North Country's Only Inpatient Psychiatric Unit Closes; Doctors Worry About Suicidal Patients

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For more than 23 years, the Androscoggin psychiatric unit took in the people in extreme crisis.

Some patients arrived hand-cuffed and escorted by police. Others showed up voluntarily out of fear that without help, they would kill themselves.

They suffered from psychosis, depression and schizophrenia.

Russ Keene, the hospital’s CEO says the unit closed for many reasons -- but the major issue was financial.

“Without question reimbursements did play part of this decision. It’s really difficult to get adequate reimbursement for psychiatric services today and I think that’s why we were the last pure designated receiving facility in the state.”

Many of the patients were on Medicaid and Medicare.

Those programs never cover the full costs of providing services.

And many private insurance polices don’t cover everything either.

Some mental health professionals in the Berlin area are worried about what will happen next.
Marty Kaufman was the unit’s psychiatrist and medical director. He helped get the program off the ground two decades ago.

Kaufman says the people in great need are still out there, but now the North Country has a very limited ability to treat them.

KAUFMAN: “Close to 100% of the patients that came in were suicidal. The problem is when a patient says I’m suicidal there’s no way to know whether the person is crying for help or whether they are immediately suicidal.”

Kaufman is most concerned for patients who seek hospitalization voluntarily.

To get the same kind of treatment that Androscoggin provided, he says they will have to go to hospitals hours away in the southern part of the state.

He doubts that all of them will find a place to take them.

Kaufman says he has seen with own eyes what happens to people without insurance.

KAUFMAN: “The hospitals are supposed to take patients regardless of their ability to pay, but patients have to be “pre-certified” and it becomes clear in discussions between clinicians whether a patient has or doesn’t have insurance and fact of matter is it isn’t easy to find a bed for a patient that has absolutely no insurance and has a very complicated psych problem.”

Area health officials hope that some patients will be able to us the smaller North Country community hospitals.

But Doctor John Burroughs, emergency room director at one such hospital, says, in his view, these aren’t the right places.

Burroughs: “If someone is in need of psychiatric hospitalization there is no way the average community hospital can provide secure hospitalization or provide the expertise. And the danger is that if someone elopes they could potentially take their own lives.”

He’s also worried about those committed involuntarily.

The plan now is to put them in a squad car and send them 3 hours south to Concord Hospital – and possibly a few other facilities.

But he worries about what happens when there isn’t a place for them – some could end up in jail as they have in the past.

Burroughs: “Well then if there’s a bed they’ll be admitted if not send back to community or if still at risk they’ll remain in jail. This is not a progressive or humane approach to psychiatric illness.”

The state department of health and human services created a task force to look at ways to fill the gap created by the Androscoggin closing.

One of the approaches that emerged is to try to treat the voluntary patients in the community – with enhanced service teams who will visit them.

A state official said there are also plans to buy three apartment buildings up north where crisis beds will be available to patients.

Those buildings will be owned and managed by Northern Human Services.

The head of that nonprofit agency is Dennis MacKay.

He says that the housing and support teams could go a long way.

MCAY: “What we’re doing is trying to prevent as many hospitalizations as possible - not replacing but preventing - by virtue of providing additional and more intense supports for people currently in the community right now.”

But regardless, there will be people who get sent to Concord’s New Hampshire Hospital.

The task of transporting them falls on the shoulders of law enforcement departments in the North Country. Scott Carr is the sheriff in Carroll County.

He is very familiar with this aspect of his job.

“We’ll ask them things like what kind of music do you like and find that on the radio and put them in an envmnt which is comforting to them as one can when they are handcuffed and seated in the back of a police car.”

Carr says he’s not looking forward to all-night drives – especially in winter.

He added that the additional labor and fuel costs will fall on county taxpayers.

There are many issues to work out, including who pays for transportation and the role of hospitals in the south.

There is talk of giving them more money if they take these patients.

State officials have invited southern area hospitals to participate in the next round of discussions.

At this point, about $1 million dollars have been set aside to help with the transition.

For NHPR News, I’m Dianne Finch