Psychiatric hospital leader favors merger idea

Posted Nov. 01, 2010, at 9:12 p.m.

BANGOR, Maine — Linda Abernethy, the superintendent of the state-owned Dorothea Dix Psychiatric Center, says a “thoughtful and careful” merger of the state’s two public psychiatric hospitals would protect a vulnerable population of patients with severe mental illness in northern and eastern Maine.

But closing the Bangor campus, an idea that also has been explored from time to time, would be “disastrous,” she cautioned.

The possibility of merging Dorothea Dix with the Riverview Psychiatric Center in Augusta was raised before the Legislature’s Appropriations Committee last week by Commissioner Brenda Harvey of the state Department of Health and Human Services. Harvey said the department hopes to operate both campuses under one hospital license and one administrative system, streamlining the budget without cutting patient services.

A formal proposal is being prepared and will be presented to the next governor and to the Legislature when it reconvenes in January, Harvey said.

Abernethy said Monday that the facility known for more than 100 years as the Bangor Mental Health Institute continues to fill a critical need in the northern half of the state. People with persistent mental illness such as schizophrenia and bipolar disorder, who are “so severely ill that their treatment and progress is expected to take more than a month,” can best be served at Dorothea Dix, she said, rather than at nearby Acadia Hospital, a private psychiatric hospital which rarely keeps patients for more than two weeks, she said.

A second private hospital, Spring Harbor in Westbrook, also is designed for shorter-stay patients, she said. The two private hospitals also specialize in treating juveniles, whereas the public hospitals treat only adults.

Dorothea Dix Psychiatric Center, which at one time housed hundreds of resident patients with chronic mental illness, now is licensed for just 100 and rarely has more than 60 at any given time, according to Abernethy. Last year, about 280 patients were admitted to the inpatient facility. The center also provides outpatient services to about 130 patients who are well enough to live in the larger community without being a danger to themselves or others.

The average length of inpatient stay is 75 to 80 days, although one patient was discharged last summer to supervised housing after a stay of more than eight years. The most common diagnosis is schizophrenia with its accompanying symptoms of paranoia and delusions, Abernethy said. Many patients are there under court-ordered commitment. Some are admitted in psychiatric crisis directly from emergency departments of hospitals in the region. Others are transferred from the Penobscot County Jail and other correctional settings.

“It is inhumane to leave people in an isolation cell [of the jail] if they can be medically treated,” Abernethy said. “They may end up going back to jail, but at least they’re going back with their illness treated.”

Many Dorothea Dix patients are familiar faces in the mental health treatment community as well as in the general social-welfare safety net, she said.

“It is one of the ironies of mental illness that you don’t think you’re sick,” she said. Patients in treatment feel better when their medications and other treatments are well-managed. But because they feel better, many stop taking their medications and participating in therapeutic activities.

“Then their behaviors deteriorate. They may lose their housing and wind up in the shelters,” Abernethy said. “Many of our patients are very well-known at multiple layers of the system.”

There are about 280 people employed at Dorothea Dix Psychiatric Center. The majority are clinical staff such as nurses, doctors, patient-care technicians, social workers and occupational therapists. Abernethy said 22 positions have been eliminated over the past year in an effort to streamline costs.

But closing Dorothea Dix would be disastrous, Abernethy said. The idea has surfaced in Augusta from time to time, she said, although there never has been a formal proposal.

“All the people we see here would have to go somewhere,” she said. “They would get pushed back into the community and end up in our shelters and jails.”

Carol Carothers, executive director of the Maine chapter of the National Alliance on Mental Illness, said Monday that the notion of consolidating the administration of Dorothea Dix and Riverview is a good way to save costs during tough budgetary times.

“People are going to be looking for ways to save money, no matter who comes in with the new administration,” she said on the eve of the gubernatorial and legislative elections.

But Carothers said Maine’s mental health system needs a closer look and possibly a more comprehensive overhaul that maximizes access to community-based services and reduces the demand for inpatient care.

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