Anoka-Metro Regional Treatment Center, a state psychiatric hospital that two years ago was in jeopardy of losing federal funding over serious violations of health and safety standards, has received a clean bill of health from regulators.

The 110-bed hospital, which treats many of the state's most complex psychiatric patients, received notice that it is in full compliance with federal rules for patient safety and hospital operations, following two unannounced visits early this year by inspectors from the U.S. Centers for Medicare and Medicaid Services (CMS), according to a letter from the agency made public last week.

The determination ends years of uncertainty about the future of Anoka-Metro, which had been plagued by patient violence and persistent lapses in adherence to health and safety standards, driven in part by a growing influx of more-volatile patients from county jails.

These problems had brought the facility to a crisis point in 2016, when CMS put Anoka-Metro on notice that it was in "immediate jeopardy" of losing its qualifications to bill the federal government for services, a significant share of the hospital's budget. The federal agency found that the hospital put patients at risk by using generic treatment plans that failed to recognize their complex conditions and unique therapeutic needs, among other concerns. Had the facility lost federal funding, it likely would have been forced to lay off staff and reduce bed capacity — a development that would have exacerbated an already critical shortage of psychiatric beds statewide, officials said.

Human Services Commissioner Emily Piper said the turnaround is the result of "an enormous effort" to improve patient care and safety at the hospital through increased staffing, better training and millions of dollars in facility upgrades.

Starting in 2016, the hospital also conducted a comprehensive analysis of the hospital's operations, including its staff training and its system for responding to incidents of violence and lapses in patient safety.

The changes were closely monitored by CMS, which made unannounced visits to the hospital in early February and April, before determining that Anoka-Metro was again eligible to participate in the federal Medicare program.

Anoka-Metro is now treating and discharging patients more quickly, thus reducing unnecessary hospital stays, and workplace morale has improved dramatically, officials said.

Piper recounted visiting the Anoka-Metro hospital on Christmas Day in 2015, soon after she took over at the state Department of Human Services, which oversees state-operated mental facilities. She said, the hospital was so understaffed — amid broader safety concerns — that nurses were being ordered to work back-to-back shifts over the holidays.

"Nurses were crying in the nursing station because they were just receiving notice that they were mandated into 16-hour shifts," Piper said. "On Christmas Day, they weren't going to see their families and they were tired."

She added, "Every time I have been back, it feels like a better place for patients to be and a better place for people to work."

Challenges remain

Even so, the state's second-largest psychiatric facility faces significant challenges. Reacting to reports that inmates with mental illness were filling up Minnesota's county jails, the Legislature in 2013 passed a law requiring state psychiatric hospitals to admit such inmates within 48 hours of a judge's order. Since the mandate took effect, the share of Anoka-Metro's population coming from jails has more than tripled, reaching more than 300 such admissions last year.

Many of the new patients have been jailed for violent crimes and arrive at Anoka-Metro in an aggressive state, having gone days or even weeks without their medications, officials said.

And like other facilities across the state, Anoka-Metro continues to feel the strain from deeper flaws in Minnesota's system for treating people with mental illnesses.

Across the state, hundreds of people with mental illnesses languish in hospital beds, even after they are ready for discharge, often because there's no place for them to transition back to society once their treatment is complete.

About 30 percent of Anoka-Metro's patients no longer require hospital-level care, but remain stuck at the facility — at a cost per patient of $1,385 a day — because they have nowhere else to go.