The LePage administration has proposed moving the location of the care and treatment of forensic patients out of Riverview Psychiatric Center and to a more suitable facility. The proposal, as I understand it, would allow for their care to take place in a facility designed for their unique issues.
The more suitable facility would address three crucial factors that have long been underserved by Riverview. First, the unique type of mental health assessment and treatment services required to address the problems of the forensic patients would be the single focus of the facility. Second, the facility would provide better patient management services that would ensure the safety of the patients and staff. Third, the civil patients remaining at Riverview would have a much safer hospital setting in which to heal and recover.
In brief, there are three types of forensic patients: those who have been adjudicated as incompetent to stand trial, those adjudicated as Not Criminally Responsible (NCR), and those awaiting trial or pre-dispositional hearings pending an evaluation. While all of the forensic patients either have a mental illness or, in the case of those remanded for an evaluation, are suspected of having a mental illness; they all have been charged with a crime; and many of them charged with a violent crime. Many of these patients will remain in the state’s custody for the remainder of their lives.
Patients on the civil side of the hospital all have a mental illness but are not there because of a criminal proceeding. The patients on the civil side of the hospital have a serious and persistent mental illness, or SPMI, that often can require many weeks and months of treatment in order to achieve psychiatric stabilization. Their recovery process includes many forms of treatment with the goal of a successful return to their homes. This lengthy recovery process is not within the capacity of our community mental health facilities and therefore remains the responsibility of the state.
Community hospitals are structured for brief psychiatric stabilization, not for the long-term treatment of patients with a serious mental illness. Unfortunately, those patients begin their admittance to Riverview through a community hospital’s emergency department and then to a community psychiatric unit. When a patient’s needs exceed the capacity of the community facility, the patient must be referred to Riverview, and the wait for a bed — which could take anywhere from many to many weeks — begins.
The original intent of Riverview was to create a facility designed to care for Maine’s most needy, mentally ill patients, which was the right thing to do. However, placing civil and forensic patients in the same facility and limiting the hospital size to just 92 beds was shortsighted and ill-conceived. Even though the two populations have mental illness in common, they have very different needs and treatment goals. Those differences should be accounted for through separate facilities.
Because of the shortage of space, our courts have a backlog of defendants awaiting evaluation. The judicial process grinds to a halt and the defendant’s constitutional right to a speedy trial is infringed upon.
Civil patients experience a similarly unwanted and costly delay of treatment due to the lack of space. A patient enters the system through the emergency department of a community hospital and is then referred to a community psychiatric unit. If the patient cannot be stabilized in a few days on the community unit a referral is made to Riverview for long-term care and treatment. If Riverview does not have an open bed then the hospital cannot transfer the patient. If the community hospital cannot open up a bed, then the next patient in line must remain in the more costly emergency department. The bottleneck is at Riverview.
Given the choice between housing forensic patients at Maine State Prison in Warren and Maine Correctional Center in Windham, I hope Windham is selected. A forensic unit is more than a secure housing facility — which Warren certainly is — it must also provide treatment. A thoughtful decision to move some forensic patients — those found not criminally responsible — to secure, private facilities also should be part the discussion.
It makes sense to leave Riverview as a state psychiatric facility for civil patients and locate the forensic patients elsewhere. It would provide more timely and more humane treatment of our civil patients and reduce costly and unnecessary extended stays in emergency departments. For different but equally important reasons, treating forensic patients at a separate facility is justified. This is not an idea whose time has come but one that has been long overdue.
Mark Holbrook, Ph.D., of Brunswick has worked as a mobile crisis clinician and on the psychiatric unit of Maine State Prison. He spent a year in training at Riverview Psychiatric Center.