Patients treated in emergency departments for mental health crises say they’re being left out of conversations about violence in health care settings and worry that, without their input, the solutions being considered at the state level could make the situation worse.
A group of certified intentional peer support specialists told the Sun Journal that their experiences receiving care for a mental health crisis in hospital emergency departments has been uneventful at best and extremely traumatic at worst. The individuals, who have lived experiences with mental health challenges, receive training from the Maine Department of Health and Human Services to serve as patient advocates in various clinical settings, including in some hospital emergency departments.
“There (are) no other medical reasons out there, that when you enter an emergency room, that strips you of your dignity and your rights than for mental health,” Jenny McCarthy, 46, of Raymond said.
Hospital officials and providers told the Sun Journal that while the issue of violence in health care settings, particularly in emergency departments, predates COVID-19, the pandemic and its “ripple effects” have contributed to the increasing frequency and severity of verbal and physical assaults from patients or visitors against health care workers.
The peer support specialists who spoke to the Sun Journal have all gone to an emergency department at a Maine hospital at least once — voluntarily and involuntarily — for help with a mental health crisis. Most have been to an emergency department multiple times for mental health care.
They all described the same situation when entering an emergency department for a behavioral reason and are “blue papered” — Maine’s legal term for an involuntary admission for a psychiatric reason.
“The first thing they do is they take things away from you,” Carly Mahaffey, 40, of Lewiston said.
“They take away your clothes, they make you change into their paper scrubs. They take away your shoes, you know, no shoelaces. They take away your phone,” she said. Sometimes, if you have someone with you, like a friend or a family member, the ED staff will not allow them to come with the patient.
“It’s like right off, you go there for help and they send you the message that, ‘Oh, you’re bad. You’re sick. You can’t even handle, you can’t even handle your clothes or your phone. So give them to us,’” Mahaffey said.
A patient who is blue papered is not allowed to leave the hospital and that in itself sets up a “power dynamic” and a “dangerous scenario,” McCarthy said.
“And I’m in no way saying that violence is ever OK. I’m not. But from the view of a patient, it is extremely scary to be stuck in a position where, in a place where there is this power dynamic . . . You’re powerless (and) there’s nothing you can say or do to change that dynamic.”
Hospital workers told the Sun Journal there is a “learned helplessness” among health care providers and they do not have the same level of protections that workers in other public places have because of their job. They also said that when an assault turns physical, staff are often hesitant to call law enforcement or pursue charges against a patient “because of the milieu in which they work,” one hospital president said.
Julie Potter, 44, of Gray said, “Violence in any workplace is not something that we should have to tolerate. But I also believe that, you know, the system that is in place for crisis services” in Maine is not working. Potter said that with few, if any alternatives to emergency departments for individuals experiencing a mental health crisis, an ED environment can actually “escalate” situations.
Potter and others said they do not necessarily see it as the fault of the providers and staff, who they acknowledge are working in a high-stress environment and may lack the proper training or tools to handle psychiatric emergencies.
‘IT WAS HUMILIATING’
“(The) nurses at the ER, they’re overworked. They’re overwhelmed,” said Joe Bennett, 56, of Hiram. “They’re doing stuff that they’re not trained to do.”
Bennett, who works with Mahaffey on the Intentional Peer Support Advisory Committee, a group of peer support specialists who advise and support DHHS on intentional peer support matters in the state, said he was diagnosed with multiple sclerosis, a chronic disease affecting the central nervous system, in late 2016 following a “horrific” process.
He said his many visits to emergency departments, mostly for MS-related medical concerns, have taught him to “walk on eggshells” when speaking with providers. It wasn’t until he became a peer support specialist that Bennett said he learned how to self-advocate in an ED.
The biggest learning moment came about a year before his MS diagnosis, when he went to the York Hospital Emergency Department with symptoms of a heart attack. Bennett said this was one of a string of such visits where he presented with symptoms of a heart attack, stroke or anxiety attack, which he later learned were presentations of his MS.
But this was before his providers had figured that out and Bennett said that he was once again feeling frustrated and disheartened because although he was in a serious amount of pain, he was medically cleared to go home. When he told the on-call doctor this, using some perhaps ill-conceived humor to play off how uncomfortable he was, it was like a flip switched, he said.
The doctor decided to blue paper him, administered the sedative Ativan, and the next thing Bennett said he remembers is waking up in a locked behavioral health unit in Biddeford. He was there for 40 hours before his primary care physician was able to get him out.
“My experience in that locked ward was humiliating,” Bennett said. “It was pretty scary. You can’t call nobody. And it’s like, they rip all your rights away from you. … It was humiliating.”
York Hospital spokesperson Jean Kolak said that while privacy laws prohibit the hospital from discussing a specific patient’s care, “we confirm that the mental health and safety of our patients is at all times a priority.”
‘I FELT TRAPPED’
Potter, who now works at a mental health agency in Auburn, said an experience at the Emergency Department at Central Maine Medical Center in Lewiston forced her to drop out of her master’s degree program for social work.
Potter said she has a “pretty extensive trauma history” and first interacted with the mental health care system when she was 14. Officially, she said she has a diagnosis of post-traumatic stress disorder, which “creates a way of being in the world that sometimes looks very different to others, and it’s hard to understand.”
In 2017, she was dealing with a flurry of circumstances that she said brought flashbacks, nightmares and insomnia. Then, she began to experience dissociative episodes, or dissociative amnesia, or what she called “losing time.”
“Although I was functional throughout my day, I wasn’t emotionally conscious,” Potter said. “So I was going through getting things done and I, like, the last time I would remember, it was 9 o’clock in the morning and then I look at the clock and it’s 3 o’clock and I’m sitting in my car with a haircut and I have no idea what happened.”
After this happened a few times, Potter said she was “very anxious and scared so I decided to go to the ER.”
But what she experienced there was the opposite of helpful. Potter said she was treated with a lack of transparency and with coercion.
“Suddenly, I felt trapped,” she said.
Potter said the nurses told her they wanted to make her more comfortable by bringing her to another part of the hospital. As they were walking over, she realized that she was being led to a room with no windows, padded walls, cameras and a single bed with no sheets.
She froze. Then she remembered that the nurses asked her to turn over her belongings. But the one thing she refused to hand over were her keys.
“I said I felt I needed a sense of empowerment because I felt like my world was out of control, so I chose not to give them my keys,” Potter said.
When she refused, Potter said CMMC called Lewiston police. When she froze and turned around to leave, two “very large” uniformed cops were behind her. One of the officers put his hands on both of her shoulders and shoved her into the room. That’s the last thing she remembered before waking up on a hospital bed with a nurse tending to her, with signs of bruising and stinging, a red mark on her neck that was sore to the touch. One officer was holding the other back, who was shouting that she had assaulted him.
“I had no idea what was going on. I was terrified,” Potter said.
Later, the nurse told her that the police officers had stunned her twice with a Taser and wrestled her to the ground, which explained the bruises and the burn. She only recently learned that her mother came to the hospital and they spoke, none of which she said she can recall.
“While Central Maine Healthcare is not able to comment on a specific patient, we can say that the safety of patients and our team members is our top priority,” CMH spokesperson Jim Cyr said in response for a request for comment.
“Regarding involuntary commitment, Central Maine Healthcare acts in accordance with Maine state law,” Cyr said.
After that experience, Potter was admitted to an inpatient psychiatric unit and although “all I could think of is this cop who kept saying ‘assault of a police officer,’” the providers there told her it would be fine, and she decided to focus on her recovery.
One day, after she left the inpatient unit and returned home, she was pulled over by a police officer who informed her there was a warrant out for her arrest for failure to appear in court on a summons. She found out that the police came to her apartment to serve the summons, but she wasn’t there; she was in the inpatient unit. Potter spent two days in jail.
She was charged with assault on a police officer, a crime that is punishable by up to five years in prison and a $5,000 fine.
Court records reviewed by the Sun Journal confirm these details.
She was in the second year of her master’s degree program and had to drop out while the charges were pending.
The court sent her for a psychiatric screening, which confirmed her PTSD and dissociative disorder diagnoses. Still, Potter said, she felt the court thought her diagnoses were “convenient.”
After what she said was a two-year court battle and a year of “good behavior,” during which she was monitored by a psychiatrist, the charges were dropped.
‘IT’S A BIG MISTAKE’
“As soon as you get that psychiatric label, that diagnosis on your record, you’re treated differently,” Mahaffey said.
Though it’s been 20-something years since she said she was blue papered while seeking care at Eastern Maine Medical Center in Bangor, Mahaffey has been working off-and-on as a peer support specialist at Health Affiliates Maine and Mid Coast Hospital in Brunswick and now works as a community mental health advocate at Disability Rights Maine. Although her professional experiences inform her perspectives, Mahaffey said her comments do not represent that of her employer.
The legislative task force created to study the process in which criminal cases can be brought against perpetrators of violence against health care workers “seems like a very counterproductive approach to be taking for such a complicated issue,” Mahaffey said.
“It’s like, why aren’t we looking at the things that are causing this violence to happen?” she asked.
Stemming from a bill introduced by Rep. Walter Riseman, I-Harrison, last year, the 12-member task force was formed earlier this summer. In June, the group’s co-chairman, Sen. Ned Claxton, D-Auburn, said he would like the task force to answer three main questions: How to protect staff from violent incidents, how to take into consideration a patient’s circumstances when deciding whether to pursue charges and how to make the criminal process more transparent, especially for the victims.
The task force is expected to submit its report and recommendations to the Legislature’s Joint Standing Committee on Justice and Public Safety in November.
At its first meeting earlier this month, the task force laid out the foundation for its study. The discussion among the group of lawmakers, hospital officials, law enforcement officers and deputy district attorneys made at least one thing clear: There are gaping holes in the matrix of Maine’s health care, legal and judicial systems when it comes to balancing patient care, provider safety and criminal justice.
Bennett fears the task force, which has representatives from the Legislature, the major health care networks, law enforcement officials and members of the judiciary system — but no patient advocates — “is a big mistake.”
“We need a seat at that task force and a voice,” he said. “That’s the only way. The way they’re trying to set it up (is) as a Band-Aid that’s going to create more chaos and trauma — trauma for our workers and the patients.”
McCarthy said in no way does she think that the issue of violence in health care settings, particularly in emergency departments, is inflated.
“But I think we’re missing the point of why it’s happening,” she said.