Let me say right up front that the story I am about to tell you isn’t pretty.
It’s about an intelligent, articulate woman in her 50s who has been stuck for three weeks in a hospital emergency department because there are no beds available in Maine for psychiatric patients with the level of care she needs.
She is actively and frighteningly psychotic and sees full-bodied people who aren’t really there, urging her to kill herself. She is highly suicidal, which is why she needs to be in a safe place. Complicating matters is that she has leukemia and is taking a lot of medications that have to be tracked and blood-tested, which rules her out from being accepted in smaller hospitals.
She is alone in a room with limited furniture that has to be bolted down to the floor or wall because anything free standing could be used as a projectile. There are no newspapers or magazines allowed, no artwork or photographs on the walls.
Peter Burgher, a well-known and respected Waterville clinical psychologist in practice 40 years, talks with her by phone at least once a day and a colleague also helps. Burgher tells me her story only because he and she both are at their wit’s end, desperate to get her into an in-patient setting.
“This is as long as I’ve known anyone to go without a bed,” he said.
Burgher has never contacted a newspaper reporter before to discuss a client, and of course, all that is confidential, but the client in this case knows he is speaking with me and she will ultimately read this column, he said. We are not identifying where the woman lives or what hospital she is in except to say it is not in our immediate area.
It is torturous being in the holding room, alone, Burgher says. She is discouraged from having visits, even from her husband, who has seen her only once in three weeks. There are a handful of other patients there also waiting for beds, and they are psychotic and typically screaming, shouting and aggressive, according to Burgher.
“She can’t get out, she can’t go home because she’s not safe, she can’t get into an in-patient bed and she has no control over her situation,” he said.
Her environment is similar to that of a stimulation deprivation chamber where essentially all the stimulation to the body and brain is eliminated and where a typical person could become psychotic, Burgher explains. In order to function, the brain needs stimulation, he said.
“There are no windows so she can’t tell what time of day it is, but she figured out a way. There is a dimmer on her light, so when it is breakfast, she puts it on high and at lunch, she puts it down by 1/4 and at dinner she puts it down again. She knows the time of day by the level of light in her room.”
The lack of in-patient beds is not new, but Burgher has seen the problem increase in the last five years.
He emphasizes that the nurses who administer medications to her are wonderful, as are the people who visit her from a nearby psychiatric hospital, but nurses are not immediately available to her and she has little human contact. Staff are busy, particularly now with the various viruses.
“If you want a glass of water, that may or may not be able to happen, depending on how busy the ER is,” Burgher said. “The system is essentially overloaded and unable to meet the load.”
When a patient such as his client comes into a holding unit, all medications are stopped and then eventually started up again. He contends that if one is kept there for more than two days, the system starts to do harm to that patient, even if medications are resumed.
“It’s not some place for someone to be very long, but that’s what’s happening. It’s happening all over the state in probably every emergency room, and in other states. The governor and Legislature and police are trying to take this more humane approach with drug abusers and homeless people who are getting more housing, and getting people into treatment, but about 50% of homeless people are mentally ill and a large percentage of drug abusers have coexisting psychiatric disorders.”
Most people who are to be placed in substance abuse or psychiatric programs must go through hospital emergency departments to get there, according to Burgher, who said many ERs are jammed with people and there’s no place to send them.
“It is a major crisis for psychiatric inpatient treatment. The question is, why hasn’t the government or Legislature targeted more money to create more inpatient beds when the problem has existed for years? It’s distressing because the system is failing my client.”
Burgher acknowledges that he also is impacted by the situation, as he hears the despair and hopelessness in his client’s voice every day and sometimes asks himself why he is doing it and why there’s no help. The solution, he said, is for the state to spend money to create more inpatient psychiatric structures, either by enlarging existing ones or building new.
“My client understands that this is not personal,” he said. “She’s just a pawn in this huge, collective healthcare system that is a failure, especially when you look at other countries around the world and how they’re taking care of their people.”
What it all boils down to, Burgher says, is that we ought to be ashamed.
“This is shameful behavior,” he said. “I have no problem saying that to anybody who is willing to hear it. We simply have a responsibility to our fellow citizens to take care of each other. We certainly have the resources to do it and we’re simply not spending.”
Amy Calder has been a Morning Sentinel reporter 34 years. Her columns appear here weekly. She may be reached at acalder@centralmaine.com. For previous Reporting Aside columns, go to centralmaine.com.
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