Spring Harbor Hospital's lobby looks more like one found in an inn than in a busy hospital.
[Editor's Note: To give a degree of anonymity to the teenager in this story, her last name has been changed.]
She's only 15 years old. But in her short lifetime, Liv Doucette has been hospitalized for mental illness 16 times.
"When I was 6, I was diagnosed with bipolar," she says. "A couple years later they added on anxiety and depression. Then around 10 or 11, they told me I had schizophrenia. A year or two later they told me it was schizoaffective.
Patty Wight: "So that's the current diagnosis?"
Liv Doucette: "Schizoaffective, with bipolar and depression and anxiety."
Symptoms of Doucette's illness include hearing voices. She says she can manage them most of the time. But sometimes those voices ramp up into what are called "command voices."
"The voices I have right now, they tease me, but they go away easy," she says. "But then, when I'm really in trouble, they're non-stop, they don't go away easy. And they're telling me to hurt myself, or fall down the stairs, or to choke my mother. Stuff like that."
When Doucette hears these command voices, it's a sign she needs her medication adjusted. This has to happen in a hospital, where doctors can monitor her response. But getting admitted to a psychiatric hospital isn't as easy as calling Doucette's psychiatrist for a referral.
"The psychiatrists have no admitting rights, or no connections with the hospitals," says Liv's mother, Annie Doucette. Annie Doucette says after she checks in with a psychiatrist, a crisis team comes to her house to assess her daughter. If they give the green light, Doucette brings her daughter to an emergency room to get medically cleared. Then, they wait, while the crisis team tries to find Liv a bed at one of the state's three private psychiatric hospitals.
"And you spend 8 to 10 to 12 hours at an ER with people evaluating you as a parent, and they don't know the case, and it's - it's horrific," Annie Doucette says.
Some psychiatric hospitals do allow direct admissions without having a patient medically cleared at the ER first. The problem is, there are often no beds available, so a patient is sent to the ER where they can be monitored while they wait for an opening.
Annie Doucette says it wasn't until four years ago, after moving to Maine from New Hampshire, that there was an opening at a psychiatric hospital that was the right fit for her daughter. It was Spring Harbor in Westbrook.
An aerial view of Spring Harbor Hospital's sprawling grounds in Westbrook.
"Actually, if you don't mind going out in the rain, I can show you a little bit of our outside area," says Dr. Joyce Cotton, chief clinical nursing officer at Spring Harbor, which resembles a coastal New England inn more than a busy hospital.
"This is our courtyard with a gazebo and a fountain, and really, it's just such a pretty area, a peaceful area, for our patients to come," Cotton says.
Spring Harbor strives to be as homey as possible. Patients typically stay two weeks, and Cotton says there is a steady stream of them looking for treatment.
"We don't actually have a waiting list per se, because again, we're acute care - we get called daily for patients," Cotton says. "But we do have patients who are denied because we don't have capacity, and more so, it tends to be much higher for our adult population. There seems to be a real need in the state for adult psychiatric beds."
Spring Harbor has 100 patient beds, but only 88 are in use. Cotton says that's because those beds used to be dedicated to children, but demand for them decreased.
Treatment at Spring Harbor is covered by private insurance, Medicare, and an annual state allotment to cover the uninsured. In order to make more beds available to adults, Cotton says the state would have to provide additional money.
"And, you know, other providers would need to come to the table to talk with us about how we best could use those beds, and how would that be paid for?" Cotton says. "How would that service be covered?"
When patients are admitted to Spring Harbor, they spend most of their days meeting with social workers and psychiatrists, and going to group sessions. Medical Director Dr. Rob McCarley says treatment is largely dictated by the patients themselves.
"And my goal is, if someone is going to stay better, they have to be invested in the treatments," McCarley says. "I can't come up with a strategy that I think works that someone else doesn't. Because as soon as they leave, they're going to say, 'To heck with this.'"
Liv Doucette says Spring Harbor is her favorite hospitals. She says the food is better than other hospitals, and so are the activities - things like art contests and volleyball, and lots of time outside.
When she first came to the Spring Harbor, she stayed for two and half months. Her mom, Annie, says that period marked a turning point in her daughter's treatment. "The environment is empowering, and the staff is amazing. I feel like I love those people."
Liv Doucette has stayed at the hospital four times, and over the course of those stays, her medication has been reduced, from more than 20 pills a day to 11. Doctors also helped advocate for her to take mainstream classes in school.
"I am now eating in the cafeteria, making new friends," Liv Doucette says. "I have three after-school activities. I haven't had a hospitalization in almost a year."
Liv says years ago, no one would have believed she'd come this far. And she's striving to go further. She's an active participant in Girl Scouts, where she's pursuing what's known as the Gold Award - the highest achievement possible. For her project, she wants to add a section on mental illness to the Girls Scouts' special needs manual.
Tomorrow, we visit state psychiatric hospital Dorothea Dix in Bangor to discover the challenges it faces in trying to improve the lives of those with the most severe and persistent forms of mental illness.
Photos: Courtesy Spring Harbor Hospital