Behavioral Health

The Mental Health Collaboration Hub

Improving hospital bed access

BY TODD ARCHBOLD, LSW, MBA

In response to the boarding crisis, the Metro Health and Medical Preparedness Coalition, in partnership with AspireMN, launched a Children’s Mental Health Services Coordination pilot in August 2022. They invited key community stakeholders to attend bi-weekly video calls to monitor community-based services for children and facilitate the sharing of information between health systems and mental health providers. In the state of Minnesota, there are over 800 beds for mental health treatment and substance use disorders for youth. Over 200 of these beds are in hospital settings, and over 600 are for longer-term residential care. Nearly 80% of the hospital beds are in the metro area, specializing in treating acute conditions or those in crisis. Interestingly, only 27% of the longer-term care beds are located in the metro area. Unfortunately, accessing the right kind of bed at the right time has proven challenging and has been a major contributor to boarding situations.

Understanding the variety of mental health treatment programs that exist and the changing criteria for admission are two of the most common problems in making a successful referral. For example, some facilities are only licensed to treat certain ages, conditions, and even genders. Others may lack capabilities of treating more complex conditions such as medical comorbidities, eating disorders, or co-occurring substance use disorders. The vast majority of youth in boarding situations are described as being aggressive, which can be a trigger for a declined admission. Understanding the nuance and reason for aggressive behaviors is important for successful placement and to avoid running into barriers. An isolated incident of aggressive behavior or aggression toward a specific person (e.g., parent or caretaker) is very different than chronic general aggression. Understanding the reason behind these behaviors is critical, and misunderstanding them can lead to exclusion from a treatment center. Lastly, most treatment centers have limitations on the acuity of cases that change based upon staffing and current patient population or milieu. This wide gap in understanding the landscape of mental health treatment settings needs to be eliminated. This is where technology and open communication can help.

Cases that are most often reported in the media are the extreme outliers.

Making Connections

Another incredibly valuable component to the MHCH is the automated tracking of cases on an aggregated level. While some health systems track their own data via electronic health record or manualized reporting (especially during the last two years), the cases that are most often reported in the media are the extreme outliers. They sway the narrative and can lead to a misrepresentation of the majority of boarding cases. The MHCH will track key components of every case, the barriers that exist and the eventual care pathway. For example, we will better understand the most common boarding cases themselves. We will monitor and track ages, genders, diagnosis and locations. In addition, we will better understand the precipitating events that resulted in a boarding situation and the desired treatment setting. From there, we can determine which treatment settings are in the highest demand or have the most barriers in accessing them. By grouping case profiles, we will better understand what the most successful placements have been and what to expect in the referral process. For example, a 14-year-old with a major depressive disorder and a suicide attempt may most often need an acute care hospital bed and should expect to wait three days for admission. Or a nine-year-old female with autism and aggression towards caregivers may need a group home and likely wait 45 days for placement. This data will help us better design our mental health systems and care pathways connecting children and youth to care faster and even work towards preventing the situations from occurring at all. This is data which does not exist in an aggregated way between providers today.

The work of the MHCH focuses on the following objectives:

• Leverage an online portal to track and monitor cases of children and adolescents boarding in hospitals and emergency departments.
• Interact across the state in real-time to facilitate prompt review of cases.
• Through ongoing data collection, identify trends and opportunities to improve access to care for children and adolescents experiencing crisis.



The MHCH exists in an online virtual environment that leverages a secure portal and regular video calls. The online portal is a tool to help facilitate information exchange, and the live facilitation of the meetings is critical in connecting providers with the primary goal of reducing the number of children and adolescents boarding in hospitals and emergency departments. The meetings can identify optimal care pathways in real-time.

A majority of parents report concern about their children’s mental health.

Through the use of this online portal and ongoing communication between hospitals and mental health treatment settings, Minnesota will be better able to monitor trends in boarding as well as identify opportunities for improving access to care. We will be better able to understand if there are key characteristics in children and youth who are waiting extended periods of time for care (i.e., aggression, co-occurring developmental concerns, etc.) and then use those findings to help advocate for increased availability of treatment services in the community. The work of the pilot team is ongoing, and the full online Mental Health Collaboration Hub will be launched in early 2023 and accessible to all health care providers in Minnesota.

Building a Stronger System

Mental illness is real, it is common, and it is treatable. More people today are facing challenges with their mental health, yet less than half of those with a diagnosable condition will receive treatment. This disparity is much greater for those underrepresented communities where the social determinants of health often have an amplified impact. Our mental health system has been shaky, fragmented and largely unbuilt for decades. Rates of suicide have been increasing since the early 2000’s, record numbers of individuals are boarding in hospitals and emergency rooms and a majority of parents report concern about their children’s mental health. It is well-documented that the pandemic has exacerbated these problems, introducing new levels of angst into family systems combined with added barriers to accessing care. One of the most notable trends in the treatment setting is the increased prevalence of trauma—adding complexity and the need for longer-term— and often deep psychological healing. The study of adverse childhood events (ACEs) is robust, and the disruptions of the COVID-19 pandemic exacerbated concerns about youth mental health and suicidal behavior. The most significant events are changes in economic stability and parental relationships or divorce.

The rate of individuals in psychiatric crisis boarding in hospitals and emergency departments has increased sharply in recent years. Emergency departments have become the most common entry point for those in crisis, and that number has grown by nearly 40% in the last 20 years, even more for youth. The most common medical reasons for an ED visit are chest pains, contusions, infections and broken bones, most of which can be addressed immediately with a clear plan for follow-up care. According to the CDC, nearly 2.3% of all ED visits result in a transfer, yet in the case of a psychiatric crisis, independent studies have shown it is closer to 15%. The odds of a psychiatric patient waiting for care in an ED are nearly 5 times greater than for any other health condition – oftentimes resulting in days in an ED awaiting the appropriate care for their condition. The wait time to access psychiatric care can range from several hours to several days. A robust study conducted in 2014 showed that over 40% of psychiatric ED visits resulted in discharge, presumably without any meaningful treatment other than ad hoc medication administration and outpatient referrals, which are rarely followed up upon.

In addition to triaging an increasing number of individuals in psychiatric crisis, hospitals are now finding themselves housing children with severe behavioral problems or chronic conditions, such as autism and developmental delays, for months at a time. Much-needed access to group homes, foster care settings and residential treatment settings has proven difficult, and at times impossible, for severe cases.  

We have all the tools, components and intelligence we need to build a strong mental health system. Solving these problems requires creativity, cooperation, humility among providers and a strong sense of grit. PrairieCare is the region’s largest provider of youth psychiatric services and is currently undergoing a 40% expansion to its inpatient service. They recently joined the Newport Healthcare family of mental health services to expand its continuum-of-care with a national platform, making PrairieCare and Newport the nation’s largest provider of specialized mental health services for youth and young adults. The health system has also partnered with Children’s Minnesota to launch a new 22-bed inpatient mental health unit that is among just a few in the nation to treat children with complex medical needs, while allowing parents to stay the night. The Minnesota Department of Human Services has also re-tooled the psychiatric residential treatment facility (PRTF) model. The changes break down both licensing and financial barriers that have plagued growth of this critical service in Minnesota.

The statewide Psychiatric Assistance Line (PAL) provides thousands of free consultations and trainings to medical professionals for better care of mental health conditions in the primary care setting. This model has garnered recognition locally by the Minnesota Hospital Association and on a national level by the American Psychiatric Association. The service is supported by grant funding from the MN Department of Human Services and the MN Department of Health. This is a unique and effective partnership between the provider community and state administration.               

A robust and effective mental health system can be built when we work together across care settings. In this context, the term care setting must be expanded to include not only hospitals and mental health treatment settings, but also services from counties, the state, social services and more. We are stronger together.

Todd Archbold, LSW, MBA, is the chief executive officer at PrairieCare.