Duluth hospitals find it's increasingly difficult, some days impossible, to treat patients arriving from across Minnesota with mental health emergencies.

A steady stream of mental health patients arriving from overflowing Twin Cities hospitals has created a crunch in Duluth.

Increasingly, emergency room doctors here must send critically ill children and adults 60 to 70 miles for mental health care. It can lengthen the wait for a mentally ill patient in need of emergency services and create obstacles for families who must travel greater distances to see a loved one.

The influx of Twin Cities patients also stands to increase the workload of St. Louis County attorneys and social workers, who must step in when a mentally ill adult must be involuntarily admitted to a hospital for treatment.

Officials from Hennepin County, which includes Minneapolis, agreed this week to reimburse St. Louis County for work needed to aid Twin Cities mentally ill patients receiving treatment in Duluth.

At least 38 times this year, Miller-Dwan Medical Center stopped accepting new mental health patients because the hospital had nowhere to put them.

Before last year, no one counted how often Miller-Dwan's mental health unit ran out of room because it happened so infrequently, said Kathy Huntley, who oversees St. Mary's/Duluth Clinic Health System's behavioral health services.

"We have been absolutely full," she said.

In 1999, on an average day, patients filled about half of Miller-Dawn's 53 mental health beds -- 16 for children, 37 for adults. Now it's closer to 80 percent, Huntley said.

"It's just kind of crept up," she said.

Miller-Dwan's surging demand can be attributed to a dearth of metro-area hospital beds for Twin Cities' mental health patients, Huntley said.

Ten percent of its mental health inpatients between June 2001 and July 2002 arrived from the Twin Cities. In May, one in four children seeking care at Miller-Dwan lived in the metro area.

Jan Malcolm, Minnesota's health commissioner, said the demand for mental health care -- from emergency services to child psychiatrists to halfway houses for adults -- has reached "rather urgent proportions."

Malcolm said Minnesota lawmakers must consider raising mental health payment rates for state-sponsored insurance. She acknowledged it's a difficult request in the current economic climate, with the state facing a revenue shortfall.

The need for hospital beds may be due in part to a growing number of previously undiagnosed patients willing to seek treatment for services as stigmas about mental health fade, Malcolm said.

A St. Paul trade group, the Minnesota Hospital and Healthcare Partnership, surveyed 100 hospitals and found hospital visits for mental health and chemical dependency jumped 16 percent between 1997 and 2001.

Low payments for mental health care from public and private insurers makes Minnesota hospitals unwilling to expand mental health services to meet with demand, Malcolm said.

The low payments keep salaries down, making it harder to recruit sought-after doctors, particularly child psychiatrists, she said.

Hospitals lack the financial incentive to meet a growing demand for health care services, she said. "It's not economically viable" to use hospital beds for mental health patients when other specialties break even or generate a profit, she said.

Overall, Minnesota lacks a necessary range of mental health care services that could prevent a crisis or help patients recover after hospitalization, Malcolm said.

Minnesota insurers and hospitals recently announced the creation of a $5 million trust fund to create halfway houses for the mentally ill.

Renee Engstrom, who oversees family services for ARC Northland, helps children diagnosed with mental illness and their families find support.

Families wait up to five months to see a child psychiatrist. Few, if any, resources exist for families who need help to head off a crisis, she said.

St. Luke's hospital receives four or five calls per weekend from Twin Cities hospitals seeking space for mental health patients, said Jo Ann Hoag, St. Luke's vice president for network development.

St. Luke's recently converted a medium-security mental health unit to high-security, expanding its capacity to take critically ill mental health patients to 22 adults. Previously, it was 12.

John Strange, St. Luke's chief executive, said the decision wasn't based on economics.

"We were filling up," he said. Strange does not yet know the financial impact St. Luke's will experience as a result of the expansion, which wrapped up this spring.

The increase proved fortunate. On any given day, 17 patients are receiving mental health care at St. Luke's -- and if patients are extremely sick, that's all the hospital's nurses, therapists and doctors can handle, Hoag said.

When that happens, St. Luke's starts looking north, to a scattering of hospitals, such as Fairview-University Medical Center-Mesabi in Hibbing, prepared to care for mental health patients.

"It's a ripple effect," she explained. "If Rochester fills up, they go to the metro. If the metro fills up, they go to Duluth. If Duluth fills up, they go to the Range."

As of the end of August, mental health admissions at Fairview-University were16 percent higher than for the same eight months in 2001, said Jack Burland, administrator for acute and ambulatory programs.

"That's dramatic in health care," Burland said.