professionals in other states to locate in North Dakota, and to offer incentives, such as financial support, to encourage people to earn degrees in the field to alleviate the shortage of mental health professionals.
“That’s fairly low-hanging fruit,” Nelson said.
Mental health service gaps have been the subject of study for years, and North Dakota has taken significant steps, including a voucher program to pay for substance use disorder treatment and the Free through Recovery peer counseling program, Nelson said.
Legislative Management will set the priorities for the upcoming biennium as officials continue to work to improve mental health services, he said. “There is only so much that can be done in a biennium,” he said.
Longer term, a solution that likely will require congressional action will be to lift a 16-bed cap on “institutions of mental diseases” in order to be eligible for Medicaid payments.
That size is too small to efficiently deliver inpatient care, said Sen. Tim Mathern, D-Fargo, who said the bed cap is the single biggest obstacle to private providers expanding access to mental health care.
Lee agreed the cap is a major impediment and said an even bigger obstacle is that going beyond the cap must be cost neutral — a requirement that defeats the aim of serving more people, she said.
The committee received testimony of the critical need for inpatient psychiatric beds in western North Dakota. Dickinson and Williston don’t have any inpatient psychiatric beds, forcing patients to travel long distances for care.
“I think we’ll look at that, as well,” Lee said.
North Dakota is establishing a bed management system, a constantly updated database showing where beds are available, making it easier to find and reserve beds for patients, she said.