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

Steve Costello, executive director of philanthropy for St. Mary’s Health System, demonstrates the ease with which patient room bathroom doors fall away from the walls in the new Adult Behavior Unit at St. Mary’s Regional Medical Center in Lewiston. The entire wing has been designed with patient safety in mind, leaving no edges to use as leverage to hang oneself. Andree Kehn/Sun Journal

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

The Household Pulse Survey, a survey of American 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.

For comparison, a survey of American households in 2019 found that about 8% of adults had symptoms of anxiety and depression.

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

“What I have seen (is) almost every patient I see, no matter what they are referred for (depression, anxiety, substance use, relationship problems), talks about how COVID has made their problem worse,” said Dr. Annie Derthick, a licensed clinical psychologist and the director of behavioral science for Central Maine Medical Center’s family medicine residency program.

“They talk about how social isolation in particular has exacerbated symptoms, put strain on relationships, limited resources and increased stress overall,” she said.

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

Many are dealing with increased financial stress and housing and food insecurity, she added.

“Our outpatient clinic literally doubled the number of referrals between 2019 and 2020,” said Kelley, who is also an attending on the inpatient general psychiatric unit at St. Mary’s Regional Medical Center in Lewiston.

“And that’s never stopped, it’s just continued to get worse,” Kelley said. “It’s probably 150% more than it was before.”

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

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

“We’d always taken patients from anywhere in the state and we got 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 anybody.”

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

Prior to the pandemic, patients might have to wait a few days or, at most, a couple of weeks to get services.

“That has completely flipped on its head,” Ryder said.

“We went from a place of, you know, people were working in the office, and someone would call and we could typically get them in within that week, if not within a few days. And today, we have an extravagant waitlist in almost every service.”

St. Mary’s emergency department went from an average of eight to 10 psychiatric patient visits per day to approximately 18.

“It’s even worse than it sounds, though, because the units are full all the time,” she said. Prior to the pandemic, the average time from when someone entered the emergency department to when they left was eight hours; it’s now 36 hours.

A STAFFING CRISIS

Compounding the high demand for care are the across-the-board staffing shortages. While Maine’s mental and behavioral health care workforce was already struggling prior to the pandemic, COVID-19 has exacerbated the issue.

“We have had a staffing crisis for the past year and a half at least. And we’re not alone,” Ryder said.

“If you were to talk to any provider in the state of Maine, whether it’s a hospital or a community mental health center or your local Walgreens, everybody is posting for staff. But, in our world, it means people go unserved.”

Patient rooms in the new Adult Behavior Unit at St. Mary’s Regional Medical Center in Lewiston all have televisions, which are required to be sunk into the wall so that all cords are inaccessible. Feedback from patients included a concern that it was too easy to lose all track of time in the unit. The new rooms all feature a protected clock. Andree Kehn/Sun Journal

Kelley said he probably lost about 10% of his nursing staff to early retirement alone. Individuals in a high-risk age group who would be faced with a potentially deadly disease every day understandably left the workforce, he said.

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

That, and high worker burnout, has caused some to leave hospital settings for private practice or to leave the field entirely.

“Who we work with are some of the most poor, disenfranchised, ill people in our communities; the most vulnerable,” Ryder said. “So, when you have to carry that, in addition to your own experience — it’s called vicarious traumatization in our field — people are often really overwhelmed.”

Ryder gets that on a deeply personal level. Her son died from an accidental overdose in December.

“I have struggled to get back on my own feet while attending to 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 before just to meet the demand left by the pandemic.

“I’ve been there 30 years; we have never had struggles like this in terms of hiring and retaining staff for the long run. It’s a different world we’re living in,” Ryder said.

CARE SETTING MAKING A DIFFERENCE

If he could point to a bright light amid 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 the caregiving,” Kelley said last October, when the unit was still under construction.

The nurse’s station in St. Mary’s Regional Medical Center’s new Adult Behavioral Unit features a monitor that gives a camera view in selected patient rooms. Andree Kehn/Sun Journal

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

The private rooms, each with their own televisions, has made an immeasurable difference, he said. Soon 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 isolate.

COVID restrictions, like isolation and mask-wearing, can be tough on anyone, but especially those experiencing mental health challenges. But over the course of the outbreak, there was not a single incident, Kelley said.

The new unit is also equipped to handle someone with COVID or another infectious disease, which means that they can stay on the psychiatric unit while they receive other medical care. Before, a patient who tested positive couldn’t be admitted to the unit and instead would have to go to a medical floor, which is not necessarily equipped to handle a patient’s psychiatric needs.

“The patients are getting along better. They’re just so much calmer and more relaxed,” Kelley said.

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