The Minnesota Security Hospital has a long and checkered history in St. Peter. Established in 1866, it was the first state hospital for the mentally ill. Recently, however, safety concerns have arisen due to a growing number of incidents associated with the facility. The hospital campus is comprised of buildings ranging from high to low security, including a nursing home.
These incidents prompted a scathing report released by the Legislative Auditor. The report on state-operated human services was released in February 2013 identifying serious concerns about the state’s approach to caring for people with mental illnesses. It makes twenty recommendations to the Department of Human Services (DHS) to address these concerns.
According to the report, long-term problems have resulted because the Security Hospital has “lacked cohesion in recent years, reflecting confusion about mission, changes in leadership and organization, turnover of key medical staff, shifting rules regarding patient treatment, ongoing concerns about staff injuries, labor-management disagreements, and a difficult relationship between the Security Hospital and SOS [State-Operated Services] leadership.”
State Senator Kathy Sheran, Chair of the Health, Human Services and Housing Policy Committee, held a Senate committee hearing to review the progress of the State’s responsiveness to concerns in the auditor’s report on Thursday, Sept. 26, at the Capitol.
“The goal [of the hearing] was to make sure there is real intervention and change happening,” Sheran said.
Issues concerning the flow of patients through the system, trends of injury to workers, and the decision making process were addressed during the September hearing.
“The decision making process needs to change from being centralized away from campus and push down to the campus [level] and include the line workers on the ground,” Sheran said. “They have the understanding of what needs to be done.”
In fact, many of the changes implemented since the auditor’s report have originated from the line staff.
“It is evidence to commitment to the cultural change [of the Security Hospital],” Sheran said. “They’re the ones asking for help.”
One major concern is the timely discharge of patients. According to the report, almost 20 percent of patients have remained at the Minnesota Security Hospital for over ten years. Some patients need to remain at the Security Hospital for life, but there are also dozens that no longer need to be there.
Lack of patient discharge has limited the Hospital’s capacity to accept new patients while there are concerns about the psychological effects of prolonged institutionalization, as well. Confinement in an institutional setting for longer than necessary may contribute to deterioration in a patient’s condition, causing more harm than good.
A second major concern is the understaffing of licensed psychiatrists at the Security Hospital. It was found that most psychiatrists were spending fewer than 40 hours a week at the Hospital, and as of December 2012, the Security Hospital had only two full-time psychiatrists and one part-time psychiatric nurse practitioner on its permanent staff.
KSTP-TV news coverage of psychiatrist understaffing raised the question, “Is the state just warehousing patients?” Negative news coverage of the Minnesota Security Hospital has made it difficult to fill the open positions at the Security Hospital and has created a significant workload for current employees, as well as safety concerns.
Some administrators suggested in the report that the shortage of psychiatrists was “one of the major factors contributing to the increase in incidents and injuries” involving both staff and patients. In 2012, there were 63 injuries resulting from patient assaults, a sharp increase from the year before. The rise in staff injuries requiring medical attention is also another major concern.
Sheran believes a change has to occur from the lowest to the highest level starting with the treatment staff.
“Psychiatrists and psychologists need adequate training for the treatment process, and the legislature needs to fund these positions,” Sheran said. “I believe the people who work there have every intention of being a good treatment center with their hands tied around their backs . . . for very ill patients.”
Aside from goals and outcome measures, Sheran believes that in order for change to occur within the system, there needs to be effective root cause analysis to determine why the problems exist.
“Outcome measures need to say more than how many injuries there are; they need to lead to analysis questions of what needs to change,” Sheran said.
One root cause that has been identified is gaps in shift changes. These gaps in coverage over some areas can lead to higher patient anxiety and more staff injuries. Staff members seek to be included in the discussion of changes to the rotation process, so injuries may be reduced and communication improved.
Changes at the Security Hospital will ideally provide a greater sense of security to both students and St. Peter residents.
Junior Kayla Pavelka is a coordinator of Wednesday Friends, a Gustavus program that organizes student volunteers to visit the Security Hospital’s nursing home. Volunteers interact with patients in the nursing home to work on building social skills through activities like crafts and playing games. For some patients, Wednesday Friends is their only interaction with the outside world.
“The staff have been very accommodating and excited [about this program],” Pavelka said. “They are more than willing to discuss any questions we have.”
The rehabilitative focus of Wednesday Friends is precisely what the Legislative Auditor’s report encouraged. With a long history emphasizing security over patient rehabilitation, the report recommended that the Security Hospital make substantive change to reflect modern approaches to caring for the mentally ill.
“Patient care is the number one priority,” Sheran said.
The hearing did not address all of the report’s recommendations, but a second session is tentatively scheduled for Wednesday, Oct. 30, 2013. The Minnesota Security Hospital will remain under scrutiny until necessary changes have been implemented to ensure it is a safe, rehabilitative, and effective environment for both patients and staff.