LEWISTON — On the children’s psychiatric unit at St. Mary’s Regional Medical Center, nurses looking out of their enclosed station face a wall and a few rooms. To see down the hallway — where a child might be yelling or crying or trying to hurt herself — they have to leave the station and peer around a corner. Line of sight is virtually nonexistent.
In the patients’ bedrooms, the furniture is particleboard and movable. Children have broken off pieces of the beds to use as weapons. They’ve pushed desks against doors to try to block anyone from coming in, not realizing the doors also open from the outside.
The unit can serve 18 children and teenagers. On paper. In reality, it rarely accepts that many because its eight bedrooms are almost all doubles and the roommate situation is tricky. Maybe an incoming child is too young to room with a teenager already on the ward, or maybe she’s a girl and the only free beds are with boys, or maybe a young patient is too violent to have a roommate.
Frequently, a third of the beds go unused, even as kids in crisis wait days in the ER for a spot to open up. For that reason, having individual bedrooms is ideal.
“Single bed(rooms) is gigantic. That’s massive,” said Michael Kelley, St. Mary’s behavioral health medical director.
St. Mary’s has been struggling for years with the set-up of its behavioral units. Fixes have been few, limited by money, space and the constraints of a 115-year-old building.
“We actually came close 12 years ago. We had blueprints; we had it designed,” Kelley said, “but because of the needs of the cancer center back then, they took the space we might have moved into.”
That’s about to change.
St. Mary’s has started a $12 million project to move and remodel both its child and adult psychiatric units. The project will also move the infusion center — where patients go for cancer treatment and other IV therapies — into a separate building off campus.
“The modern thought is that somebody who’s dealing with cancer would rather be in a comfortable outpatient setting than feeling like they’re coming into a hospital,” Kelley said.
The whole project is expected to take three years. With three phases, it is one of the most intricate projects the hospital has ever done and one of the most expensive in the past 20 years.
The hospital is at the end of the project’s first year. It plans to move the children onto their new floor around Thanksgiving.
The infusion center will move across the street, to 106 Campus Ave., in 2018. Adult psychiatric services will move to their new home in the hospital in 2019.
St. Mary’s just needs about a million dollars more than it has right now.
“We absolutely cannot finish this whole thing without probably an additional $1.3, $1.4 million,” said J. Bradford Coffey, president of St. Mary’s Health System Foundation. “It’s really critical.”
‘We’re in a crisis’
St. Mary’s is the second-largest behavioral health program for children and adults in Maine.
Every year, it sees 45,000 visits to the hospital’s adult and child inpatient and outpatient programs, with 2,700 admissions. People come from all over the state.
Maine has a shortage of inpatient mental health programs, but the need is particularly great for kids and teens. There are so few available beds across the state that it’s not uncommon for a child to spend a day or longer in the hospital’s behavioral health emergency room waiting for an inpatient bed — especially over the weekend, when fewer admitted patients are discharged.
On one recent Monday, three teenagers in St. Mary’s ER had been waiting 48 hours or more.
“A lot of times by Saturday night, every psychiatric bed in the entire state is full,” Kelley said. “So Sunday, people are just sitting in the emergency rooms waiting for discharges on Monday. It’s a predictable flow, unfortunately. We’re in a crisis.”
St. Mary’s children’s unit has been on floor A2 since 1993. Young patients spend on average of eight to 10 days there. Depression, bipolar disorder and attention-deficit disorder are among the most common diagnoses, but the unit also routinely sees children with autism, schizophrenia, anxiety and other disorders.
The unit was last renovated in the early 1980s.
If they’re coming from another part of the hospital, young patients and their families get to the psychiatric unit by walking through the hosptal’s service corridor, which is gray, low-ceilinged and lined with industrial bins and biohazard stickers. If they’re coming from outside the hospital, they enter from an outside door and go up a couple of floors in the elevator. Either way, patients and their families end up at the unit’s locked doors, in a cramped, unheated vestibule with an old wooden bench and little else to welcome visitors.
“We do have families that come onto the unit and within minutes they decide to take the kid out,” said Paul Rouleau, director of behavioral operations.
The unit’s shabbiness isn’t its only problem. It’s also potentially dangerous, offering poor sight lines, plumbing fixtures and suspended ceilings that could be used for suicide attempts, breakable and movable bedroom furniture and group therapy rooms with viewing windows so tiny no one outside the room can easily see in, forcing staff to resort to yelling when they need help.
“There’s huge amounts of safety factors that we just couldn’t (address) here,” Kelley said. “The new construction is going to be dramatically safer.”
The unit will move to a newer part of the building on D3, a medical floor that’s no longer needed because health care trends have led to fewer admissions for surgery. The new unit will be 40 percent smaller — from 12,500 square feet to 7,500 — but Kelley believes the space will be more usable.
The new unit will have a full entryway, with a nearby room for private meetings with families. The nurses’ station will be smaller but open, with a line of sight all the way down the single hallway. Outside windows will be larger to let in more natural light, and interior viewing windows will be bigger so staff can more easily see what’s going on inside group therapy rooms.
Plumbing, lighting and sprinklers will be recessed for safety, and windows will be covered by between-the-glass blinds rather than tear-down curtains to reduce the chance of hangings. Beds and chairs will be made from molded plastic, while desks and bench seating will be built into the wall.
The unit will have 11 private rooms and one double room, cutting its number of beds from 18 to 13. But because almost all of the rooms will be private in the new space, staff members won’t have to turn away children who don’t match with a roommate. Hospital officials expect they’ll be able to serve as many patients as they do now.
Adult unit no better
The adult psychiatric unit is older than the children’s unit and has similar problems. Some of them are worse.
The adult unit is so old that its electrical system can’t handle modern medical technology, such as providing oxygen and other medical gases through the walls. Doctors have to judge whether a patient with both medical and mental health problems would be better off on a medical floor, where they won’t get the intense psychiatric care they need, or the psychiatric floor, where medical care can be less than ideal.
“We don’t even have enough electrical plugs to plug in electrical beds,” Rouleau said. “We sometimes have to run extension cords, which is not entirely a good thing to do in a psychiatric unit.”
Other problems are more about comfort. While the old children’s unit provides a shower for every double room, the old adult unit has only two showers for everyone on the floor.
“Which is sort of gross,” Kelley said. “The adults will be so overjoyed to have showers.”
Like the children’s unit, the adult unit regularly gets people who balk at the state of the place.
“All the time,” Kelley said. “Especially, I hate to say it, the higher functioning adults. They look around and they’re like, ‘Oh, I’m not staying here.’ That happens almost every month or two, we have somebody who walks on and wants to leave within five minutes.”
The adult unit will move to C4, one floor away from the children’s unit, making it easier for staff to dash from one to the other when needed. The adult unit will share the same floor as the hospital’s detox unit, which will allow adult psychiatric patients to more easily attend substance-abuse group therapy sessions.
The adult unit will also see many of the same changes as the children’s unit: bigger windows, safer building features, updated heating, plumbing and electrical systems.
The current unit has 24 beds, most in double rooms. The new floor will have 22 beds, most in single rooms.
The entire three-year project is slated to be complete in 2019.
St. Mary’s plans to split the $12 million cost, borrowing half and funding half. It began quietly fundraising last year. So far, donors have committed about $4.7 million.
“For all intents and purposes, we’re really still in the quiet phase,” said Audrey Thomson, executive director of philanthropy for the St. Mary’s Health System Foundation. “We’ve gone to our leadership here, our board, people closest to us. We’re talking to some major prospects in the community. Then we’ll go out farther and talk to others.”
Although St. Mary’s recently received a $10 million commitment from the Albert Lepage Foundation, that money was earmarked for improving the patient experience and cannot be used for this project.
At the beginning of the year, St. Mary’s will launch a fundraising campaign among its employees. A Lewiston-Auburn community campaign will begin in late 2018.
After years of waiting, Kelley said he’s happy to see the project finally started.
“It’s unbelievably exciting. This is going to be a quantum leap,” Kelley said. “We have amazing care, but the environment affects the perception of the care. It’s how you see quality.”
A staff member works with children in the St. Mary’s children’s behavioral health unit in Lewiston. The viewing windows are so small that staff members have had to resort to yelling to get help in the group therapy rooms when needed. (Daryn Slover/Sun Journal)
Michael Kelley, chief medical officer for behavioral health, tours the new St. Mary’s children’s behavioral health unit in Lewiston. (Daryn Slover/Sun Journal)
An adolescent room in the current St. Mary’s children’s behavioral health unit in Lewiston. (Daryn Slover/Sun Journal)
Chief Medical Officer for Behavioral Health Michael Kelley, left, and Paul Rouleau, director of behavioral operations, tour the new St. Mary’s children’s behavioral health unit in Lewiston. (Daryn Slover/Sun Journal)
Michael Kelley, chief medical officer for behavioral health at St. Mary’s Regional Medical Center. (Daryn Slover/Sun Journal)
An artist’s rendering of a child’s bedroom on the new children’s behavioral health unit. (St. Mary’s Health System)
An artist’s rendering of the view from the nurses’ station in the new children’s behavioral health unit at St. Mary’s Regional Medical Center. Nurses and other staff members will be able to see along the whole hallway from the station. On the current unit, the nurses’ station faces a wall and a few rooms. (St. Mary’s Health System)