This Issue:
We are holding a conversation on this severe and urgent statewide issue, impacting most communities and that this issue cannot be solved by one entity. Our goal is to bring awareness to this issue and work towards collaborative, trauma-informed efforts to address this.
The Consumer Council System of Maine (CCSM) has been made aware of an increase in stories being shared about unsafe discharges from emergency rooms to places unable to provide adequate care such as warming centers, shelters, or even the streets. This is posing a major safety concern and appears to be a universal experience across several shelters statewide. Many of these patients are not only experiencing mental health challenges, but also physical health problems that require sustained hospital care.
Recommendations:
1. All hospitals need to have (and/or contract with a third-party) a human 24/7 to be a dedicated patient advocate either on-site or on call for the hospital team to utilize for safe discharge planning. Information about the advocate’s role should be made available to the patient at the onset of their visit, both verbally and with written materials.
2. We encourage all hospitals to integrate safety planning as needed with the individual’s treatment plan.
3. We recommend a mechanism for data collection to ensure that these recommendations are adequately met. This could be integrated into Maine’s recent implementation of APPRISE Healthcare Data.
4. Develop a mechanism for billing General Assistance in the patient’s town of origin for return transportation. Currently, patients are at the mercy of the hospital system for transportation vouchers that are often inconsistent.
5. A commission or workgroup should be initiated to study the impacts of this issue, including representatives of the hospital system, shelter/warming center staff, case managers, continuum of care and regional housing councils, lived experience communities (both mental health and substance use disorder), public housing authorities, Maine State Housing representative, caregivers, medical professional associations, town managers/GA representatives, law enforcement, DHHS representatives, representative from the AG’s office, and a representative from the Governor’s office.
Expected Outcomes:
- Better physical and mental health outcomes for unhoused individuals in need of sustained care.
- Fewer stressful and unpredictable situations for shelter staff, hospital staff, and emergency services.
- More streamlined collaboration between hospitals, shelters, and emergency services, resulting in fewer traumatic experiences for all involved, a stronger standard of care, and fewer recurring visits to the emergency department.
- The suggested commission/work group would work to ensure that these areas of concern are addressed along with others including: transportation barriers, shelter capacity, hospital capacity, expanded recuperative care, etc.
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