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If you are experiencing a mental health crisis, call the Maine Crisis Hotline at 888-568-1112.
Kelly Barton is the president of Maine Behavioral Healthcare. Scott Oxley is the president of Northern Light Acadia Hospital.
Across our state, hospital emergency departments are full, with some having to divert all but the most critical cases. Non-urgent procedures are being rescheduled. Patients are being treated in hallways due to a lack of space. And, in some cases, a third to half of Maine’s emergency department beds are filled with people experiencing behavioral health crises.
As many of us know from our own experiences with serious health conditions that need immediate care, emergency departments are staffed and set up to provide short-term treatment of acute health issues. Emergency care teams expertly and efficiently triage situations by ordering tests, diagnosing pain, stitching us up, setting our bones and, if necessary, coordinating admission to an inpatient unit. Even though emergency departments are not configured to provide longer-term care, many of the behavioral health patients who are now in emergency care have been there for days — and in many cases for weeks and months.
The top reason it is so difficult to discharge behavioral health patients from emergency departments to more appropriate levels of care is because Maine faces a critical shortage of community-based behavioral health services, especially those that provide secure, residential care for youth and adults with specialized needs. Many emergency department beds across our state are occupied by patients awaiting placement in a safe, therapeutic environment that can provide the structure and treatment necessary to allow patients to live productive lives.
There is a shortage of outpatient behavioral care options in many states — Maine included — because those states are not providing adequate reimbursement to organizations that provide community-based behavioral health services. We are grateful that Maine’s governor and Legislature supported some increases for these services during the last legislative session, but much more needs to be done to build a comprehensive continuum of services to meet the needs of our most vulnerable youth and adults who experience behavioral health crises.
This is particularly difficult given the current staffing shortages, which is exacerbating an already challenged set of services. The crisis in community-based services prevents the natural flow of patients between levels of care that is needed to sustain the system and keep emergency departments from overflowing. For example, patients with acute mental health needs can get stuck in hospitals because they can’t be safely discharged to community settings. In turn, those hospital beds are not available for emergency patients who are experiencing acute crises. This is particularly challenging for children who cannot live safely at home and who need secure residential care.
While Maine Behavioral Healthcare and Northern Light Acadia Hospital have not shuttered services because of under-reimbursement, some community providers have been forced to greatly reduce or close services at a time when behavioral health needs are skyrocketing. At the same time, Maine sorely lacks sufficient services to meet the needs of children, adolescents and young adults who cannot safely live at home because of their behavioral health needs.
We encourage you to think of it this way: A person experiencing a mental health crisis may require as much outpatient care and treatment as a person who suffered physical trauma in a car accident. But while the car accident survivor can be transitioned to treatment by a primary care provider and a physical therapist, the person in an emergency department for a behavioral health crisis has far fewer long-term treatment options in the community, particularly if they need residential care.
It is important that we all understand the dynamics at work within our hospital emergency departments and the significant role that a lack of community-based mental health services play in determining whether there is space available should you need it.
We need your support in making sure Maine has the properly funded continuum of behavioral health services. The pandemic is creating a surge in the need for behavioral health services. Ensuring that patients have access to appropriate treatment will put them on the path to success and clear a path for us all to receive the levels of care our emergency departments are meant to provide.