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Forum Editorial: North Dakota’s ‘Third World’ response to the acutely mentally ill must stop

North Dakota's rural hospitals must step up to help stabilize the acutely mentally ill who are in crisis, so these vulnerable people don't end up in jail for their personal safety, a shameful practice that has gone on far too long.

Editorial FSA
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It was disturbing to learn that some — many? — hospitals in North Dakota are turning away those who are in an acute mental health crisis. That revelation came from a consultant’s recommendations for ways to improve North Dakota’s mental health system.

We’ve known for years that jails too often serve as warehouses for the mentally ill. Those suffering from mental illness are locked up because the local hospital can’t — or won’t — take them long enough to stabilize and transfer to an urban medical center, a wait that can last days.

“Rural hospitals often do not want to care for ‘those people,’ as described to us while conducting interviews,” even though they receive federal funding to provide service for “acute care of all types,” the Renee Schulte Consulting authors wrote .

"In North Dakota, hospitals are blatantly refusing to treat patients presenting with acute psychiatric issues,” the report continued, explaining that the refusal is a violation of a 1986 federal law for hospitals receiving Medicare payments.

There’s more: “Across the state,” the report continued, “countless reports have been provided of hospitals refusing to admit patients in acute psychiatric crises and coercing community-based providers and/or families to ‘take them back’ even when clinically inappropriate and ill-equipped to manage individuals in need of emergent psychiatric stabilization."


A spokesman for the North Dakota Hospital Association claims hospitals aren’t turning away psychiatric patients at the emergency room, but can only hold them for a few days until a bed opens at a hospital that can provide treatment.

But here’s the simple truth: Our jails wouldn’t be used to house the mentally ill if our hospitals had the capacity to care for them.

It’s inexcusable. The consultant compared North Dakota’s reliance on jails to take in the seriously mentally ill to the sort of grim situation expected in a Third World country.

Yet the appalling practice has been going on for years — and it’s been acknowledged for years, at least since Schulte flagged it in a report in 2014. Bear in mind, these patients have not been accused of any crime, yet they are being locked up because there’s no other place to safely keep them.

The time for studying this disgraceful problem is over. It’s past due time to act.

Fortunately, the Schulte study points to a practical and affordable solution. By using telepsychiatry services, rural hospitals can get the help they need to assess patients who present to their emergency rooms in a mental health crisis, and determine what should be done for the patient.

That would cost, according to a “ballpark estimate,” a modest $1.5 million to $2 million per year. The advocate for hospitals said it could cost $100,000 per room to equip a standard hospital room to handle a psychiatric inpatient.

Let’s assume that the remodeling estimate is accurate. If so, the state could spend a modest $3.6 million to equip one room in each of the state’s 36 rural, critical access hospitals.


So we’re not talking about huge sums of money to help some of our most vulnerable residents. This shouldn’t be, as they say in politics, “a heavy lift.”

It’s time for North Dakota to quit dawdling and to address this shameful problem, once and for all.

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