KNOXVILLE, Tenn. — In October 2023, state lawmakers from Knoxville asked the state to look into whether East Tennessee needed a new state, inpatient psychiatric hospital. Months later, a report was released from the Tennessee Department of Mental Health and Substance Abuse Services saying the region needed more beds serving psychiatric patients.
"The central part of East Tennessee has nothing," said Sen. Richard Briggs (R-Knoxville). "And that's what the real issue is. We do have mental hospitals in other parts of the state. But if you look at a mental health hospital desert, it centers around Knoxville. And of course, for the middle part of East Tennessee, we're the primary city. But again, this isn't just for Knoxville. It's for all 24 counties that would be serviced by this hospital."
The report discussed the closure of Lakeshore Mental Health Institute starting in 2011, after more than a century. Prior to its closure, the state facility served 24 counties in total — mostly in East Tennessee. Following its closure, three private hospitals in Anderson County, Blount County and Washington County took over services and were contracted by the state.
The closure also made the nearest state-run facility to Knox County the Moccasin Bend Mental Health Institute, located in the Chattanooga area.
"Tennessee is one of 13 states with the lowest public inpatient psychiatric hospitalization rates at eight or fewer per 100,000 of the population," the report said. "The availability of robust community resources in Tennessee likely contributes to the lower inpatient psychiatric hospitalization rates."
Briggs said the report recommends a new East Tennessee facility with 50 beds. But by 2050, the need is expected to grow to 100.
"I think what it says is that we have a lot of needs in this community that are not being met by the present facilities," said Briggs. "I know our county sheriff says that the Knox County Jail is the largest mental health facility in the state right now. And even up to 25% of our prisoners have serious mental health needs that can be served in some place other than the county jail."
Sen. Becky Massey (R - Knoxville) said this announcement is only the first step.
"I just think this is the first step in, and we will work as a delegation, we will work together to bring this to fruition," said Massey. "No specific timeline, I would hope, I would love, to get it on in the budget next year. But it's, we will work until we get it taken care of. You have my commitment to that."
Following the closure of Lakeshore Mental Health Institute, the report said around $20.5 million in state funding was moved to community programs such as crisis stabilization units, school-based behavioral health liaisons, housing services, criminal justice liaisons and medically monitored detox withdrawal management.
When it was closed, the facility had 2,237 admissions, the report said. Since then, the number of patients at contracted facilities in East Tennessee has grown, reaching a peak in the fiscal year 2018 with a total of 4,204 admissions. After that, admissions decreased and the report warned a lack of staffed beds contributed to that decrease.
"I happened to be on the Knox County Commission back in 2012, when they closed Lakeshore, and the hope would be that those patients could be discharged from the Lakeshore Hospital when they closed Lakeshore and they could all be treated as an outpatient," said Briggs. "And that happened in many cases where Helen Ross McNabb, which does an incredibly good job in our community, took over those patients. But the problem is the need has just grown and grown and grown."
It also said the state-run facility in Chattanooga serves a patient population with significant needs. Around 66% of patients at contracted facilities were diagnosed with mood disorders, while 33% had mood disorders MBMHI. Around 10% were diagnosed with drug-related disorders in private hospitals and 19% were diagnosed with psychotic disorders. At MBMHI, 21% were diagnosed with drug-related disorders and 28% were diagnosed with psychotic disorders.
The number of patients in East Tennessee is only expected to grow as the area's population increases, the report said. The area of the former Lakeshore facility is expected to have a population of around 1.8 million people, according to the report.
"There are currently 334 staffed adult inpatient psychiatric beds out of 422 licensed adult inpatient psychiatric beds available at private hospitals in the former 24-county Lakeshore Mental Health Institute catchment area," the report said.
The report urged leaders to consider some specific factors about the region's bed capacity. Those specific factors are listed below.
- Current bed capacity and unpredictability of private market
- Burden on patients receiving treatment far from family and other supports and difficulty in aftercare planning/placement
- Increasing regional population and number of residents with severe mental illness
- Lack of ability to care for highest need patients among private operators
- Lack of capacity and expertise to treat admissions from jail or forensic cases among private operators
- Burden on law enforcement to travel to Chattanooga for regional mental health institute admissions
"The lack of a state hospital northeast of Chattanooga creates an increased burden to patients who are hospitalized a sizeable distance from their families and/or friends who may offer therapeutic benefit to the patient while hospitalized. It also creates a financial and personnel burden for law enforcement agencies who are compelled by statue to transport patients and for the local governments which fund them. Additionally, the department acknowledges that we cannot project decisions by private market hospital operators to close existing facilities or open new facilities or their willingness and ability to serve indigent and uninsured Tennesseans," the report said.
Massey said building a closer mental health in-patient care facility will keep those who need it, closer to their family.
"Well, obviously, folks that have more severe mental illness, persistent mental illness, or that are coming from jails or court-ordered forensic evaluations won't have to be so far away from their families," said Massey. "And it's a proven fact that if your family and your friends are closer to you, you do better in your recovery. And one of the things that I thought was interesting in my research getting ready for this, was 90% of the folks that were at Lakeshore in the year before they stayed in at an average of less than 10 days."
Briggs also said he agrees jails are not the place to have people who need mental health help.
"It's not the place to take them where they need to be as they need to not only be in a different type facility than in a jail, they need to have the treatment," said Massey. "Our sheriff's office, our correction officers at the county jail, they do a wonderful job. I mean, it's a tough job. And it's a wonderful job. But, they are not mental health professionals. And what we really need particularly for those that are severely mentally ill is to have them in a facility where they can be properly treated."
The report said MBMHI admitted 688 patients from the area previously served by the Lakeshore facility in the fiscal year 2023.
This hospital has not yet been approved to be built. Both senators say the next steps are to gather more support and secure funding.