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Bill Seeks to Provide Beds for Psychiatric Emergencies
05/07/2013   Reported By: Patty B. Wight

Imagine you get sick, so sick you need to check yourself into the hospital. And what if the hospital doesn't have any available beds, so you have to wait in the emergency room for days, or weeks, or maybe even go home without treatment? According to many doctors and social workers, that's frequently the situation that psychiatric patients find themselves in. A bill before the legislature aims to ensure those patients get a bed.

Dr. Karen Rice is chief psychiatry resident at Maine Medical Center. She said the hardest parts of her job is telling patients with mental illness who come to the hospital that she can't get them the care they need because there are no psychiatric beds available. Rice delivered emotional testimony before members of the legislatures Health and Human Services Committee.

"These are patients who have hit rock bottom," Rice said. "These are patients who are ashamed to have mental illness. But they finally decide to walk in the door. They are patients brought in with loved ones who have pleaded with them for years to seek help."

This is a problem hospitals across the state now face. The chief of the emergency department at Mercy Hospital in Portland Dr. John Southall said there was a time when moving a psychiatric patient out of the ER and into the hospital was measured in hours.

"Now, for those suicidal and behavioral health patients, we measure it in days, even weeks," said Southall. He said while patients wait in his ER, they stay in a small, windowless cubicle devoid of any stimuli or anything they could use to harm themselves.

"So I don't know what you need to do under our current judicial system to qualify for solitary confinement, but I'm pretty sure coming to an emergency department asking for help from a behavioral health standpoint doesn't qualify you for solitary confinement, and yet that's essentially what we do," Southall said.

Maine jails face similar problems caring for mentally ill inmates. Democratic representative Mark Dion is a former Cumberland County sheriff.

"Listen, in my twelve years as sheriff, I saw us transform slowly from a correctional institution to a de facto mental hospital," said Dion. "There were days where 100 percent of the inmates required psychotropic drugs. Sometimes we waited weeks for a bed for an individual for whom we had convinced a judge they should be committed to a facility."

Dion is sponsoring a bill that would require Maine's Commissioner of Health and Human Services to provide hospitalization for a mentally ill person in psychiatric crisis. He was prompted to do so by the Maine Chapter of the National Association of Social Workers. that group's executive director, Susan Lamb said her group isn't just upset:

"We're infuriated," she said. "Because it's been getting worse progressively, year after year after year, for about twenty years."

But Dennis King, the president of Spring Harbor Hospital and Maine Mental Health Partners said while he agrees that Maine needs to improve the care it provides for the mentally ill, he thinks Dion's bill is impractical. Because, he said, it would require the state to find care for patients waiting longer than 12 hours at a facility outside of Maine.

"If those beds existed out of state, and I would submit to you that theres is every bit of evidence to said that the out of state placements are unlikely because of cost considerations as well as practicality," King said.

The Maine Disability Rights Center also opposes the bill. Counsel Helen Bailey said outside of cost issues, it fails to address other, important needs, such as in-community services, which could prevent the need to go to the hospital in the first place.

"This bill proposes a very simple solution to really what is a very complex problem," said Bailey.

Supporters acknowledge that the bill faces hurdles because of cost. But said they believe there is a way to reshuffle the current system to provide better care for the mentally ill.

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