Acadia Hospital in Bangor, one of two private psychiatric hospitals in the state, is seeking an expansion so it can accommodate more patients amid a rise in demand for psychiatric care. Credit: Gabor Degre / BDN

If you are experiencing a mental health crisis, call the Maine Crisis Hotline at 888-568-1112.

People with psychiatric needs in Maine’s hospitals have at times taken up half of the emergency room beds in Maine’s largest hospital system, illustrating a dire need for psychiatric services as hospitals face an unprecedented capacity crunch.

The problem, often referred to as boarding, has been a long-standing concern in Maine and the subject of various lawsuits. Most recently, the Maine Supreme Court imposed restrictions on how long a patient can be held in intensive care without a judge’s notification after a patient was kept in a Damariscotta emergency room for a month.

But the situation has become more dire as the coronavirus pandemic has stressed hospitals’ capacity and staff. Like several of the long-standing challenges facing health care in Maine, it can be traced to what service providers say is a long-term lack of investment in services and low reimbursement rates. That lack of available service has resulted, at times, in patients staying multiple days or weeks in an environment health experts say is detrimental to their health.

That timeframe is not uncommon, hospitals said. At MaineHealth, the state’s largest hospital system, between a third and half of the provider’s 219 emergency department beds are holding people with behavioral health needs, said Marc Glass, a spokesperson for Maine Behavioral Healthcare.

The average length of stay for those patients is 26 hours — more than five times the average length of time a person with a physical injury stays in the ER — but some patients have stayed for more than 20 days if placement for them is particularly difficult. The system saw 1,122 behavioral health patients in October, a high point for the year; a quarter of those patients were children.

Kelly Barton, the president of Maine Behavioral Healthcare, said the emergency department functions as a place where someone in crisis can easily get care. Sometimes patients admit themselves or are brought in by a provider or police.

Emergency department employees can stabilize patients and occasionally offer them medication that treats their condition, Barton said, but it is no substitute for the clinical care many need from a psychiatric hospital.

“What we end up seeing as patients end up staying with us over longer lengths of time, they tend to deteriorate,” Barton said. “So the issues they came in with might get exacerbated as they sit longer and longer.”

Not only are most emergency department employees not equipped to provide psychiatric care, the environment itself is a problem. Emergency rooms are hectic places to begin with, and are even more so these days as hospitals struggle with workforce shortages and elevated COVID-19 cases. Maine set four new records for COVID-19 hospitalizations within the last week.

It has caused some hospitals, such as MaineHealth and Rumford Hospital, to treat patients in hallways. Many hospitals have temporarily suspended non-emergency procedures. In perhaps the starkest example, Lewiston’s Central Maine Medical Center had to close its intensive pediatric unit and suspend trauma admissions.

The demand for psychiatric care has spurred Northern Light Acadia Hospital in Bangor, one of Maine’s two private psychiatric hospitals, to expand its 100-bed facility so it has exclusively single rooms. The hospital typically can only accommodate about 60 patients at a time despite having 100 beds, because many patients can’t be treated in rooms with another patient.

Augusta-based MaineGeneral has seen 20-30 patients a day who need behavioral health services. Wait times can range from days to up to two months for patients with acute needs, spokesperson Joy McKenna said. The hospital has started a telehealth service for pediatric patients to provide care while they are being held, and it is converting space in the emergency department so it can be designated for patients who need psychiatric care.

Houlton Regional Hospital saw at least three behavioral health patients last week in its 25-bed acute care facility, according to a spokesperson, and those patients can stay anywhere from a few days to two or three weeks. At York Hospital, up to about a quarter of the hospital’s 13 emergency department beds are taken up by behavioral health patients on average.

Steve Michaud, president of the Maine Hospital Association, said the situation is worsening burnout among staff already stretched to their limits.

“As one emergency department nurse said to me, what used to be one bad day is now every day,” he said.

Malory Shaughnessy, executive director of the Maine chapter of the Alliance for Addiction and Mental Health Services, said behavioral health providers are seeing waitlists with up to a thousand adults and hundreds of children on them as the pandemic has led to an increase in mental health and substance use disorders.

The amount of investment into mental health services has varied throughout the years, and while the state is working to boost Medicaid reimbursement rates and provide more funding, those changes cannot address the immediate crisis, she said.

“The bubble is getting pinched in all these different places and just popping and popping and popping,” she said. “The bottom line is that there’s a hell of a lot of need, and not enough access.”