Oct 18, 2023 —

The mental health crisis is having a very tangible effect in Watertown.

The hospital there, Samaritan Medical Center, is having to expand its emergency room to accommodate a sharp increase in the number of patients needing acute mental health care — even though it only built its emergency room just over a decade ago.

“Pre-pandemic we might see on average about four patients per day coming into our behavioral health unit,” said Thomas Carman, Samaritan’s president and CEO. “Since then, the beginning of 2022, we began to see on average about eight patients a day. And sometimes that would peak as high as 20 patients on any given day.”

Carman says too often patients were stuck in the ER waiting room when they needed immediate attention.

The $2.5 million expansion will almost double the number of special safe beds for behavioral health patients.

Samaritan CEO Thomas Carman on effects of mental health crisis in Watertown

Carman spoke with David Sommerstein. Their conversation has been lightly edited for clarity.

THOMAS CARMAN: In the summer of 2022, we actually went about 45 days that our emergency department was on psychiatric diversion [having to transfer patients to other hospitals due to lack of space] because we had more than seven patients in our facility. We just couldn’t accommodate anymore.

DAVID SOMMERSTEIN: So what do you know about why so many more patients are coming into the ER looking for behavioral health treatment, so many more than just a few years ago?

CARMAN: That is a great question. And I’m not sure we have a real firm answer for that. We do believe that the [COVID-19] pandemic has contributed to this. It could be because of the isolation of the pandemic, it could be because of the pandemic itself.

There are probably many other factors as well. It could be the rise in homelessness that we’re seeing [in Watertown]. It could also be the rise in drug use as well. There are probably a lot of different factors, but we do not have a specific reason for this significant growth. And I don’t think it’s unique to Watertown and Jefferson County in the North Country. I think this is happening across the state and across the nation as well.

SOMMERSTEIN: One thing I noticed from your data is that there were a lot more children seeking behavioral health care. What can you say about that?

CARMAN: You’re absolutely right. That is something that we have seen a dramatic increase in, the number of children who are seeking care. I suspect this is probably more related to the pandemic, probably not having schools in person for a long period of time, maybe the isolation that the children were experiencing as well. But it has been a significant increase. And frankly, that’s the population is more difficult for us to treat as well.

For those who can withstand outpatient care, we have some great services throughout the region. But for those that need inpatient care, we do not have any inpatient mental health unit beds for adolescents or children. So we have to have those patients transferred across the state.

SOMMERSTEIN: Explain to people why you need separate rooms for people who come in with behavioral health issues rather than just regular people coming into the ER needing rooms.

CARMAN: So the purpose behind a behavioral health unit, number one, is it’s much more secure. It’s secure for the patients that are coming in, it ensures that they are protected. Each of these rooms is relatively sterile, it has nothing on the walls that someone could hurt themselves with or hang themselves with. We refer to that as ligature risk. And we need to make certain that there’s nothing that a psychiatric patient or behavioral health patient could harm themselves with. So these behavioral health rooms themselves are designed specifically to ensure the safety of the patients that we’re treating,

SOMMERSTEIN: What kind of issues are people coming in with? How would you describe the range of symptoms that people come in with who are needing his help?

CARMAN: We have great support in this community for behavioral health patients, both with the programs that we run at Samaritan, and other community-based organizations. There’s a great network of programs throughout Watertown, Jefferson County, and frankly, the North Country.

But when a patient does present to Samaritan to the emergency department, they’re generally presenting as a harm to themselves or others. So they either have suicidal ideations where they might harm themselves, or where they might have indicated that they would harm someone else. That’s typically what brings the patient to the Samaritan emergency department, which is why even expanding outpatient services is not necessarily going to solve this problem. Because once they get to that stage, we are really the only place that can safely take care of them.

SOMMERSTEIN: This expansion is going to cost $2.5 million. That’s a huge expense that you didn’t see coming. And that was a response to a pretty drastic change in the healthcare needs of the population. As a health care system, how do you manage that?

CARMAN: So that is a challenge for us. As you noted, this was not an anticipated project that we took on, but something we have to do. We have not budgeted for this in our capital budget. But we are very, very fortunate that we have already some folks that have brought forward some donations to help with this. Our own Children’s Miracle Network is providing $300,000 for this project. Jefferson County, through some of the funding that they have available for addiction issues, is also providing $430,000 to us, as well as our foundation through some of the fundraising that they do through a golf tournament as well as the festival of trees, will also be used for this project. And we are seeking other funding as well to try to help offset this. Otherwise, the hospital will pay for this out of its reserves.