BANGOR, Maine — Maine’s underfunded community mental health system is at least partly to blame for an increase in violent behavior in hospital emergency departments, according to an administrator at Eastern Maine Medical Center.
A leading advocate for Mainers with mental illness said there’s no doubt the incidence of violence is going up in hospital emergency rooms, but cautioned against assuming mental illness is to blame in all cases.
Whatever its cause, an increase in violence is behind EMMC’s recent decision to help the Bangor Police Department buy a Taser — the generic term is “electronic control weapon” — to keep in the emergency department 24 hours a day for the use of police officers.
The Bangor City Council will decide Aug. 10 whether to allow the Police Department to accept the grant, up to $1,000.
Karen Clements, administrator of the EMMC emergency department, said Wednesday that a scarcity of inpatient psychiatric beds and outpatient counseling and support services is among the factors driving up assaults and other aggressive behavior, not only at EMMC but at hospitals throughout Maine and across the country.
“You see everything,” Clements said of behavior in her emergency department. It includes oral threats, hitting, biting, kicking, choking and threatening staff and other patients with knives and other weapons, she said.
Over the past five years, she said, the emergency department has seen an increase in patients with histories of mental illness, aggression and suicidal behavior, as well as more people clearly under the influence of drugs and alcohol.
“It is important that I keep the department safe for staff and patients and visitors,” Clement said. For more than five years, she said, the hospital has hired Bangor police officers to safeguard the emergency department during the nighttime hours, when the likelihood of violence goes up.
A police officer is assigned to the ER at EMMC from 8 p.m. to 2 a.m. every day. The new Taser, if it is acquired, will be locked in the emergency department when the officer is not on duty but kept holstered on the officer’s person during the duty shift.
Police Chief Ron Gastia said Wednesday that the department doesn’t have enough Tasers for every on-duty officer to carry one, and it’s not possible to ensure that the officer assigned to the hospital has one. While it is rare for a situation to escalate to the point where a Taser would be needed, he said, the electronic weapon, which typically causes no lasting physical harm, is preferable to a gun.
The weapon, when discharged, shoots two probes into the skin of the target. The probes remain attached to the weapon, which then releases a 50,000-volt electrical charge for about five seconds. Standard household current is 120 volts.
“It disables people,” but only temporarily, Gastia said. Additional jolts can be delivered if the subject doesn’t become more cooperative.
The Bangor Police Department bought its first Taser in 2000. Gastia said the department now has “fewer than 10” of the weapons to share among all on-duty officers.
Gastia said police are trained to warn their targets orally before using a Taser, but that in some circumstances it may not be possible. Tasers should not be used on women who are known to be pregnant, on children or the elderly, or in areas where there are flammable or explosive materials, he said.
Carol Carothers, executive director of the Maine chapter of the National Alliance on Mental Illness, said Wednesday there’s no question that hospital emergency departments are seeing an increase in aggressive behavior. But she cautioned against assuming that everyone who becomes belligerent, aggressive or even violent in an emergency room suffers from a mental illness.
“There are any number of reasons why somebody could become assaultive in the emergency department,” including long waits for treatment, she said.
“You assume that people who go to the hospital are there because they need help with health care,” she said. “You would hope they would get that care rather than getting arrested or Tased.”
Carothers said health care providers should be trained in methods for de-escalating potentially violent encounters with patients.
At EMMC, Clements said most emergency department staff go through training on dealing effectively with upset patients, including positioning themselves for safety, treating with medications, using mechanical restraints, and defending themselves if they are attacked.
Even just having an armed police officer in the ER has had a dampening effect on violence, Clements said.
“What’s the first thing you do when you see a state trooper on the interstate?” she asked. “You slow down.”
Calls on Wednesday to other large hospitals in Maine — MaineGeneral in Waterville and Augusta, Central Maine Medical Center in Lewiston, and Maine Medical Center in Portland — found none that hire police coverage for their emergency departments.
Portland police, under the leadership of Chief James Craig, just began a three-month experiment to carry Tasers.