BANGOR, Maine — On a recent day, there were nearly 60 patients in emergency rooms around the state waiting for a psychiatric hospital bed and supervised inpatient care.
“That’s a high number,” Scott Oxley, Northern Light Acadia Hospital president, told Bangor city councilors during a workshop earlier this month. “On average it’s been running around 30 to 35 [patients]. Prior to COVID, that’s what we saw as well.”
Acadia Hospital’s count is based on information from the 22 emergency departments that it contracts with around the state, and the figures fluctuate on a daily basis.
That allows the facility, one of two private psychiatric hospitals in Maine, to keep track of the number of patients seeking care and move them up the list in terms of priority, Oxley said during an interview Thursday. The real count of those waiting for a psychiatric hospital bed is much higher, though it’s difficult to quantify, he said.
The statewide demand for psychiatric services continues to grow, even as the COVID-19 pandemic appears to be waning. This means patients are stuck in emergency departments for hours or sometimes days at a time, and this “de-facto place of care” is not ideal for someone needing treatment for their mental health condition, Oxley said. Acadia Hospital’s $49.2 million expansion, including a new pediatric wing and renovated rooms for adults, is meant to address the psychiatric care bottleneck.
“Like any problem of this magnitude, there’s a series of solutions and different time horizons that go along with them,” said Oxley, who is also Northern Light Health’s senior vice president. “The urgency is not enough inpatient care, so to address that, we’re really expanding our functional capacity so we can take care of more patients, both adults and kids.”
Social isolation and other challenges during the pandemic led more people to seek mental health care, particularly for children, and hospitals around the state are still seeing that demand, Oxley said. Maine is also struggling with a shortage of therapists and psychiatrists, causing “pressure points on both sides,” he said.
When Acadia Hospital opened in 1992, it was licensed to have 100 inpatient beds, but most are in semi-private rooms with two beds each. About 40 beds are unused because most patients cannot share a room.
Following the expansion, expected to be complete in January, the hospital will still have 100 beds — 50 for adults and 50 for children — but they’ll be in their own rooms to give patients the privacy they deserve, Oxley said. The rooms, from paint colors to lighting to textures, are designed with patients in mind and will allow more people to receive care in a safer environment tailored to their healing, according to Northern Light Health officials.
“What distinguishes a behavioral health space from any other type of health care space are anti-ligature features,” said Tim Doak, Northern Light Health’s vice president of facilities, sustainability and supply chain. “Some of these folks may have suicidal ideation or may want to harm themselves, so a lot of thought goes into the space and how we furnish it.”
Tim Dock, vice president of facilities, sustainability and supply chain for Northern Light Health (left), and Scott Oxley, the hospital’s president, give a tour of an ongoing expansion at the Stillwater Avenue facility. Credit: Linda Coan O’Kresik / BDN
During a tour of the construction site for the new pediatric addition, Oxley pointed out that each of the two floors is shaped like a wedge. This gives staff a better line of sight when monitoring patients and improves overall safety, he said.
Stairwell entrances will be at the end of both the north and south wings, said Dwane Albert, Northern Light Health’s facilities project manager. The addition also will have group spaces for therapy, art and other activities, plus a comfort room where kids can draw on the chalkboard wall.
Two courtyards for children and adolescents are still under design, but they will feature swings and other equipment, Albert said.
Although the expansion is much needed, Oxley acknowledged that adding more psychiatric hospital beds isn’t a long-term solution.
“We’ve got to go way upstream on this issue,” he said. “We need to identify the illness much earlier in the cycle and do something about it, get those interventions in place.”
During the workshop with city councilors last week, Oxley said community-based resources and services, which keep people from entering the emergency department, are not as strong as they should be. Those services include case management, law enforcement, crisis stabilization units and more.
That’s why, in 2021 for example, the average wait time was 49 hours for the 4,209 patients waiting in emergency departments around the state for a psychiatric bed, according to data provided by Acadia Hospital.
Maine also needs a strong workforce, he said, and that means connecting with children at a young age and getting them to think about careers in health care and behavioral health.
Historically, the state has struggled with having enough mental health support in place for its residents, Dr. John Campbell, vice president and senior physician executive at Acadia, told the council last week.
Deinstitutionalization emptied the state’s psychiatric hospitals beginning in the 1950s. When the Mental Health Systems Act of 1980 passed, federal funding became available to states for the planning of mental health services, though the law was mostly repealed by the following administration. For decades, there hasn’t been enough funding, and it has contributed to today’s problems, like the psychiatric care logjam, Campbell said.
Separate from the expansion, Acadia Hospital is placing more of an emphasis on mental health screenings during primary care visits in hopes of catching and treating a disorder like depression sooner.
The hospital also has grown its presence in middle and high schools. Therapists visit 25 schools primarily in Penobscot County, though also in Somerset and Washington counties.
Their role is to work with students facing behavioral health challenges, as well as to provide guidance to administrators and teachers about how to manage the children, Oxley said. He can see the day, not too far down the road, when therapists will play a larger role in elementary schools.
Oxley also highlighted Behavioral Health Homes, a state program that helps Mainers with chronic conditions and those at risk of poor health outcomes. They receive case management and help with coordinating housing and doctor’s appointments, among other services, he said.
Acadia manages 1,100 patients in the program funded through MaineCare, the state’s Medicaid program, and Oxley would like to see it expand to commercial insurance populations in the coming years.
The hospital has remained operational during construction. Acadia’s expansion also involves redesigning spaces for outpatient care because when that delivery system is robust, it keeps people from needing inpatient services, Oxley said.
That includes improvements to the hospital’s mood and memory clinic for patients with illnesses such as dementia and Alzheimer’s disease, along with the pediatric day treatment program, which serves 30-35 children throughout the school year.