Controversial provider opens St. Paul hospital, expanding mental health access

The $80 million Capitol Park Mental Health Hospital will open later this month with some lofty goals: Improving psychiatric care in Minnesota, reducing pressure on emergency rooms and adding much-needed treatment options for patients who are elderly or have co-occurring addictions.

If it can do all that, the hospital — operated by the Tennessee for-profit Acadia Healthcare and Minnesota nonprofit Fairview Health Services — might achieve an unspoken goal of proving a long list of doubters wrong.

“We’ll give it a shot,” said a skeptical Sue Abderholden, executive director of NAMI Minnesota. The advocacy group for people affected by mental illness didn’t support the hospital proposal in 2022.

“Hopefully it will help. We do need more beds. There’s no question about that,” she said.

Capitol Park is opening amid a rising need, as hospitals in Cambridge, Litchfield, Staples and Fergus Falls, Minn., have closed inpatient psychiatric units. Minnesota also is revisiting the adequacy of its mental health system following the shootings at Annunciation Catholic Church and School in Minneapolis. With up to 144 beds, the stand-alone psychiatric hospital will somewhat offset Fairview’s closures of St. Joseph’s Hospital in St. Paul and a psychiatric unit at Fairview Southdale Hospital in Edina.

Yet few hospital projects in Minnesota’s history have created as much handwringing. The state Department of Health in 2022 greenlighted its construction but raised “significant concerns” that Capitol Park would primarily treat low-acuity patients while saddling other hospitals with more complex and costly cases.

The hospital will open in phases while it hires staff and undergoes federally required inspections and accreditation. Eventually, it will have six 24-bed units, specializing in geriatrics, mood disorders, thought disorders and co-occurring mental health and substance abuse disorders.

“Being able to offer a state-of-the-art, brand-new facility that is designed with the patients in mind is something that is a true joy,” said Rachael Flohrs, Capitol Park’s chief executive.

Capitol Park also represents a dramatic investment in a medical specialty that historically has been neglected and unable to meet patient needs. Each year on average, 559 patients are stuck for a day or more in hospital ERs while waiting for inpatient beds to treat their psychoses — and that is just in the new hospital’s service area, the state estimated.

“The need for mental health care in general continues to increase,” Flohrs said.

Fairview has reduced demand for inpatient beds by diverting patients in mental health crises from its ERs at Fairview Southdale and the University of Minnesota Medical Center to special stabilization units. But the need persists statewide. Only 67 inpatient psychiatric beds were available for adults last Tuesday morning in a 300-mile radius of Minneapolis, according to the Minnesota Mental Health Access database. Eight were in the Twin Cities, but 38 were more than 200 miles away, in Fargo or Thief River Falls, Minn.

Capitol Park will mostly receive patients who are transferred from other hospitals or facilities. But it does have a 24-hour intake center and is federally required to assess patients who show up on their own.

Some of the apprehension about the hospital stems from its ownership. Acadia is a publicly traded company and the nation’s largest stand-alone behavioral health operator. Most Minnesota hospitals are nonprofit.

State leaders raised similar concerns two decades ago, preventing a for-profit group from building a psychiatric hospital in Woodbury before it eventually opened the PrairieCare hospital in Brooklyn Park. The 101-bed hospital has become a key part of Minnesota’s pediatric mental health system.

“PrairieCare has had to continually prove ourselves and build our brand recognition,” said its chief executive, Todd Archbold.

Acadia has endured high-profile controversies, including reporting in the New York Times that its hospitals detained patients longer than medically necessary to maximize insurance payments. Acadia is opening a 144-bed hospital in North Carolina but closed one in Washington and is closing another facility in Utah that has been investigated for patient neglect.

A written statement from Acadia said the length of stay at its hospitals is in line with national averages and that “certain media reports paint a false picture” of the company’s standards and compliance with federal regulations: “The dignity and wellbeing of our patients is at the core of everything we do.”

No hospitals can be built in Minnesota unless the Legislature grants an exception to a construction moratorium, designed to prevent redundancy and wasteful health care spending. Lawmakers made an unusual choice with Capitol Park, approving it in principle but giving the state health department the final say.

To alleviate its concerns, the department required that Capitol Park submit regular reports on staffing levels and how it admits and discharges patients.

As a standalone psychiatric hospital, Capitol Park isn’t eligible for some federal reimbursements for the care of patients with public Medicaid health insurance. Minnesota as a result expects to pay an extra $2 million or more per year for care that Medicaid patients receive at Capitol Park rather than at community hospitals.

The St. Paul hospital campus has long been an incubator for new ideas; Bethesda hosted the first patient who in 1959 received an external, battery-powered pacemaker, built by Medtronic co-founder Earl Bakken. It was converted during the pandemic into the nation’s first hospital to exclusively treat COVID-19. Bricks from the old hospital were preserved as benches outside Capitol Park.

One argument against adding high-cost hospital beds is that Minnesota wouldn’t need them if it had more stepdown treatment programs to free up existing beds. But even if hospitals could discharge patients more quickly, state officials found they would immediately be filled by patients waiting in ERs.