Facing the mirror of truth, the health care delivery system for those with mental illness is fractured.
Battling the ravages of mental illness is a shared effort that involves not only the mentally ill, but the community they live in.
And humanizing that communal effort is what a group of Washington County individuals involved in the Integrated Behavioral Health Community Circle (IBH) is trying to do.
America’s culture leaves little room for acceptance or understanding of what this devastating disease does to society. Mental illness knows no class line, or race differentiation, no age, no gender. It does not discriminate. All are faced with the stigma attendant with their disease. Mental Illness is not always easy to diagnose and treatment can be complicated.
Since March 2012, 35 people, all members of IBH, have met in Machias with the goal to improve the system of care delivery in Washington County for those who suffer with Persistent Severe Mental Illness (PSMI). The group is made up of primary-care providers, behavioral-health providers, veterans, crisis responders, law enforcement officials, lay community members, the clergy, a high student and patients who have battled mental illness.
PSMI may include people who have everything from bipolar disorder to schizophrenia or severe depression or anxiety. These are individuals who may make poor decisions because of misinterpreted circumstances, impaired judgment and/or limited social skills.
Maine has the National Association of Mental Illness group (NAMI) that works tirelessly on behalf the mentally ill. There is a local NAMI chapter in Machias. NAMI has a website that lists resources for patients, families and provider communities. The IBH is creating a “Toolkit” of resources for the county that will include the NAMI resources.
A primary goal of IBH is to create a support system for mentally ill clients who have experienced crisis and who access care through the local emergency room. There are innumerable stories of mentally ill patients returning again and again to the emergency room and depending on the severity of the crisis is shackled, both for their safety and the safety of the staff.
Hospitalization is complicated and expensive.
The hospital assigns one-on-one nursing coverage while patients await a psychiatric bed in the emergency room. Patients awaiting a psych bed in the ER receive top priority. But once they are transferred to an inpatient bed, their situation is no longer classified an urgent need. They remain there, however, the most expensive bed in the hospital, while they await a psychiatric bed in Bangor or other parts of the state to open up.
One IBH member observed, “If a person has a broken leg, the system says how we can help that person. When a person has an ill or broken mind, the system says how can we protect ourselves against that person?”
Mentally ill people often are jailed.
Ann O’Brien, psychiatric nurse practitioner at Eastport Health Care and an IBH member talked about
what happens to mental ill patients who wind up in jail. O’Brien is a volunteer at the Washington County
jail in Machias. “Our local jail has established systems to aid the most mentally ill clients who are
incarcerated. For many, this means one-on-one observation. All the corrections officers have received
training to aid in understanding mental illness and to provide some basic skills for treatment,” she said.
Holly Gartmayer-DeYoung, creator and facilitator of the IBH Community Circles, applauded the efforts of
those on the front line. “We recognize the systems within our community are all linked either directly or
indirectly. It is significant to hear all who share, but particularly the patient’s voice and the voice of law
enforcement and its role in our system,” she said. “Law enforcement works side by side with emergency
staff and with community providers to ensure the client in crisis is safe.”
Those individuals who have suffered from a mental illness will be expected to be an integral part of the
recovery system for others, she added. It is hoped that they can help avoid an exacerbation of an
unfolding crisis because they can say “I have been in your shoes; let me help you to regain control of
IBH continues to collect data to show the kinds of improvements needed and align those changes with
the stories heard from patients, their families and from the provider-care community. After that, the
IBH plans to appeal to state government for help. IBH’s goals include ways to improve the quality of
care, improve access for mental health services and contain or decrease cost of treatment.
But more is needed.
Special training for all first responders including EMS and emergency room staff has been suggested.
Access to psychiatric support for ER doctors is also being explored, using a Telepsych unit linking a
psychiatrist in another community to the local ER doctor. Consideration of inpatient beds in Washington
County is also being investigated. Although there may be regulatory constraints that prohibit some
things from occurring, IBH continues to explore every possibility.
Outside groups are helping.
Aroostook Mental Health Center (AMHC) provides “Crisis Response in Washington County. “ Ashley
Pesek, LCSW, an emergency services specialist at AMHC, said that in 2011, the Emergency Services
(Crisis Response) in Washington County showed 1,037 face-to-face contacts with patients in crisis. In
2012, they had 1,015 face-to-face crisis response contacts. But only 25 percent of those were
transferred to an inpatient psychiatric unit.
There has been a steady increase in the time that patients must spend in a medical facility before being
transferred to a psychiatric hospital. Those individual who are most difficult to place are the elderly with
underlying medical issues, adolescents, and individuals who are detoxing. AMHC reports that staffing Mental Illness in Washington County Maine the Emergency Services program in Washington County, requires 12 full-time employees, plus per diem staff and various licensed clinical staff that support the team.
Helping the mentally ill is complicated.
And that complexity can also lead to problems for agencies including law officers who are stuck at the medical facility for long periods until help can be obtained for the patient, clients being discharged back to the community with no follow-up help and patient families feeling scared and alone in managing severe and persistent mental illness.
As more and more state and federal funds are cut, agencies are being asked to provide more with less revenue. This is unacceptable for those providers who want the best for their patients, Gartmayer-DeYoung said the IBH Circle is exploring several options to change the current system including lay peer volunteer as part of the treatment team in the ER and psych beds or Crisis Stabilization Units in Washington County. But before that can happen the IBH Circle has to cut through the state and federal red tape to meet the challenges that exist and bring hope to the most vulnerable in society.
This article is respectfully submitted for publication. It reflects the collective thoughts of the Integrated Behavioral Health Community Circle participants. Particular thanks for their contribution and wordsmithing are offered for Diana Graettinger, Anne O’Brien PNP, Anne Leaver LCPC LADC, Ashley Pesek LSCW, Rose St. Louis, and numerous peer community voices.
Holly M. Gartmayer-DeYoung
CEO, Eastport Health Care Inc.