BISMARCK — Lawmakers studying how to close gaps in North Dakota’s mental health system want to consult with expert architects to help plan a new state hospital incorporating cutting-edge technology and design.
There is broad consensus among officials that North Dakota’s aging state hospital needs to be replaced with a more modern and efficient building. A consultant recommended a new hospital with 75 to 85 beds for adults, which would be less than the current capacity of 100 acute psychiatric beds.
Representative Jon Nelson, R-Rugby, chairman of the Acute Psychiatric Treatment Committee, said he would like advice from specialists with expertise in the design of psychiatric hospitals. Using specialists was successful in building a new medical school at the University of North Dakota, he said.
“I would like to use this example,” he said. “It was a good example of efficiency,” providing a medical school on the cutting edge of the budget.
A clear sign that the days of the current public hospital could be numbered: a recommended appropriation of $2 million to demolish several unused buildings on the Jamestown campus, including an old dairy barn and a water treatment plant .
In 2020, state hospital superintendent Rosalie Etherington estimated a replacement would cost $150 million to $160 million, but Nelson said he didn’t have a cost estimate. Ideally, he said, construction could begin in the 2023-25 budget biennium.
“It could be a bit aggressive, actually,” he said. “Hopefully we can make this work.”
Beyond the construction of a new hospital, efforts continue to make behavioral health care more accessible in communities.
A key to determining which recommended improvements will be implemented will likely come from a study proposed by the legislative leadership of a series of recommendations from consultants’ reports in 2018 and this year. Legislative management is a 17-member committee and includes executive members.
The recommendations given to the interim legislative review committee call for allowing the state’s more than 30 critical access hospitals to manage behavioral health crises by stabilizing the patient before transferring them to specialist care.
This capacity, if achieved, would be in addition to the availability of mental health crisis services at each of the state’s eight regional social service centers, whose teams are tasked with providing 24-hour coverage in a 45 mile radius.
A phased approach, selecting critical access hospitals that can serve every region of the state, is probably the most practical way to expand behavioral health crisis services in rural areas beyond social service centers. , Nelson said.
“I would love to see a pinch of it statewide,” he said. “Some safety features 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 is the lack of mental health professionals in critical access hospitals and counseling centers, a problem that can be at least partially addressed by expanded behavioral telehealth services.
“Everyone deserves access to the same care,” said Sen. Judy Lee, R-West Fargo. Connecting the public hospital to a local treatment system will be essential, she said.
“We don’t need a big long-term hospitalization plan anymore,” she said. “That’s not how the treatment works.”
Instead, there is a need for short-term residential stays to assess and stabilize patients and then provide ongoing outpatient care, Lee said.
Lawmakers are expected to consider proposals to streamline licensing to make it easier for mental health professionals licensed in other states to locate in North Dakota, and to offer incentives, such as financial support, to encourage people to obtain degrees in the field to alleviate the shortage of mental health professionals.
“It’s a pretty low fruit,” Nelson said.
Gaps in mental health services have been studied for years, and North Dakota has taken important steps, including a voucher program to pay for treatment for substance use disorders and the counseling program peer review Free through Recovery, Nelson said.
Legislative leadership will set priorities for the next biennium as officials continue to work to improve mental health services, he said. “There is not much to do in a biennium,” he said.
In the longer term, one solution that will likely require congressional action is to lift the 16-bed cap on “mental illness facilities” in order to be eligible for Medicaid payments.
That size is too small to effectively deliver hospital care, said Sen. Tim Mathern, D-Fargo, who said the bed cap is the biggest barrier to expanding private providers’ access to health care. Mental Health.
Lee agreed that the cap is a major hurdle and said an even bigger hurdle is that exceeding the cap must be cost-neutral — a requirement that defeats the purpose of serving more people. people, she said.
The committee heard testimony about the critical need for inpatient psychiatric beds in western North Dakota. Dickinson and Williston do not have inpatient psychiatric beds, requiring patients to travel long distances for treatment.
“I think we’re going to look at that as well,” Lee said.
North Dakota is implementing a bed management system, a constantly updated database of where beds are available, making it easier for patients to find and book beds, she said.
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