BISMARCK. Social services officials sent a woman with acute mental illness and homicidal tendencies to Unity Medical Center in Grafton. She spoke about a shooting plot at a local business that she targeted due to her lack of outlets.

But there was a referral problem: Unity Medical Center, a rural emergency hospital, does not have psychiatrists, clinical psychologists, or other mental health professionals trained to manage such a complex case.

The woman remained in Unity’s emergency room while the hospital’s small team spent hours faxing documents to other hospitals in the area, desperately trying to find a psychiatric bed where she could be treated.

“I am not trained to care for a critically ill mentally ill patient,” Dr. Matthew Vichito, Unity’s family physician and chief medical officer, told lawmakers on Wednesday, June 15. His role, he said, should be limited to determining whether there was a physical condition that could explain her unstable mental state.

Vichito’s testimony was given before the North Dakota Legislative Assembly’s Psychiatric Emergency Committee, which will prepare proposals to address the state’s recognized mental health crisis.

Eventually, after 15 hours, Unity found a psychiatric bed, Vichito said. “We keep patients for several days, fortunately rarely,” he said.

Dr. Matthew Wichito Grafton Unity Medical Center ND.JPG

Dr. Matthew Wichito, Chief Physician at Unity Medical Center in Grafton, North Dakota.

Provided by Unity Medical Center, Grafton, North Dakota.

Vichito’s testimony highlights the challenges legislators and social service officials face as they work to enable North Dakota’s 36 emergency hospitals to help fill gaps in mental health crisis services in rural areas, considered one of their most pressing needs.

Jake McTaggart, head of Sanford Health’s Hillsborough and Mayville hospitals, estimated that it would cost $100,000 per bed to convert a standard medical-surgical ward into one that can safely care for a person with acute mental illness.

But the real problem, he says, is a dire shortage of nurses and other health workers.

Sanford Medical Center in Hillsborough was short of two registered nurses for nine months and relied on costly temporary nurses, McTaggart said.

Senator Tim Matern, a Fargo Democrat, asked McTaggart, “If we gave you $100,000, would you do it?”

“Not without my staff,” MacTaggart replied.

Rep. John Nelson, R-Rugby, the committee’s interim chairman, said he believed the goal was to call on critical access hospitals to stabilize acute mental illness patients rather than provide inpatient mental health services.

Both McTaggart and Vichito denied the allegations made in the consultant’s report that rural hospitals were “dumping” mentally ill patients.

“We don’t abandon these patients,” Vichito said. “They are dumped on us.”

If a judge does not order treatment, McTaggart said, patients may refuse treatment, which can sometimes be presented as dumping.


Jake MacTaggert is an administrator at Sanford Hillsborough Medical Center. David Samson / Forum

The committee, which has received many recommendations to expand telemedicine services to make care affordable in rural areas, heard from Integrated Telehealth Partners, a firm that provides mental health assessment and follow-up services for emergency departments at 65 Iowa hospitals, including 59 critical access hospitals. .

The average response time is 68 minutes and the average evaluation time is 47 minutes, Doug Wilson, the firm’s founder and president, told lawmakers.

When Integrated Telehealth Partners started, 70% of patients with mental illness admitted to emergency departments were hospitalized when Integrated Telehealth Partners started, he says, a figure that fell below 50% when the firm began working with hospitals.

The firm also provides services to prisons. The Committee was told that prisons large and small in North Dakota are struggling to cope with inmates suffering from mental illness.

Integrated Telehealth Partners provides mental health services to prisons, with appointments available seven days a week, with new appointments within three days. Urgent appointments are available 24 hours a day, seven days a week, Wilson said.

Numerous studies have shown that telehealth mental health services deliver results equivalent to face-to-face care, he says.

Pamela Sugness, director of mental health for the North Dakota Department of Human Services, presented the committee with a list of proposals in response to recommendations in a Renee Schulte Consulting report that evaluated the state’s mental health services for the committee.

These offerings include support for:

  • A new public hospital in Jamestown with 75–85 beds and a revised mission for the public hospital that will no longer provide mental health services in Jamestown and Devils Lake. Instead, the state will look for local partners to take on this role.
  • Treatment of drug addiction at the place of residence outside the State Hospital.
  • Demolition money is no longer needed on the Public Hospital campus.
  • Expanding treatment for substance use disorders in rural areas.
  • Expansion of crisis stabilization services, including the delivery of electronic tablets to prisons for telemedicine consultations on the care of mentally ill prisoners.
  • Increase financial accountability and budget transparency so that officials can better understand how mental health care funds are being spent.
  • Reducing staffing barriers in behavioral health care.

Sen. Cathy Hogan, D-Fargo, said clarifying the mission of the public hospital will be important when designing the new hospital. Basic questions need to be answered, including: “Do we really need a children’s ward in a public hospital?”
Nelson said mental health services for teens are a priority. “We are aware of the gaps in services for teenagers,” he said. “This is something we need to do sooner rather than later.”

Talk of a new public hospital should not overshadow the need for more programs, Matern said, which prompted Sagness to agree.

“I talk about prevention and early intervention all the time,” she said. “We need to keep investing sooner.”

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