Children's Minnesota to open inpatient psychiatric unit

Children's Minnesota is opening an inpatient psychiatric unit in response to rising levels of pediatric depression, anxiety and other mental disorders that have been exacerbated by the COVID-19 pandemic.

The 22-bed unit will open next year in St. Paul, addressing a frustration for mental health advocates that Minnesota's largest pediatric system hadn't provided inpatient psychiatric care before.

Even before the pandemic, hospitals were "boarding" children in crisis for hours or days in their emergency rooms because there were no open inpatient beds, often discharging them without treatment once they were no longer risks to themselves or others, or transferring them far away.

Limitations on in-person learning, social gatherings and extracurricular activities in response to the pandemic created more sources of stress that built up in these children, said Dr. Rob Sicoli, medical director of Children's emergency departments in Minneapolis and St. Paul.

"The need to provide more mental health resources to the pediatric community was present prior to the COVID pandemic," he said. "It was a definite need and it's only been amplified by the effects of the pandemic."

While mental health-related visits to Children's emergency departments dropped slightly from 1,757 in 2019 to 1,729 in 2020 — when the pandemic prompted declining hospital usage for many conditions other than COVID-19 — the pediatric provider is projecting a 17% increase in 2021 based on visits in the first three months.

Brooklyn Park-based PrairieCare also announced this summer that it is expanding its 71-bed child psychiatric hospital by 30 beds.

That expansion followed a decision by the Minnesota Legislature this summer to waive the usual government review of hospital expansion proposals in order for PrairieCare and Regions Hospital in St. Paul to add more mental health beds.

Children's had excess bed capacity under its hospital license so its project didn't trigger a review. Between the PrairieCare and Children's projects, Minnesota's inpatient pediatric psychiatric capacity will increase by more than 2,200 patients per year.

The "intensity and complexity" of child psychiatric disorders already were growing, but the pandemic added new sources of stress, said Todd Archbold, PrairieCare's chief executive. Summer historically has seen a decline in inpatient pediatric psychiatric usage, but that hasn't happened the past two years, he added.

"During the thick of quarantines when the pandemic was really ugly last winter-spring, I think a lot of the stress that parents and caregivers had been holding had been kind of rubbing off on kids, if you will," Archbold said. "You know, they pick up on those things … and they were spending a lot more time together because they weren't in classrooms and they weren't at soccer practice and so forth."

Pressures leading up to the pandemic were reflected in the 2019 Minnesota Student Survey, which found that 24% of 11th-graders had seriously considered suicide at some point in their lives — an increase from 20% in 2003.

Teen suicides have not increased, though. Minnesota reported 37 suicides among people 12 to 18 in 2020, down from 50 in 2017, according to death certificate records. The state reported 21 teen suicides in 2021 through August.

Children's inpatient expansion follows the opening this summer of a day treatment program for teenagers at its outpatient facility in Lake-ville. The pediatric provider has been centralizing many of its mental health resources in its St. Paul hospital campus, which also houses treatment centers for eating disorders and developmental disorders.

"As the kid experts, it's our duty … to address this crisis and support families with the full spectrum of pediatric resources they need," said Dr. Marc Gorelick, president and chief executive of Children's.

Sue Abderholden of NAMI Minnesota supported the expansion, noting that Minnesota needs more child mental health services at all levels.

"We've waited a long time for Children's to embrace the fact that they need to be attending to the acute inpatient mental health needs of these children, too," she said.

Minnesota leaders have been wary of inpatient psychiatric expansions, hoping instead for alternatives that keep patients from suffering crises and needing hospital admissions in the first place.

The state blocked a proposal in 2007 by PrairieCare (then Prairie-St. John's) to build a 144-bed adult and child psychiatric hospital in Woodbury, based largely on a preference to solve Minnesota's mental health treatment shortage with outpatient alternatives.

Even then, state research noted a shortage of inpatient psychiatric beds for kids. And a subsequent report by the Minnesota Hospital Association showed that child mental health-related emergency room visits rose from fewer than 10,000 in 2007 to nearly 20,000 in 2016.

Solutions have been erratic, though. Cambia Hills of East Bethel was a much-anticipated 60-bed intensive residential treatment facility when it opened in April 2020. It closed abruptly in June — with its operators blaming the state for a lack of a payment rate increase, and state regulators noting that it had been cited for regulatory violations of patient care standards.

Jeremy Olson • 612-673-7744