Maine Med president: Lack of state mental health investment is major factor in ER violence

Imagine coming to work each day having to wonder, “Is this the day I’ll be physically attacked or verbally assaulted?” Sadly, that has become the reality for the health care heroes working in our state’s emergency departments, like the one here at Maine Medical Center.

Lucy Dawson, a member of the Maine State Nurses Association—a union that represents workers at Maine Medical Center—speaks to reporters Thursday during a protest of emergency department working conditions. The union cites decades of abuse from patients as one of their concerns. Ben McCanna/Staff Photographer

Violence in hospital emergency departments is becoming an everyday occurrence, and that is unacceptable. For years now, MMC and other hospitals have worked to address this epidemic, but the situation has reached a tipping point, and we need help from our elected leaders.

In recent months, the COVID-19 pandemic has brought more severely ill patients to our EDs, including a surge in people experiencing severe behavioral health issues, including many children. The lack of community health resources to meet their needs has forced our EDs to become something they were never meant to be: a place of last resort for individuals who have a behavioral health diagnosis but lack access to appropriate residential care and community treatment options.

While the pandemic and subsequent shortage of workforce are partly to blame, an equally significant problem preceded the pandemic and has been exacerbated by it: Maine’s failure to invest in a full continuum of services to serve patients with behavioral health needs.

This is particularly true of secure residential treatment for individuals who have a propensity for violence. When the state significantly downsized its mental health institutions and closed the Pineland Hospital and Training Center for the developmentally disabled, Maine failed to build and sustain adequate residential and community-based treatment services for those who have the highest level of need. Instead, they live in homeless shelters, jails, residential homes without clinical services and, now, our EDs. Maine has relied upon out-of-state facilities as well, which is a tragedy for families, especially during the pandemic. Today, about one-third of MaineHealth’s ED beds are filled with patients awaiting transfer to appropriate behavioral health services and settings. Many wait days, and some are stuck in the ED for weeks and even months.

We all agree that individuals with mental illness and developmental disabilities should be in the least restrictive settings in which they can safely and successfully live. But when group homes and residential treatment facilities do not have adequate clinical resources to manage a patient’s behavior, they often bring the individual to the ED. When the police do not want to criminalize an illness, they have no options but to bring people to the ED. When a parent cannot control a child with behavioral health needs, they often bring them to the ED. In these instances, stabilization may occur, but without a safe place to be discharged, the patient and care team suffer. The state’s crisis systems for these individuals are failing, and the EDs have become the state’s behavioral health safety net.

But the ED is a highly restrictive and often chaotic place. It is neither adequately staffed with behavioral health experts nor designed to provide ongoing treatment. The ED is meant to safely stabilize someone in crisis for a few hours – not days, weeks and months.

In January, Maine Medical Center alone had one behavioral health patient who had been in the ED for four months, and another is still there after more than two months. Neither has the capacity to live on their own. Both have been violent, causing numerous injuries to our care team members. One was discharged to a group home without clinical services and returned to the ED within three days. Today, despite many meetings with the Maine Department of Health and Human Services and other agencies, both patients are still there. Without significant and robust clinical services provided to their homes and residences, these patients will continue to languish in the ED, and, in all likelihood, continue to inflict injuries while they do.

The situation is untenable. Members of our care team are speaking out, and they are right to object to this situation. We must do better. The state must invest in the facilities and services needed to better support these patients. We implore the governor and legislature to work collaboratively with health providers to build a system that better supports the needs of this vulnerable population.

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