In a decision that has dismayed mental health advocates, Essentia Health has stopped admitting patients with severe mental illness to its psychiatric unit in Brainerd, citing concerns that they were overburdening the facility.

The Duluth-based health care system said St. Joseph's Medical Center in Brainerd in September stopped admitting "involuntary" patients held under a court order, known as civil commitment. Instead, the hospital's 16-bed psychiatric unit now admits only patients who voluntarily accept treatment — who tend to have less-acute mental health problems than those who are civilly committed.

The move has alarmed advocates, psychiatrists and state officials, who raised concerns that it could set a dangerous precedent. If other private hospitals follow St. Joseph's lead, hundreds of Minnesotans with complex psychiatric disorders might have nowhere to go during a mental health crisis, they said.

Executives at St. Joseph's said the shift will make the unit safer for patients and staff, while opening additional beds to care for other patients.

Like many private hospitals across the state, St. Joseph's has struggled to accommodate a surge in court-committed patients with serious and persistent psychiatric problems. Many of them languished for weeks in the hospital's psychiatric unit as they awaited admission to crowded state facilities, occupying beds that could be used by people with less serious mental health problems, officials said.

"There became a huge bottleneck in the state system, and we had to respond," said Adam Rees, president of St. Joseph's and surrounding clinics.

Patients who were civilly committed were staying an average of 40 days at St. Joseph's mental health unit, nearly eight times longer than patients who voluntarily sought treatment, officials said. By accepting only voluntary patients, the hospital will be able to treat an additional 200 or more patients a year, including more patients from the Brainerd Lakes area, hospital executives said.

In a written statement, Human Services Commissioner Emily Piper called Essentia's decision "extremely troubling." She expressed concern that denying treatment to a certain category of patients would shift the problem to other already overburdened hospitals and emergency rooms.

"The patients [Essentia] has decided to turn away are some of Minnesota's most vulnerable people," Piper said. "They are in crisis and should not be denied treatment as if they are an inconvenience."

The move also could put more pressure on county jails, which treat thousands of mentally ill inmates each year, though they are not properly equipped to do so, advocates warned.

"These are real people. They aren't chess pieces," said Sue Abderholden, executive director of the National Alliance on Mental Illness of Minnesota. "And they don't just go away because you won't admit them."

Essentia was also in the news recently because of a dispute over its attempt to require hospital employees to have flu shots, which triggered a lawsuit by one of its unions.

Stretched thin

Statewide, a severe shortage of inpatient psychiatric beds and limited access to care in the community have led to dangerous overcrowding in hospital emergency rooms and excruciatingly long waits for treatment.

The crisis was exacerbated by a 2013 law that requires the state to find a psychiatric bed within 48 hours for anyone in a jail who is determined by a judge to be mentally ill. The law was meant to reduce the number of inmates sitting in jail without mental health treatment; however, it has forced hospitals to keep mental health patients longer because they have nowhere to send them.

When it opened in 1987, St. Joseph's behavioral health unit was designed to handle patients who needed a short-term intervention during a mental health crisis. Many of these patients suffered from depression or suicidal thoughts and needed to stabilize for a few days before case managers helped them transition back into the community.

Over time, the unit's patient mix changed. About a third of the patient population became civilly committed patients with serious mental illnesses. More than half came from outside the six-county Brainerd Lakes area that the hospital has long served. As the statewide shortage of beds deepened, mental health patients were being sent to St. Joseph's from as far away as Wisconsin and Iowa, hospital officials said.

Safety issue

Safety became a concern. The court-committed patients had longer stays and were more hostile to treatment, and their aggressive behavior sometimes disrupted therapy for other patients on the unit, officials said.

In 2013, a patient being held on a civil commitment hurled a wooden chair at a nurse, frightening other patients. The next day, six voluntary patients all asked to be discharged. There have been at least 20 other violent incidents on the unit since that assault, officials said.

There are concerns, however, that St. Joseph's move will put pressure on other private hospital systems to limit admissions to voluntary patients. That, some warn, would create a major gap in the state's continuum of care for people with mental illnesses, with the most serious patients shunted to state-operated facilities.

"It's discriminatory and I'm not sure how they can get away with it," said Dr. Barry Rittberg, an assistant professor of psychiatry at the University of Minnesota. "This sends a message that they only want the 'nice' patients, and that will make it more difficult for the other hospitals."

An estimated 5.4 percent of adults in Minnesota, or about 220,000 people statewide, are diagnosed as having a serious mental illness that impairs their daily ability to function, according to a report last year by mental health task force appointed by Gov. Mark Dayton. A small subgroup, about 4,000 people, are committed by the courts as mentally ill each year.

Twitter: @chrisserres