A bill designed to reduce mental health crisis admissions in Maine emergency rooms would establish four “assessment centers” where patients could receive short-term treatment before placement in the state’s mental health system.
The assessment centers – also called receiving centers – could cut back on emergency room visits for patients who would be better served in other settings, advocates say. The bill, sponsored by Rep. Charlotte Warren, D-Hallowell, with the backing of the National Alliance on Mental Illness, Maine, does not yet have a public hearing scheduled.
Many of the details – such as how much it would cost, where the centers would be located and how many beds they would have – would be worked out later if lawmakers and the Mills administration warm to the idea. Patients would typically stay at an assessment center up to three days, and would be referred to other treatment programs, such as community-based treatment or residential treatment for more severe cases.
Jenna Mehnert, the executive director of NAMI Maine, said the receiving centers would likely have about 10 beds each. But turning patients over every two to three days means each center could serve hundreds of patients per year.
Nationally, the receiving center concept is still in its infancy, although it’s sprung up in some counties in Texas, California and Arizona, and Arkansas started a statewide program last year.
Mehnert said the centers would be staffed by employees with professional experience in mental health, compared with emergency rooms, which treat a variety of patients with many different physical and mental ailments.
“If you are suicidal and going through a psychological crisis, the emergency department is not where you want to be,” Mehnert said. “ERs are loud, bright, fast-moving and not private. They are not calming places to be.”
‘SEEMS LIKE A GOOD CHANGE’
Mehnert said the bill, if approved, would not completely eliminate the need for ER mental health admissions, but would “dramatically reduce” such admissions.
Emergency department visits for depression, anxiety or stress increased by 55 percent nationwide from 2006-13, and by 52 percent for psychoses and bipolar disorders, according to a December 2016 study in Healthcare Cost and Utilization Project, a scholarly journal.
In Maine, hospital emergency rooms reported 16.6 mental health admissions per 1,000 population in 2011-14, the latest figures available and similar to the national average, according to state and national statistics.
Jeff Austin, vice president of government affairs for the Maine Hospital Association, said the organization hasn’t yet taken a position on the bill, but the measure could have merit.
“At a very high level, it makes sense to provide alternatives to the emergency department for the assessment of individuals in crisis,” Austin said. “The emergency department is certainly appropriate if there is an emergency medical need that has to be addressed. But if the only issue is behavioral, having someone assess the individual outside the sometimes hectic emergency room and triage where the individual should go seems like a good change.”
Mehnert said Maine has a mental health capacity problem, and the assessment centers could be a part of the solution by easing the severity of the need.
She said there are 669 psychiatric beds in Maine, including long-term care for the most severely mentally ill, such as those residing at Riverview Psychiatric Center in Augusta and Dorothea Dix Psychiatric Center in Bangor.
Mehnert said it’s unclear what the average demand is for beds, but according to experts in the mental health field in Maine, demand far exceeds supply. Reports of patients staying in emergency departments for weeks because of capacity issues are commonplace.
IN ARKANSAS, IT’S SAVING MONEY
Two Lewiston hospitals were fined by the federal government last year for illegally turning away patients who were having mental health crises. The hospitals, Central Maine Medical Center and St. Mary’s Regional Medical Center, filed corrective action plans with the federal government saying they were overwhelmed with mental health patients.
The assessment centers proposed in the bill also would help alleviate the population of mental health patients in jail, which Mehnert says is a related issue. Many of the emergency room patients who have mental health issues were brought there by police officers who arrested them for misdemeanors and took them to the hospital because they were having a crisis. If people can get the help they need, it would likely reduce recidivism, Mehnert said.
In Arkansas, two crisis stabilization units opened in 2018 – in Little Rock, and in Fort Smith in western Arkansas. The crisis units are similar to what an assessment center in Maine would be.
Joey Potts, director of Five West Crisis Stabilization Unit in Fort Smith, said while discussion about the law that created the crisis units centered on diverting people from the criminal justice system, more people were diverted from hospital emergency rooms.
“At first, they would go to the ER and then come here, but now as word has gotten around people are coming straight here,” Potts said. For the patients, she said, it’s “10 times better than an emergency room.”
Potts said they haven’t done a detailed cost analysis yet, but it’s saving money, because their program costs $350 per day per patient, compared to $800 to $1,200 per day at the ER.
ADVOCATES FOR COMPREHENSIVE FIX
Rise Haneberg, deputy division director of behavioral health at The Council of State Governments Justice Center, said the programs in Arkansas and other parts of the country are part of the Stepping Up Initiative, which is designed to reduce the number of people with mental illness in jails.
She said the assessment centers may be a good idea, but that they should be done in concert with the entire mental health system, jails and hospitals, or it could simply create bottlenecks elsewhere.
“You have to come up with a comprehensive solution and not do things piecemeal,” Haneberg said. “This is all pretty new to all of us.”
State Sen. Cathy Breen, D-Falmouth, said if the state doesn’t look at fixes to all mental health services, the assessment centers could be just a “Band-Aid” for the capacity problem.
Scott Ogden, spokesman for Gov. Janet Mills, said that the assessment center bill would be carefully considered.
“The Mills’ administration will consider all legislative efforts, including this bill, that examine options to alleviate pressure on emergency departments and provide effective, appropriate care to Maine people,” Ogden said in a statement.
Joe Lawlor can be contacted at 791-6376 or at:
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