Rights and Legal Issues

Persons Experiencing Psychiatric Crises: Information for Emergency Department Staff and Others Regarding Available Resources, Protocols, and Requirements

If an Individual Needs Hospitalization, How is it Determined Where the Individual Should Be Hospitalized?

The Department of Health and Human Services has established a three-tiered system of hospitalization intended to hospitalize individuals reasonably near their home communities, avoid multiple admissions and discharges from multiple hospitals within the same hospitalization period, and create single gateways to the state psychiatric centers.

1.) Community Hospitals with Psychiatric Units
Community hospitals with psychiatric units are the first level of hospitalization response. The community hospitals are for short-term admissions, generally 30 days or less. These hospitals have committed to a no-reject policy for providing coverage to individuals in their Community Service Network area. While that may not always be possible, particularly for specialized services, the intent of the policy is to provide services as close to an individual's home as possible.

2.) Specialty Hospitals
Maine’s two specialty psychiatric hospitals, Acadia Hospital in Bangor and Spring Harbor Hospital in South Portland, are the next line of treatment and will take admissions from the community hospitals. Individuals will transfer to the specialty hospital closest to their home community. These psychiatric hospitals are designed to treat individuals with greater acuity and clinical complexity than community hospitals are able to effectively and safely serve.

Additionally, Acadia and Spring Harbor serve as community hospitals for their local areas.

3.) Public Hospitals
Riverview Psychiatric Center in Augusta and Dorothea Dix Psychiatric Center in Bangor are the tertiary hospitals and will take referrals from Spring Harbor and Acadia, forensic admissions, and other admissions based on unique clinical needs.

Unusual Circumstances
Consumers in community hospitals may bypass hospitalization in a specialty hospital when:

A consumer’s history and current presentation indicate that a longer term of stay is likely;
A consumer’s documented clinical history makes a particular hospital inappropriate;
A consumer has serious objections based on a documented serious incident or experience that would make a particular facility inappropriate.

If the community hospital finds that unusual circumstances, as described above, apply, then it must confer with the closest specialty hospital. The specialty hospital retains authority to decide whether to refer the patient directly to one of the state facilities, provided, however, that if there is a disagreement between the specialty and community hospital about a proposed referral, that disagreement will be resolved by the DHHS Office of Adult Mental Health Services.