Imagine being the parent of a child who struggles to cope. One day your child has a major episode of aggressive, out-of-control behavior, and the only immediate option is a trip to the emergency room. It becomes clear pretty quickly that your child isn’t stable enough to return home right away, but a shortage of beds at other facilities and a lack of other direct care resources keeps them in limbo in the emergency department. 

Even when medically cleared for discharge, your child remains for days and even weeks in the emergency department waiting to get necessary behavioral health services to address whatever had brought about the original episode.

The stress mounts for both you and your child, and the costs of staying in the emergency department keep piling up. No help seems available anywhere in Maine, and the last thing you want is to see your child sent out of state, potentially very far away. You feel trapped.

This increasingly common scenario is one I’ve sought to address. This year I introduced L.D. 118, which directs Maine’s Department of Health and Human Services to collect detailed data on these extended emergency department stays, identify gaps in appropriate care and develop the resources needed to cut down the length and frequency of these stays.

The purpose of this proposal is to make progress on an issue that has caused children and adolescents, families, communities and the health care system to suffer.

Having worked as a social worker/clinical counselor for my career, including work as a crisis unit clinician, I can attest to the shortage of behavioral health services and facilities that has only gotten more severe over the years.

This shortage is harmful, counterproductive and extremely expensive. Emergency departments are intended for exactly what the name says – emergencies, not ongoing behavioral health care. Their rooms are frequently tiny, windowless, lacking in privacy, with security guards on duty, where the child remains long past the time when hospital level care is needed.  This just exacerbates the conditions that brought the young person to the emergency department in the first place.

When the lack of behavioral health resources comes up in a policy conversation, the phrase “we just need more beds” often accompanies it. Certainly more beds in Maine-based facilities designed specifically to help minors struggling with behavioral health would be a major upgrade, but that leaves out the kind of preventative tools that might help children and adolescents maintain better control and get to a place where they don’t have to risk being apart from their families.

With better data, Maine could find out more about what the specific needs are and what tools are the most effective, whether we are talking about home-based services, crisis services, case management, psychiatric hospital beds, partial hospitalization programs, residential treatment beds or something else.

L.D. 118 helps us better understand how many minors find themselves “stuck” in emergency departments and what types of resources are lacking in each case. It helps identify which parts of Maine have the greatest need, which demographics are affected most and what the biggest barriers to delivering services are. Those barriers could be distance in rural areas, communication between providers or the lack of a good treatment plan.

The bill creates a work group to gather and process the data, with the end result being a clear, targeted policy and budget ask from lawmakers and the governor, allowing Maine to quickly make the right investments.

I can’t stress enough how important it is that we take action. We know there’s a problem, and we know it’s causing harm both emotionally and fiscally.  A failure to act would mean we’d be allowing more children and adolescents to be traumatized with extended emergency room visits, potentially multiple times over.

We have the opportunity now to do the work – to determine specifically what course we need to take to better meet the behavioral health needs of our young people. It’s time to get going.

— Special to the Press Herald


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