LEWISTON — Hospital representatives say mentally ill patients are too often forced to stay in emergency rooms for days — sometimes weeks — because inpatient facilities cannot take them. 

They say the problem is complex, a mix of too few hospital beds, too few psychiatric workers, too few long-term treatment programs and too many patients with particular needs. 

“You’d be surprised at the number of patients every day in the state of Maine stuck in (emergency departments) waiting for placement in psychiatric units,” said Paul Rouleau, director of behavioral operations at St. Mary’s Regional Medical Center and Community Clinical Services. “That happens on a daily basis.”

Long waits have been a problem for years, especially for children and the elderly, who require specialized inpatient psychiatric care. The issue made headlines Friday when a Northwood, N.H., mother told WMTW that her 19-year-old daughter was spending her 10th day in St. Mary’s Regional Medical Center’s psychiatric ER because no one in five states had an inpatient bed for her. 

Late Friday morning, Maureen Cahill said her daughter, Chyann Cahill-Hassett, had finally found a spot — at the same hospital where she’d been waiting in the ER. 

“We were either told that there were no beds available or there would be at least a two-week wait before she could get a bed,” Cahill said of the 10-day, five-state search. “I firmly believe that if this had not hit the press, she would still be sitting in the ER.”

A St. Mary’s spokeswoman said patient privacy regulations prevented her from talking about a specific case or confirming whether the teenager was a patient there.

However, hospital representatives spoke about the general issue of psychiatric wait times.

“The majority of folks are there just for a few hours, but it’s about two or three patients a week who stay for an extended period of time,” Rouleau said.

He defined “extended period of time” as longer than 24 hours.

St. Mary’s is not alone.

Jeff Austin, vice president of government affairs and communications for the Maine Hospital Association, said it’s a problem his member hospitals struggle with every day.

“Someone who is in need of inpatient psychiatric care being stuck in an emergency department for days is not unusual. It is all too common and it’s very unfortunate,” Austin said. “It’s not a therapeutic setting for someone in an acute mental health crisis.”

He and others say the problem is complex.

Although there are 545 licensed inpatient beds for psychiatric patients in Maine, not every bed is open to every patient. Children and adolescents, the elderly, violent patients and patients who also have developmental disabilities require specialized care that not all inpatient units are able to provide.

Even when a bed is available in a program that meets a patient’s needs, the hospital may not have the staff to cover it. Or the bed, in a two-bed room, may have to stay unoccupied because the room’s current occupant is sick or can’t handle a roommate. 

“So we may have 500 beds, but they’re not really 500 beds,” Rouleau said.

There is also a shortage of long-term treatment facilities, creating a domino effect. An ER patient can’t move to an inpatient bed because that bed is taken by someone doing their own waiting for a long-term spot.

And, experts say, hospitals are seeing more people in crisis, which is increasing demand.

“It just seems like there is more and more need,” Austin said.

Several years ago, St. Mary’s created an ER just for people with mental health issues. That ER saw an average of 225 patients a month the first year and research suggested there would be a 20 percent increase. Today, the ER sees more than 400 patients a month, a 78 percent increase.

Cahill, who sat in the St. Mary’s ER with her daughter, said the long wait hurt her daughter’s mental health.

For 10 days, she said, the teenager had medication, food and nursing care, but didn’t see a psychiatrist until day nine. Cahill said her daughter had to sleep in chairs because she had no bed and had to share space with other patients in crisis. 

Cahill said her daughter has cognitive issues, as well as psychiatric issues, putting her at the mental age of 12.

“There was somebody who basically had too much to drink and his pants kept falling down and he went to go sit on Chyann’s lap,” Cahill said. “Another woman was crawling across the floor vomiting, trying to get to the bathroom.”

Rouleau said psychiatric patients in the ER have access to private exam rooms with beds, as well as a common area.

Hospital representatives said long ER wait times have no simple fix. They would like to see more short-term and long-term beds, especially for patients with particular needs. They would like to solve the staffing shortage so more already-licensed beds can be used.  

They would also like to see better mental health care in the community so people don’t reach the crisis stage. St. Mary’s hopes its recent efforts will help at least locally. Last year it started providing mental health services in its primary care practices.

Maine Department of Health and Human Services spokesman David Sorensen said the state would like to see a better mental health system overall.

“We are working with community mental health providers to improve responsiveness and effectiveness,” Sorensen said in an email. “A better-managed system would result in fewer preventable inpatient admissions, and we have to recognize that this is not a 9-to-5 job; oftentimes, a community-based intervention at night or on a weekend can prevent an inpatient admission.” 

Cahill said her daughter was being evaluated as a patient at St. Mary’s. Although out of the ER, Cahill believes they’ll have another wait soon — this one for a long-term bed.

“I believe that we’re going to be back at square one,” she said. “There may be a recommendation made for a certain placement for Chyann, but the problem will be there is no availability.”

ltice@sunjournal.com

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