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Maine Bill Aims to Extend Involuntary Hospital Holds for Mental Patients
02/18/2014   Reported By: Patty B. Wight

How long should a hospital be allowed to involuntarily hold an individual needing mental health treatment?  Right now, hospitals have 24 hours to find someone a bed at a psychiatric hospital.  But a new bill under consideration in Augusta would extend that window to a week.  Hospital officials who support the measure say they're already holding patients longer than the law allows because of a lack of psychiatric beds.  But opponents say the bill creates a patchwork solution that comes at the expense of the patients.  Patty Wight reports. 

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Maine Bill Would Extend Involuntary Holds
Originally Aired: 2/18/2014 5:30 PM

This is a bill about balancing patient rights with the reality of Maine's troubled mental health system.  If someone is brought to an emergency department needing mental health treatment but doesn't want to accept it, hospitals have 24 hours to find a psychiatric bed and get a court order for treatment. 

The problem is, most of the time, there are no psychiatric beds available.  And that, says, Dr. Steve Diaz, chief medical officer at Maine General Hospital in Augusta, leaves hospitals between a rock and a hard place.

"We are not going to release somebody after 24 hours if we think they are a danger to themsleves or others," Diaz says. "We are just not going to do it.  Now we are in violation of the law."

Maine General, like many hospitals across the state, often have to hold patients needing psychiatric treatment for days or weeks until a bed is available.  Given they have no choice in the matter, Dr. Diaz told members of the Legislature's Judiciary Committee that hospitals should be legally protected when they fail to comply with the deadline.

That's the intent of the bill, says its sponsor, Republican Rep. Richard Malaby, who conceded to the Judiciary Committee that it addresses just one small part of a broken mental health system.

"The underlying problem is complex and will be difficult to solve as it will take time," Malaby said. "In the interim, we should not ignore the legal situation our hospitals are facing." 

The Maine Hospital Association's Jeff Austin says it's important to note that the bill doesn't remove the expectation that involuntary mental health patients should get a psychiatric bed in 24 hours.  It just allows hospitals to avoid legal trouble if they can't find one.
"We do not  believe that this law - that this bill -  would result in patients being held longer in EDs than today."

Even so, the bill doesn't sit well with mental health advocates, like Simonne Maline.  She's executive director of the Consumer Council System of Maine, which represents mental health consumers.

"It's inhumane to think that consumers of Maine are going to bear this bill and the realities of this work to make everybody else OK, to make the hospital system OK," she says.
Mark Joyce, a lawyer with the Disability Rights Center, says before enacting a bill to solve the problem of long wait times at emergency departments, lawmakers should determine  the root cause. "Is it a lack of psychiatric beds, or is it something else?" he says.

Joyce says he thinks the problem has more to do with the fact that many hospital employees don't have a strong grasp on the criteria for involuntary commitment.  "I've been doing this for 13 years, and one of the things we've seen come into our office is that the individual who is making that initial application is not trained sufficiently."

While some lawmakers acknowledge that this is a problem that needs to be addressed, it's not clear how it should be accomplished.  Judiciary Committee Senate Chair Linda Valentino says lawmakers themselves are now between a rock and a hard place when asked to balance the concerns of mental health advocates with hospitals that are forced to violate existing law. 

"As the Judiciary Committee, we can't ignore that fact and put our head in the ground and say, 'Just ignore the law' to the hospitals," Valentino said.

Some committee members say that injecting more funding into the mental health system could alleviate the problem.  But with the state's tight budget, the only option left to advocates could be to file a lawsuit.


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