Eduardo Colon, the new chief of psychiatry at Hennepin County Medical Center, is not the typical button-down hospital executive. Known for jovial humor and blunt-spoken toughness, Colon has spent most of his 37-year career providing direct psychiatric care to hospital patients and, at 62, still makes daily rounds at HCMC’s medical unit, seeing patients often deep in the grip of mental illness and emotional despair.
Colon, who took over this month following the retirement of Michael Popkin, now faces the daunting task of running one of Minnesota’s largest psychiatry programs amid a statewide crisis in mental health care. A severe shortage of beds and limited access to services in the community have led to dangerous overcrowding in hospital emergency rooms across the state and excruciatingly long waits for treatment. At HCMC, some patients with severe mental illnesses are waiting up to six months for admission to state-run facilities.
In a recent interview, Colon referred to the surging volume of mental health patients at HCMC as “mind-boggling” and spoke of the urgent need to solve the state’s chronic shortage of inpatient beds and lack of transitional housing in the community.
“We assumed that once people returned to the community that they would get everything they needed to stay there,” Colon said, referring to Minnesota’s effort to move psychiatric patients out of large institutions. “I think that assumption was flawed.”
As head of an acute psychiatric unit that handles 12,000 patient visits a year, Colon could play a key role in setting mental health policy at the state level. At the same time, he is pushing a series of short-term steps to ease pressure on the hospital’s overcrowded psychiatric unit. These include embedding more mental health professionals in primary care clinics, to serve patients before a mental health crisis occurs, and creating more short-term housing for patients after they no longer need acute psychiatric care.
“[Colon] has a great bully pulpit to demand systemic changes, and he’s someone who might actually use it,” said Roberta Opheim, the state ombudsman for mental health and developmental disabilities.
A longtime instructor at the University of Minnesota, Colon takes every opportunity to speak out against the fear and stigma associated with mental health treatment. This month, he led a panel discussion at the Mixed Blood Theatre in Minneapolis following twin performances of a play, “Because,” which explored different forms of mental illness and its impact on families. He is a frequent guest on the WCCO radio show, “Healthy Matters,” and he gives occasional lectures at area schools and corporations, where he often talks about the relationship between physical and mental illnesses.
“Any time you take me out of [HCMC], you run the risk of me preaching about the importance of recognizing and treating mental illness,” Colon said.
Even in his new role, overseeing a department with more than 160 staff members and a $42 million annual budget, Colon said he still expects to spend about half of his time working directly with patients.
“It keeps me real,” Colon said this week, between patient visits. “Many [hospital] systems have leaders that don’t have a clue as to what actually happens to people.”
Like hospitals across the state, HCMC is affected by a new law that gives jail inmates with mental illnesses priority for psychiatry beds in state-run facilities. The law, known as the “48-hour rule,” requires that state mental hospitals accept jail inmates within 48 hours after they are committed by a judge as mentally ill. The law was meant to reduce the number of inmates sitting in jail without psychiatric treatment; however, it has put greater pressure on an already-stretched mental health system, forcing hospitals to keep psychiatric patients longer because they have nowhere to send them.
Increasingly, HCMC nurses and other general hospital staffers find themselves responding to outbursts in the emergency room or on the general hospital floor, because there are no available beds in the psychiatric ward, which operates at capacity 98 percent of the time, hospital officials said. When beds do become available, they are often far away. In some cases, HCMC must transfer patients to psychiatric wards as far away as Fargo or Duluth — isolating patients from their families and support networks, which Colon called “unacceptable.”
The average length of stay at HCMC’s inpatient psychiatric ward increased 9 percent last year to 13.7 days, but Colon said “a fair cadre of patients” are waiting two months or longer for placement in the community after they no longer need acute care.
“We are constantly having to juggle, when a bed does become available, who comes up [for release]?” Colon said.
To ease some of this backlog, Colon said the county might secure short-term residential housing for mental health patients who are stable but need further assistance before returning to the community. HCMC estimates that a single, 12-bed crisis home could serve 334 patients a year and save 2,341 hospital inpatient days, with the long-term savings far exceeding the upfront cost to buy a facility.
Colon also made it clear that he wants to prevent hospitalizations by engaging more people in the community before their illness reaches the crisis stage. HCMC has behavioral health staff in 10 of its primary care clinics, from downtown Minneapolis to Brooklyn Center.
“With all the stigma around mental illness,” Colon said, “I think this is a group that in general has not received the financial support and the political support that they deserve.”