LEWISTON — St. Mary’s Regional Medical Center has shut down its Behavioral Intensive Care Unit and will make other changes to its mental health services, in part, to save money. 

The hospital closed its six-bed unit about two weeks ago. The unit had been established about 10 years ago with the goal of providing intense supervision to people who were suicidal, intrusive to other patients or otherwise would have needed one-on-one support on the larger psychiatric ward. The small unit could provide that supervision without one-on-one workers.

The unit was composed of two bedrooms with three beds each. That design was supposed to be temporary until St. Mary’s could convert the space to six individual bedrooms, but the building proved too old to convert.

This year, officials decided the unit wasn’t fulfilling its promise.

“The budget just made us really look at every single thing we were doing. We were going, ‘Are we getting all the advantages we thought we would out of it?’ The answer was ‘no,'” M. Ed Kelley, chief medical officer for behavioral health, said.

The unit did little to reduce staffing needs. Issues arose when severely ill psychiatric patients shared a bedroom. And with only two bedrooms available, the unit often had to turn away people because opposite gender patients could not share a room. 

Patients didn’t like the setup, either. 

“They felt like it was a little small jail,” Kelley said. “You can imagine if you’re really suicidal and somebody says, ‘Now you’re going to go into this little bitty room with two other patients.’ They felt it was almost a punishment.”

Patients who would have gone to the unit will now be served in the regular psychiatric unit. Some, including suicidal patients, will get one-on-one supervision.

Aggressive patients and others whose needs are too great for the regular unit will be sent to another mental health facility, such as Spring Harbor Hospital in Westbrook. Kelley noted that Spring Harbor does not have a behavioral intensive care unit either, but it is better equipped to handle those patients. 

“St. Mary’s was supposed to be an acute stay hospital, for short stays under 30 days, not violent patients,” Kelley said.

With the unit’s closure, St. Mary’s will now drop from 30 beds to 24 for psychiatric patients. Because the unit generally sees 23 or 24 patients a day, Kelley believes the bed loss won’t cause a problem. 

Although the hospital has shut down its unit, there will be no staff cuts.

St. Mary’s is also making changes to its intensive outpatient program that serves people with drug and alcohol addiction. 

Starting in December, the hospital will require uninsured patients to provide a “down payment” when joining the outpatient program, even if they qualify for free care.

“Free care for most hospitals, and definitely St. Mary’s, was really supposed to be for emergent, acute, medically necessary care. When we looked at (the intensive outpatient program), frankly we said it’s an enhancement of care, but lots of people get clean and sober without an (intensive outpatient program),” Kelley said. “Detox is medically necessary, you’re going to die without it. An (intensive outpatient program) is a support.”

St. Mary’s hospital-wide charity care has steadily increased over the years. For the first 10 months of 2013, it stood at $20 million. For the first 10 months of 2014, it stood at $22 million.

Kelley said the hospital had not yet determined how much patients will be required to pay for the outpatient program.

The hospital is considering scholarships to help with the cost. Program directors can also override the cost for specific patients who need it, regardless of scholarship availability.

The hospital’s behavioral health program also plans to make other small changes, Kelley said, but those have not yet been finalized. 

Officials believe all the changes could help save the hospital approximately $800,000. 

As officials considered changes to save money, they also considered changes requested by patients.

Also starting in December, the the hospital will drop its morning intensive outpatient program for addiction in favor of an evening program. The change will allow more people to work during the day.

“A lot of times when somebody comes into detox it’s because they’ve lost their jobs, because they’ve sort of fallen on hard times and they need to get back in the workforce,” Kelley said. “Something we teach constantly with chemical dependency treatment is get on your feet, get a healthy life, get working, get busy, because if you sit around twiddling your thumbs all day you’re going to be more likely to relapse. The irony was if they were in our (morning) program they couldn’t.”

That outpatient program will also stop accepting people who use suboxone, a drug that lessens the affects of opiate withdrawal.

“It’s difficult for somebody who comes into (an intensive outpatient program), who truly wants to be abstinent, when everybody around them is popping suboxone,” Kelley said. “The opiate addicts who did want to really have true abstinence with no suboxone found it horribly hard when they had people bragging about their suboxone in front of them.” 

Patients will still be allowed suboxone as they detox within the hospital. 

ltice@sunjournal.com

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