Like in other places, the emergency department at the Rainy Lake Medical Center is where people come if they think they’re having a heart attack or have broken their arm or find themselves in a mental health crisis.

But unlike some hospitals, there’s no special emergency department for people in crisis and no inpatient beds for psychiatry patients in International Falls, Minn., a city of 6,000 people near the Canadian border.

The shortage of mental health care in rural areas means patients in need of inpatient psychiatric care are often waiting days to be transferred to beds far from home. It’s a situation that’s challenging for patients, families and health care providers, one with no obvious solution.

At the hospital, you can see how providers have to make do. Instead of a psychiatric emergency department, there’s a room next to the nurse’s station, which can be retrofitted to make it safe if people are experiencing psychosis or threatening to hurt themselves.

“We can remove all the cords from the room,” said Cherrie Belanger, the hospital’s nursing director. “There are no curtains or anything hanging that they can harm themselves with.”

But that’s about all she can offer in an emergency. There’s one crisis bed in town. The closest inpatient bed is in Hibbing, Minn., which is two hours away.

The emergency entrance to the Rainy River Medical center in International Falls. Evan Frost | MPR News

If a patient does need to be hospitalized, Belanger and her nurses get on the phone and start working their way down her list of about 25 facilities across Minnesota and beyond.

“We try to find a bed. It takes hours upon hours of nursing care to locate a facility that has an opening,” she said.

Even so, it can take days or sometimes even weeks for them to find a spot, during which time the patient is stuck waiting in the emergency department.

And once the hospital finds a spot, the patient still has to get there. It mostly relies on the city’s ambulance service to transport the patients. Depending what’s happening that day, the ambulance can’t be taken out of service to drive a patient long distances.

Those distances are rough on everybody. Tom Parish’s son has been hospitalized all over the state at least a dozen times. He wishes there were an inpatient facility closer to home.

“We went through three years where we were visiting every weekend, and that gets a little burdensome,” he said.

And it’s hard on the hospital, too. Belanger estimates that the emergency department sees between 10 and 15 mental health crisis cases every month. On a bad day, she might have three or four patients in at the same time.

“I think it causes a lot more strain on the nurses and the physicians in the ER than any other type of patients — just because we feel so badly that we can’t provide the care that they truly need,” she said.

Rainy Lake Medical Center nursing director Cherrie Belanger inside of the hospital's emergency room. Evan Frost | MPR News

That’s partly because neither the nurses nor the emergency doctors have any psychiatry training beyond what they learned in school. Plus, a patient waiting in the ER also takes up a valuable bed and sometimes requires extra staff.

None of this is unique to International Falls. Dennis Mohatt, who studies rural mental health care at the Western Interstate Commission for Higher Education, said it’s a long-standing problem.

“There have been just sort of chronic mental health professional shortages across you know five decades,” he said.

It’s not just inpatient beds that are missing, though. The only psychiatrist in town retired last fall and the psychiatric nurse practitioner is looking to follow suit.

But in one respect, International Falls is in a better position than many rural areas because it has a community mental health center, Northland Counseling Center, which provides outpatient services, treatment for substance use disorders and other community-based services.

The center also runs a mobile crisis unit, whose volunteers do everything from going to a person’s house to helping the emergency room staff determine if somebody needs inpatient care.

The clinic is busy. It bills itself as the only mental-health care provider in town that accepts Medicare. It’s working on plans to expand.

This reporting is part of Call to Mind, our initiative to foster new conversations about mental health.