Pandemic restrictions on hospital beds create severe mental health bed shortages for children

There’s been a sharp increase in the number of children with emotional or behavioral health issues being dropped off at M Health Fairview Masonic Children’s Hospital. Due to a shortage of rooms, the hospital set up beds in an ambulance garage. The Star Tribune reports the hospital took in 145 children since September who stay an average of 15 days. That’s up from 1 or 2 children a month. This extreme case reflects the widespread shortage of mental health facilities for children in Minnesota.

Pandemic restrictions boosted children’s mental health needs  

Multiple factors are fueling this shortage. On the demand side, pandemic-related restrictions have imposed substantial burdens on children’s mental health. School closures and mask mandates in schools upended the caring and attentive educational environment families rely on. Likewise, restrictions on sports and other activities removed social interactions that are key to a child’s development.  

All of these restrictions were placed on children in 2020 despite early warnings of the mental health risks and early scientific evidence showing that they were generally not at risk for serious complications from COVID-19. In June 2020, an article published in the journal Minerva Pediatrica led by stating: “Although medical literature shows that children are minimally susceptible to 2019-Corona virus disease (COVID-19), they are hit the hardest by the psychosocial impact of this pandemic.”

Nonetheless, Minnesota, under the leadership of Gov. Tim Walz, locked children out of schools and sports far too long without properly weighing the well-understood risks to their mental health. This mistake was clear to many people at the time. For instance, in August 2020, Florida Gov. Ron DeSantis described mental health as “the big enchilada” moving forward as he pushed to re-open schools.

Today, the unfortunate real-world evidence confirming the wisdom behind the Florida governor’s prescient push to open schools is showing up in hospital emergency rooms across Minnesota.

Hospital moratorium cut off supply

On the supply side, another central factor driving mental health bed shortages is Minnesota’s decades-old moratorium on building new hospital and nursing home beds. The only way to build a new hospital bed in Minnesota is to either replace an old hospital bed or go lobby the legislature for an exemption from the law.

As American Experiment’s research shows, this moratorium has successfully held down the supply of hospital beds. However, the research also shows this type of law fails to achieve its goal to keep health care costs down by limiting capacity. Capacity is indeed limited, but costs nonetheless rise. That’s largely because the moratorium protects hospitals from lower-cost competitors.

The Star Tribune reports PrairieCare received legislative dispensation last year to add 30 beds to its pediatric hospital in Brooklyn Park, and Children’s Minnesota is similarly groveling before the Legislature to gain an exemption to add 22 psychiatric beds to its St. Paul campus. Without the hospital moratorium, all of these beds would likely have been built years ago. This shortage is not a new problem for the state.

Minnesota Legislature voted down psychiatric hospitals in the 2000s

Recognizing the need for a specialty psychiatric hospital, North Dakota-based Prairie St. John’s requested an exemption from the moratorium in 2007 to build a 114-bed facility in Woodbury. However, the team of market analysts at the Minnesota Department of Health, no doubt schooled in public health and not business markets, determined the hospital was not in the public interest. Incredibly, part of their rationale relied on the conclusion that it “would likely have a negative financial impact on existing hospitals.” With this conclusion from the health department and stiff opposition from competing Twin Cities hospitals, the Minnesota legislature shot them down.   

Notably, as MinnPost reports, Prairie St. John’s saw the need because its hospital in Fargo “kept getting waves of children and teenagers from the Twin Cities in dire need of mental health treatment.” Due to this demonstrated need that Minnesota’s Department of Health ignored, Dr. Stephen Setterberg sold his interest in Prairie St. John’s and the next year successfully lobbied Minnesota’s legislature to get a much smaller 22-bed facility built in Maple Grove. That was 92 beds short of their earlier goal. Those are beds that could have been available to children today.

At the time, Setterberg told MinnPost, “Operating in North Dakota, it’s a free-market mentality, and if you want to start a hospital and it meets regulations, go for it. Because we came out of that political environment, we were just absolutely blindsided by politics. It took a couple of years to get our bearings after the first go-around.”

That free-market mentality remains absent in Minnesota. Instead, the state’s hospital moratorium allows entrenched interests like M Health, PrairieCare, and others to block competition.

Make no mistake, Minnesota’s non-profit hospitals have directly contributed to the suffering of children with mental health issues by lobbying to block competitors from opening facilities that would better serve them where they live in Minnesota.

Instead, too many Minnesota families must place their struggling children in facilities hours away from home, if they can find a facility at all. Better policy decisions by Gov. Walz on COVID-19 restrictions and a repeal of Minnesota’s hospital moratorium could have avoided these types of hospital bed shortages. A better policy decision in the future can avoid making the same mistake twice.