Mental health care providers face unprecedented challenges amid pandemic

Steve Costello, executive director of philanthropy for St. Mary’s Health System, demonstrates how easily patient room bathroom doors come off the walls in the new Adult Behavior Unit at St. Mary’s Regional Medical Center. St. Mary’s in Lewiston. The entire wing has been designed with patient safety in mind, leaving no edges to use as leverage for hanging. Andrée Kehn/Sun Journal

LEWISTON — Mental health care providers have faced unprecedented challenges in the 23 months since the pandemic began in Maine, as demand for care has soared, staffing shortages persist and a historic number of health professionals are leaving the field.

The pandemic has “significantly increased” the need for mental health services, said Dr. Michael Kelley, psychiatrist and chief behavioral health officer for St. Mary’s Health System.

The Household Pulse Survey, a survey of US households conducted by six federal agencies to track the social and economic impacts of COVID-19, found that 32% of adults reported symptoms of anxiety and depression in December 2021 and 42% of adults reported symptoms in December 2020.

By comparison, a 2019 US household survey found that around 8% of adults had symptoms of anxiety and depression.

It’s not just the volume of patients that has increased, but also the level of care required, Kelley said. For example, substance use disorders have been “amplified,” with a record number of accidental overdoses reported last year.

“What I’ve seen (is) almost every patient I see, no matter what they’re referred for (depression, anxiety, substance abuse, relationship issues), talks about how COVID has made their problem worse “said Dr. Annie Derthick, licensed clinical psychologist and director of behavioral sciences for the Family Medicine Residency Program at Central Maine Medical Center.

“They talk about how social isolation in particular has exacerbated symptoms, strained relationships, limited resources and increased stress in general,” she said.

The Serenity Room in the new Adult Behavior Unit at St. Mary’s Regional Medical Center features ligature-protected furniture with no accessible wires or cords that could be used to self-harm. Andrée Kehn/Sun Journal

Many face increased financial stress and food and housing insecurity, she added.

“Our outpatient clinic literally doubled the number of referrals between 2019 and 2020,” said Kelley, who also serves as inpatient general psychiatry unit ward at St. Mary’s Regional Medical Center in Lewiston.

“And it never stopped, it just kept getting worse,” Kelley said. “It’s probably 150% more than before.”

In some parts of the state, it can take six to nine months to find a supplier, he said.

“We had to, for the first time in St. Mary’s history, limit our watershed to just the tri-county area,” Kelley said, referring to Androscoggin, Oxford and Franklin counties.

“We had always taken patients from anywhere in the state and we had so many that just to be able to service our own area we had to limit it, which is sad. We would never want to limit our care to anyone.

Lewiston-based Tri-County Mental Health Services has also seen a dramatic increase in demand, CEO Catherine Ryder said.

Before the pandemic, patients might have to wait a few days or, at most, a few weeks for services.

“It completely flipped,” Ryder said.

“We started from a place where, you know, people were working in the office, and someone would call and we could usually get them in within a week, if not a few days. And today we have an extravagant waiting list in almost every service.

St. Mary’s Emergency Department has gone from an average of eight to 10 psychiatric patient visits a day to about 18.

“It’s even worse than it looks, though, because the units are full all the time,” she said. Before the pandemic, the average time between someone entering the emergency department and leaving was eight hours; it is now 36 hours.

A PERSONNEL CRISIS

In addition to the high demand for care, there are general shortages of personnel. While Maine’s mental and behavioral health staff were already struggling before the pandemic, COVID-19 has exacerbated the problem.

“We have had a personnel crisis for at least a year and a half. And we are not alone,” Ryder said.

“If you were to speak to a provider in the state of Maine, whether it’s a hospital or a community mental health center or your local Walgreens, everyone posts for staff. But, in our world, that means people are not being served.

Patient rooms in the new Adult Behavior Unit at St. Mary’s Regional Medical Center in Lewiston are all equipped with televisions, which must be recessed into the wall so that all cords are inaccessible. Patient feedback included a concern that it was too easy to lose track of time spent on the unit. The new rooms all have a protected clock. Andrée Kehn/Sun Journal

Kelley said he probably lost about 10% of his nursing staff to early retirement alone. People in a high-risk age group who would face life-threatening illness every day naturally left the workforce, he said.

“When you, every day, are talking with a patient and you have to wonder if that person might be exposing you, it’s incredibly stressful,” Kelley said.

This, and high worker burnout, has caused some to leave the hospital setting for private practice or leave the field altogether.

“The people we work with are some of the poorest, neediest and sickest people in our communities; most vulnerable,” Ryder said. “So when you have to carry that, on top of your own experience – it’s called vicarious trauma in our field – people are often really overwhelmed.”

Ryder understands this on a deeply personal level. Her son died of an accidental overdose in December.

“I struggled to get back on my feet while meeting the needs of our community at the same time,” she said.

Even without a staffing shortage, service providers like Tri-County Mental Health Services and St. Mary’s need more providers than ever to meet the demand left behind by the pandemic.

“I’ve been there for 30 years; we have never had such difficulties in terms of hiring and retaining long-term staff. It’s a different world we live in,” Ryder said.

THE CARE ENVIRONMENT MAKES THE DIFFERENCE

If he could point to one bright light over the past two years, it’s St. Mary’s new behavioral health inpatient unit, Kelley said. The 18-bed unit was designed to be “a place to give care that matches caregiving,” Kelley said last October when the unit was still under construction.

The nurse’s station in the new adult behavioral unit at St. Mary’s Regional Medical Center has a monitor that provides a view of the camera in some patient rooms. Andrée Kehn/Sun Journal

Now, with patients on the unit, the updated space — with its simple rooms, private bathrooms and large windows — the level of care St. Mary’s can provide is “night and day,” for compared to the old unit, Kelley said.

The private rooms, each with its own TV, made an immeasurable difference, he said. Shortly after patients were able to fill the new unit, they experienced an outbreak. Before the unit opened, patients would have been stuck in dark, dingy rooms with no source of entertainment and possibly a roommate, and now everyone has their own space to self-isolate.

COVID restrictions, like isolation and mask-wearing, can be difficult for everyone, but especially those with mental health issues. But during the outbreak, there hasn’t been a single incident, Kelley said.

The new unit is also equipped to care for someone with COVID or another infectious disease, which means they can stay in the psychiatric unit while they receive other medical care. Previously, a patient who tested positive could not be admitted to the unit and instead had to go to a medical floor, which is not necessarily equipped to meet a patient’s psychiatric needs.

“Patients get along better. They are so much more calm and relaxed,” Kelley said.

“And I think – I hope – they feel more supported just because the environment is designed for them.”


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