Breaking the Cycle: Melissa Skahan on Transforming Lives at Mercy Hospital

Lisa Belisle: Hello. I am Dr. Lisa Belisle and you are listening to or watching Radio Maine, our video podcast where we explore and celebrate creativity in the human spirit. We're sponsored by the Portland Art Gallery in Portland, Maine. Today it's my great pleasure to have with me Melissa Skahan, who is the Vice President of Mission at Mercy Hospital, and I'm intrigued by this title. It's pretty fantastic, Melissa, that you get to be the Vice President of Mission.

Melissa Skahan: Yeah, it truly allows me to be involved in all kinds of different things. I have had the privilege of being involved in both inpatient and outpatient services, but also very focused on vulnerable populations. So I have a lot of freedom to influence not only the patient experience, employee experience, but also the lived experience of a lot of our patients, which is wonderful.

Lisa Belisle: So I've been a big fan of Mercy Hospital for many years. In particular, I delivered two of my children there at the old Mercy Hospital. One of them, she was pretty much delivered in front of, it was probably Sister Catherine McAuley, in the hallway. She almost didn't make it to a room. This is my little Sophie who's now 23. But Mercy's done a lot of changing since I delivered those babies. There's a big beautiful campus that's over on the Fore River and it's kind of expanded. There's the outpatient footprint. How long have you been with Mercy and how long have you been doing the work you're doing?

Melissa Skahan: Yeah, absolutely. I've been at Mercy for 17 years, so have been very much a part of a lot of the transformation and growth. The beautiful thing about Mercy is the core of it has not changed. We're still sponsored by the Sisters of Mercy. We still are very, very focused on each encounter and the person that we're serving. So as you mentioned, we have a big, beautiful campus that really brings to life a lot of the environment that really is a therapeutic relationship with patients. So that notion of light and being able to see potentially the ocean, the Fore River, from your room and having private space with beautiful artwork in the hospital. So we really tried to enliven all the good things that we know about healing and also bring forth that core mission and values of Mercy.

Lisa Belisle: Well, I can tell you it also personally meant a lot to me because when I went through my own breast cancer diagnosis and surgery, I had surgery there. My surgeon was at Mercy, still is at Mercy. It's been now a decade. So it was such a great experience to be working not only with the people, but also with that atmosphere. The healing atmosphere is really so important to patients, and I really like this idea that you're connecting with people, but you're connecting with them in a way that is important to them at the time. So for me, during that experience, I needed to be in a surgical suite with a nice waiting room where my family could be, or I needed to be with a place where I could deliver my babies. But Mercy is so much more than that. Mercy has McAuley House, for example, and so many other things where you're connecting with people where they need that care. Talk to me about what specifically you've been doing.

Melissa Skahan: Yeah, so you mentioned McAuley Residence, and the beauty of the work of Mercy is it's truly always focused on systems change and holistic care. So at the height of the opioid crisis, really 2009, we were beginning to see a dramatic impact to women specifically. They were more likely to overdose, more likely to get a prescription for pain medication and really were highlighted nationally as a vulnerable population. Mercy Hospital had a transitional housing program that was formerly of the Sisters of Mercy called McAuley Residence, and I redesigned it after watching the lived experience of a lot of women with opioid use disorder to become solely focused and expert in that space. So what began as a small house with three apartments has consistently refined itself and paid attention to data and outcomes and to the people that we serve to really today be expanding statewide.

We have in Portland now the ability to serve 25 families. So it is a two-year length of stay, includes housing. When you think about very vulnerable people, housing is often one of those really foundational needs to allow them to heal. So we partner with Community Housing of Maine and those 25 families are provided seamless access to care, substance use treatment, mental health, as well as their physical health. And then we focus on parenting education. And another interesting component, we watched the dynamic of removal of children from home. So we continue in the state of Maine to see an increase in the number of children removed from homes secondary to substance use disorder, and today 52% of those removals are secondary to substance use disorder. So the ability to really get upstream and be that healing, that therapeutic presence for a group that we know that we can have consistent outcomes with.

We launched in 2009 and '10 and fast forward to today, our outcomes are remarkable. We take highly complex families. Children are as complex. They really have comprehensive health needs, behavioral health needs, and the ability to really address all of those seamlessly helps people stabilize. These incredibly highly acute families with chronic, relapsing, developmental concerns and unmet health needs get to a place where at the end of their stay they're able to thrive. Kids are at grade level, they're highly engaged in school. We deliver college courses on site. We focus very much on breaking that cycle of generational addiction and poverty. So we have two locations in Portland, two in Bangor, and Community Housing of Maine received a $15 million award from congressionally directed spending from Senator Collins's leadership to advance into four additional counties. So really excited to see how we can impact directly the struggles of these families. It would be wonderful to get to a place where we didn't have increased removals from these homes and you saw women and their children thrive.

Lisa Belisle: What I find so interesting about what you're describing is the nature of going upstream, whereby in medicine, at least the type of medicine that I've been exposed to in a traditional sense as a physician, is very much downstream. It's very much, we'll meet you at the hospital if you have an urgent issue. And you're talking about, let's try to get people before they even need to go to the hospital. Let's try to help them with their mental, emotional, physical health so they don't actually need to get to the place of urgency and emergency in substance use disorder or other ways. But it's incredibly complex as you're describing it. How do you decide where to start?

Melissa Skahan: One of the fascinating things I watch, and I've just spent significant time with a variety of families who will be coming into our new program on Winter Street in Portland, many of the women that I spoke with have had 10 years of high-risk behavior of active substance use disorder and involvement of a variety of different groups, be it child protective, be it the medical community. The opportunity to get, instead of allowing those 10 years to unfold, to truly seek that level of engagement early on. So ideally it would be wonderful in that first interaction with the family to lean in a very comprehensive way because we really know what works. I think the critical component that we provide these families is how to navigate a lifelong of substance use disorder. This is not something where there is a quick cure. It's truly a lifetime of actively remaining in recovery. So we teach folks that if they do return to use, they know how to stand right back up and lean into the treatment and all of the supports they need. We teach them how to really create and live healthy lifestyles to create this incredible home for their family. So I would love to have us get to a place where we had that first encounter with Child Protective Services or other groups, that we are tapped and we have the ability to really serve the family.

Lisa Belisle: It is interesting because child protective services, once they're called, that is a moment of crisis for that family. It may be crisis in a different way that's perhaps not medical yet, but it is crisis and it's something that children will remember. Most of them are old enough to have some memory that's going to move into the next phase of their life. It could impact the lives down the road. So this idea of breaking the cycle of intergenerational, I guess, disruption is really important because you're not just dealing with the people that are in front of you right now, you're dealing with future generations.

Melissa Skahan: Absolutely. And the children, as I mentioned, are incredibly complex. That tenure of use often gets them very close to high-risk behavior. They most often have significant trauma. They may have a variety of different diagnoses associated with mental health or medical health. I think it's really ensuring that their needs are met and that we pay deep attention to their trauma and that reunification is incredibly deliberate. I think that another critical component is moms have incredible guilt and shame around use that influences their children. Many of the women that we have served over the last decade were in the system. They were potentially foster children. So they know how it feels, and with that, there's significant guilt and shame. The beauty is really giving voice to that with the right behavioral health support and that full family systems work as well as healing. Just watching these women transform, complete their college education, they're often first in their family to consider that. It really is fantastic to watch.

Lisa Belisle: I'm wondering if you and I have maybe similar reasons for being interested in families, being that we both come from large families. You're at the end of a large family of origin. I'm at the beginning of a large family of origin, and for me the beauty of that was just to see the interplay amongst family members and how different everybody was. If you come from a family of two and there's one other person, you have that person and yourself. You come from a family of 6, 7, 8, 9, 10, and you're like, how could all of these people have come from the same parents in the same household? Do you think that that actually did impact your interest in the work that you're doing now, as being from a large family?

Melissa Skahan: Yeah, absolutely. When I think about my family, not only do I have six children in my family, but we had several cousins and all of those also had that same size. So you have this little community of people that adore you and have your back and would always be there for you. What I watch with some of these families that I serve, they may not have anything healthy to draw forth. So what would it look like if we interrupted that? What's it going to take for these families to have the same experience we did, where they have a loving, growing family? It doesn't mean that we were perfect in any way. There were certainly trials and tribulations, but at the end of the day, that love, that unconditional love you have in families is really important. A critical piece that we help families understand is how to navigate, with healthy boundaries, that relationship. When you look at a lot of the research around foster families or just a lot of work with vulnerable families, much of it acknowledges that they will reconnect with their family of origin. That is a deep draw for all of us. So the ability to help people develop those healthy skills so that they can do that with ease and then also remain in recovery and healthy themselves.

Lisa Belisle: Another area that I think you have an interest in and background in is education and the importance of education. You've already mentioned this with these families and with these women, but how, for you, did this end up getting you to the place where you are now if you previously were more focused on education specifically?

Melissa Skahan: Yeah, I think it's an underlying question I'm always asking. So certainly while in education, I was drawn to children who learn in alternative ways, who really may not thrive unless it is experiential, unless there are different ways for them to express themselves. And so service learning, character education, a lot of these different modes were a passion of mine. Similarly, as I work with families today, it's truly that notion of how do we as a system, healthcare or education, need to adapt so that these people, this population with a certain profile, can have the most consistent outcomes. And that's been the beauty of the work that I'm doing at McAuley, certainly work that I did in education, and most recently we repurposed a former convent to serve homeless, pregnant, immigrant women. And that piece has also held up a great opportunity to understand from a cultural humility space, how do we as a system, both education and healthcare, need to adapt so that we can be successful with the population.

Lisa Belisle: So again, it comes back to meeting people where they are and understanding what they're telling you that they need versus making assumptions about what people need. And I would think that if you're somebody who does not currently have a home and is also not currently from Maine, then a lot of the support structures probably have been torn away and you're really rebuilding from the very, very foundational level.

Melissa Skahan: And I think two critical things that I've observed there is just the human resilience, just that notion of spirit and that power to connect even when you don't share language. That's been fascinating to watch as we bring together pregnant women from all over the world. Often we have five plus languages in play, and yet that sisterhood or that connection is remarkable to watch because they offer, in very different ways, connections that I didn't predict. I really assumed that we would have to have a lot of interpreters in play, but we certainly do that just to ensure that understanding is there, but also just that human connection.

Lisa Belisle: I think when it comes to pregnancy also, one of the things that I know that I felt myself as somebody who gave birth to three children is that there's simultaneously this vulnerability and also this fierceness, where you feel you have this very precious thing that you are going to bring into the world and you feel like somehow you need to protect it, but also that you're going to protect it. You're going to make sure that this little thing comes into the world and becomes a human creature. And so I wonder if that's also part of that resilience that you're describing, is the fierceness around being a mother.

Melissa Skahan: Absolutely. There's nothing like the power of a mother, and certainly a pregnant woman as it relates to their baby. I think a critical thing that I've watched is that bond that they have, but also just their shared experience. And I think it also has made me realize how difficult the healthcare system is for people who may come from a different part of the world that have not experienced organized healthcare, or non-native English speakers. I think much of what I had assumed is that with interpreters and community health workers that that was enough, and that is not enough. We really need to create space where there's shared decision making, where we understand more deeply what their birthing experience should be, needs to be. It's really provoked a heightened level of curiosity for me. And the beauty is a partner in this organization, a nonprofit ethnic-based community organization. Her presence has just been incredibly valuable in really helping me understand and Mercy understand how best to serve, but also how to give space so that there is truly shared decision making, especially for women who may have experienced racism in their country of origin, may not be used to really feeling empowered in our spaces.

And they have been just foundational in building up these women to really be powerful mothers and powerful women during their pregnancy, and helping us understand as a health system how to really ensure that we're all curious and that we're all committed to really continue to adapt.

Lisa Belisle: I'm wondering what it has been like for you to be right in a front row seat with the Sisters of Mercy as they've continued to evolve. Because I know that the sisters that were the educators of my mother when she went to parochial school, I think are not the same sisters that we probably see today. And as an organization, I'm sure it's not the same organization. I'm wondering what you've seen, what has your witnessing been on this whole process?

Melissa Skahan: Yeah, absolutely. So the Sisters of Mercy, when I first came to Mercy, we had sisters in habit roaming the halls. You had sisters in vice president roles, you had chemists and accountants and pharmacists. You had a variety of really just remarkable women leading the organization. Fast forward to today, we don't have any employed Sisters of Mercy. We do have sisters serve on the governance level, on our board of directors, and there are probably 60, 70 sisters in the state of Maine. Many of them were leaders or teachers at McAuley High School, and they are certainly aging. I think what hasn't changed is their deep commitment to service. And so their foundation is certainly there. Globally, the Sisters of Mercy have kind of come under one umbrella. So what used to be like a Northeast Sisters of Mercy group and then a Mid-Atlantic, they now have an institute that they have formed that oversees all healthcare, education, and their different ministries. So they're certainly not as physically present. Part of my role as Vice President of Mission at Mercy is to ensure that we enliven their charism, which is really their mission and values, in everything that we do. So I work very closely with the Sisters of Mercy, both at the institute level but also locally in Maine.

Lisa Belisle: It's really impressive to me that in a day and age of sort of deinstitutionalizing pretty much everything, where we've said, well, we don't believe in the importance of religion, let's just say, or corporate structures or whatever it is, I think the fact that the Sisters of Mercy has been able to just figure out their identity in a new way. They're still there. They're just doing it differently. And I think this idea of mission is truly important because at the end of the day, really it's, how do you achieve the goal? How do you achieve the goal of being of service? So instead of holding onto, this is what we were before, they have embraced what they need to be now and into the future. And that I think is pretty astounding when we think about how other institutions have just folded. This is a strong group if they're still out there and they're just doing things in different ways.

Melissa Skahan: Yeah, very strong. A great example is Francis Ward Convent that has now been repurposed to house homeless, pregnant immigrant women. When the Sisters of Mercy, it truly was like an assisted living, really was a place where they had their elders. It was purchased when they closed the mother house on Stevens Avenue. So a lot of transitions, a lot of loss for the sisters. They move into Francis Ward and then determine that that isn't the best way to care for elders, and they determine they're going to move on from that facility as well. So it was listed for sale, and watching the coming together around developing this space for women of color who are pregnant and homeless, to really come and receive just holistic, highly coordinated care. It really was secondary to us consistently seeing Maine consistently seeing poor health outcomes. So we came together after just a variety of really chilling data, and the Sisters of Mercy offered up this space at a reduced rate to allow for the good works to continue.

So what was a vacant convent now is filled with 15 moms, 15 infants and often 10 children. So to go there to see what used to be vacant, and now see soccer balls bouncing off the walls, and these children who otherwise would've been homeless or highly housing insecure, have seamless access to all the care they need. We also deliver workforce development on site. So we have English, you see that education, I always have to get back in to have language acquisition, digital literacy, and we offer behavioral health services for the children. It is that comprehensive approach, but it would not have happened without the sisters really offering up this space that is remarkable to look at. So it still has that Mercy feel, and we've welcomed women whose story is just so striking, walking for months, just their lived experience. So to be able to create that space wouldn't happen without the sisters, and they take great pride. Several of them volunteer there, and there is nothing like walking into Francis Ward and seeing a Sister of Mercy with two babies on her lap because she's in her glory serving the women.

Lisa Belisle: I love that. This is what ultimately you're using, both sort of evidence, the evidence base and the numbers, but you're also using love, and ultimately it does take all of the above to deal with the complex issues that you've been describing. Whether it's not currently having a home or whether it's substance use disorder or whether it's complex medical needs, it's going to always take both.

Melissa Skahan: Yeah, oh, absolutely. I have opportunity to work a lot with our employees. What we talk about extensively is ensuring that we pay deep attention to each encounter, each encounter with our patient, and that we demonstrate love and compassion, but also with each other. Healthcare is hard. And so making sure that all of our staff and patients really have a certain type of experience, our culture is incredibly precious to us all, and we pay deep attention to it.

Lisa Belisle: When we asked you before you came in to reflect on your experiences and what was important to you, one of the things that you talked about was navigating through the loss of a colleague. So I just wanted to ask you, in your final thoughts, what was it about that? Because if you're bringing forward this idea of the importance of not only caring for the community but caring for one another, I suspect that that plays into it somehow.

Melissa Skahan: No, for sure. So you're bringing up an experience that was very traumatic for Mercy. We had a security officer years ago who was killed on site. I think, as you can imagine, we came together in a significant way as a Mercy community, but it was my first time directly engaging. The young man was from the Sudanese community. So I had the opportunity to truly experience how that community grieves, how they come together in this just incredibly remarkable way. And I also had the opportunity to understand what they needed to have happen. A great example is in Sudanese culture, they carry the body in a procession towards the church. And as you can imagine, at that time, we were talking about 600 people that wanted to march, carrying the body, very out of the box for a Western way of grieving.

And yet we were able, I had the privilege of really working closely with the family as well as the Sudanese community, as well as law enforcement, to come up with a solution so that they could march from the West End all the way to the East End. And so I think it probably was one of my first experiences really understanding how to ensure that you're always present and that you're always really listening and learning and being willing to be fierce. Because as you can imagine, there was a lot of concern around us marching. So I think it was transformative for me because it was certainly the first experience where I had worked so closely with people from Sudan and also planned a march for 600 people.

Lisa Belisle: Well, Melissa, I really appreciate your taking time out of your busy schedule to come and talk with me today. Clearly the work that you do as the Vice President of Mission for Mercy Hospital is both far reaching and very important. So I know that people are going to be really fascinated to hear about what you do on a regular basis and where Mercy's going in the future. So thank you for coming in and having the conversation with me today.

Melissa Skahan: Oh, absolutely. Thank you for inviting me, and I look forward to seeing the podcast. Thank you.

Lisa Belisle: I'm Dr. Lisa Belisle, and you have been listening to or watching Radio Maine, our video podcast where we explore and celebrate creativity in the human spirit. Today I've been speaking with Melissa Skahan, who is the Vice President of Mission with Mercy Hospital, right in the, well, I was going to say in Portland, but now statewide, really, with the connections. And I encourage you to learn more about the work that they're doing. It's obviously multifaceted, but Melissa, what's the best way for people to learn more about mission?

Melissa Skahan: Yeah, absolutely. Always feel free to reach out to me at Mercy Hospital. Certainly any number that you call, people would easily connect you to me. Happy to chat.

Lisa Belisle: Well, thank you for joining us here today on Radio Maine. And thank you, Melissa.

Melissa Skahan: Absolutely. Thank you.