Adding needed beds for mental health: MetroHealth about to open $42M Behavorial Health Hospital in Cleveland Heights

CLEVELAND, Ohio — While some area health systems are contracting, MetroHealth System is expanding with the region’s largest investment in behavioral health in decades.

The $42 million, 112-bed MetroHealth Cleveland Heights Behavioral Health Hospital opening Saturday, Oct. 8, is expected to treat about 5,000 patients a year for such conditions as bipolar disorder, depression, addiction, mood disorders and dual diagnosis, or having both mental illness and substance abuse.

Safety features, such as doors that are impossible to barricade, cut down the risk of injuries. And the behavioral health hospital will have specialized units for treating adolescents and the elderly.

The opening of the behavioral health hospital will come a week before MetroHealth opens its new 11-floor Glick Center on its main campus.

The expansion in Cleveland Heights will increase the number of psychiatric beds available in Cuyahoga County, but it’s not enough to completely solve the problem of too much demand for too few beds, exacerbated by the upcoming closing of psychiatric services of St. Vincent Charity Medical Center.

Cuyahoga County is on track to have a record number of fatal overdoses this year, and the COVID-19 pandemic increased demand for mental health counseling. Nearly 5 million people visited emergency departments with mental, behavioral and neurodevelopmental disorders in 2018, according to the U.S. Centers for Disease Control and Prevention.

Local behavioral health experts praised MetroHealth’s commitment to mental health.

“It’s fantastic. I mean, that’s the bottom line. This is terrific,” said Dr. Leo Pozuelo, chair of psychiatry and psychology at the Cleveland Clinic. “Not having an adequate number of inpatient beds in the city of Cleveland hampers the care that our patients receive.”

Opening comes as another hospital is about to close

However, the imminent loss of St. Vincent’s inpatient psychiatric care beds and its psychiatric emergency room places more pressure on MetroHealth to care for the underserved.

St. Vincent will close inpatient care, surgery and emergency room services on Nov. 15, offering wellness and outpatient services instead at its location just south of downtown Cleveland.

St. Vincent currently has 20 inpatient psychiatric beds and 15 detox beds, and served nearly 1,000 psychiatric inpatients in 2021, the hospital said. Its psychiatric emergency room, which has caregivers specialized in psychiatric assessment and counseling, served about 3,000 patients annually.

“We were counting on (Cleveland Clinic) Lutheran and St. Vincent to take care of the West Side,” said MetroHealth CEO Dr. Akram Boutros. “Now we will need to figure out how to increase services.”

With an eye to MetroHealth’s commitment to addressing the social determinants of health, the hospital located its new hospital near impoverished areas where people see the police more often than healthcare providers, Boutros said.

“How do I tell somebody from East Cleveland to get on a bus and come to (the West Side’s) MetroHealth to get care?” Boutros said. “So if we were going to do it (develop a larger psychiatric department), we were going to do it in another place.”

Shortfall of psychiatric beds in Greater Cleveland

Cuyahoga County has 220 fewer beds than needed to fully meet residents’ need, according to national guidelines cited by MetroHealth. Economic pressures and a lack of staff contribute to the undersupply.

Many nonprofit hospitals don’t have psychiatric units because those departments often operate at a loss, even with payments from private insurance, Medicaid and Medicare, Boutros said.

“The cost of providing behavioral health and addiction services is significantly more than what you get paid for,” Boutros said. “It’s very difficult to make ends meet for behavioral health hospitals.”

The Clinic, a major provider of mental health inpatient beds in Northeast Ohio, has 269 in-patient psychiatric beds across its health system, as well as 16 chemical dependency beds at Cleveland Clinic Lutheran Hospital.

Yet, Clinic patients sometimes wait up to 36 hours to be admitted to a behavioral health unit, Pozuelo said.

The University Hospitals system has 101 psych beds, and no detox or substance use beds.

Highland Springs Hospital, a private hospital with facilities in Highland Hills and Solon, and six, state-run regional psychiatric hospitals also provide care to this population of patients. There are no state-run psychiatric hospitals in Cuyahoga County.

Many beds at nonprofit hospitals are left empty due to a shortage of mental health caregivers to staff them.

As many as 15% of the Clinic’s psychiatric beds usually go unused because of staffing issues, Pozuelo said.

Cuyahoga County has about 450 psychiatrists and addiction medicine specialists, for a population per provider ratio of one provider per 2,795 people, according to a behavioral health workforce tracker developed by Washington University in Washington, D.C.

In 2019, nearly half of Cuyahoga County residents who needed inpatient behavioral health care had to go outside of the county to receive it, MetroHealth said.

Lack of adequate pay and job stress make it hard to retain mental healthcare workers, said Scott Osiecki, chief executive officer of the Alcohol, Drug Addiction and Mental Health Services board of Cuyahoga County.

“It’s a difficult job, it’s stressful and we need people (over) 24 hours,” Osiecki said. “They can actually make more money working in McDonald’s or Walmart.”

MetroHealth, anticipating staffing problems, will phase in the new hospital’s units over the next several months as it recruits staff. The facility is slated to reach its full staff of 225 employees in mid-2023, Boutros said.

The system expects to hire many of St. Vincent’s behavioral health caregivers. “The faster the staff gets recruited, the faster we will open,” Boutros said.

Inside the Behavorial Health Hospital

Connected to next to the MetroHealth Cleveland Heights Medical Center near the Severance Town Center, the three-story, 79,000-square-foot hospital features large windows looking onto peaceful woods, calming hues of blue and areas for communal meals.

The behavioral health hospital is designed to encourage patients to get out of their rooms and join others for meals, watch television or play basketball in an adjoining outdoor space.

These activities teach people with mental disorders how to function independently despite their mental condition.

“If you are severely depressed, it takes a lot of energy to get out of bed,” said Dr. Julia Bruner, MetroHealth senior vice president for behavioral health and correctional medicine. “You often will need not only medications, but you’ll also need an environment that’s conducive to encourage you to do so.”

The hospital has five units – geropsychology, dual diagnosis, mood disorder, thought disorder and adolescents. Group therapy and other programs will address the specific needs of those different patient populations.

GeroPsych refers to delusions or other mental conditions exacerbated by dementia. The dual diagnosis unit treats patients who have a mental health condition and substance abuse disorder. Thought disorder patients have hallucinations or delusions, and mood disorders involve depression and anxiety.

The facility was designed with patient safety in mind. Door handles, faucets and shower heads are designed to make it difficult to tie a rope to them. Bathroom doors are made of foam and attached to the wall with Velcro, so that caregivers can quickly remove them to reach distressed patients.

This is not a lockdown facility. Most patients will be voluntarily admitted. For another 15% of patients, hospitalization is required because they are at risk of harming themselves, Bruner said.

In a cost-saving move, the Cleveland Heights Medical Center emergency department is being renovated to accommodate a psychiatric emergency room. The shared emergency departments will link the medical center and behavioral health hospital.

The new hospital will accept patients from other MetroHealth locations, area hospitals and community behavioral health organizations across Northeast Ohio. Family and friends also can bring loved ones to the Cleveland Heights hospital’s psychiatric emergency room for evaluation.

“I’m completely excited,” MetroHealth’s Bruner said. “It’s going to be phenomenal for our community.”