BANGOR, Maine — Dorothea Dix Psychiatric Center has stopped accepting new patients temporarily in an effort to streamline operations and cut expenses in advance of upcoming budget cuts.
Superintendent Linda Abernethy said Tuesday that the move is one of many possible operational changes at one of the state’s two public psychiatric facilities.
Those changes could be just the beginning.
A work group created as part of the state’s $6.1 billion biennial budget that passed in June has been meeting since early August to determine the long-term fate of Dorothea Dix.
That group has until Dec. 1 to present recommendations to the Legislature, but with some members advocating strongly to keep Dorothea Dix open and some convinced that it should be closed, a consensus remains elusive.
Rep. Sara Stevens, D-Bangor, is one of two legislators assigned to the work group and is on the side of keeping the facility open.
“When this work group was formed from the governor’s original language, it was written so that the outcome was all but predetermined,” she said. “We had to rewrite it to ensure that wasn’t the case. My focus is making sure these patients are properly taken care of.”
Sen. Nichi Farnham, R-Bangor, has not made up her mind on what to do with Dorothea Dix. She agrees with Stevens that the patients need to be the most important priority but said the financial realities cannot be overstated.
“We need to ask, ‘Is there another place for those services to be provided?’ and ‘Can they operate in the same setting but with more efficiency?’” Farnham said.
Maine Department of Health and Human Services Commissioner Mary Mayhew has made one thing clear during the work group’s sessions so far: There is no money available from the state.
Right now, Abernethy said Dorothea Dix serves about 60 patients every day. Most of those patients are short-term admissions, but some stay much longer.
The short-term goal, she said, is to reduce the number of daily beds to about 50. To do that, the facility needs to stop accepting new patients until enough current patients are discharged. Abernethy said she did not know how long that would take.
Already, Dorothea Dix had stopped accepting forensic patients, or suspected criminals awaiting legal resolution, after a suspected murderer escaped in July and concerns were raised that the facility was not equipped to handle those patients.
In addition, nearly 150 people use outpatient services offered by Dorothea Dix. Those patients could look for care elsewhere, but Abernethy said it’s not as if those services are abundant in the local area.
Stevens said she has not been convinced that closing Dorothea Dix outright would save money, particularly when considering transportation costs, because the facility’s patients still need to go somewhere.
The future of Dorothea Dix has been up in the air for a while, but the discussion resumed once Gov. LePage took office and appointed Mayhew as DHHS commissioner. Both have stated publicly that they support the privatization of psychiatric care.
Still, when the 2012-13 budget passed, funding for Dorothea Dix remained level for the first year but, beginning in 2013, the annual budget would be reduced by $2.5 million.
Abernethy said that cut actually amounts to about $7 million because the state funds are used to leverage federal dollars. In all, if Dorothea Dix remains open, it will operate with a budget that’s 25 percent smaller than the current budget.
The other state-run psychiatric facility, Riverview Psychiatric Center in Augusta, is much newer, has more beds, with 92, and a broader mission. It was spared from budget cuts.
When the Dorothea Dix work group first met on Aug. 12, members were asked to state their general feelings about what should happen to Dorothea Dix. The prevailing sentiment was to keep it open, according to the minutes of that meeting.
In subsequent meetings, though, a rift emerged.
At a Sept. 9 session, the group took a straw poll vote. The options were to close Dorothea Dix, move it or merge it with another facility. Seven members voted to move the center. One voted to close and one to merge. Three voted to keep it open.
At the most recent session on Sept. 30, members of the work group were split into two subgroups: one to make the case for keeping the facility open, the other to outline steps needed to close it.
The work group will meet at least four more times, including a session scheduled for Friday, Oct. 14, during which the public will have an opportunity to comment.
Abernethy said she doesn’t have a sense of what will happen, but her hope is that the patients are not lost in the discussion about Dorothea Dix’s future.
“I can go get another job,” she said. “I’m not sure some of these people have anywhere else to go. We’re talking about some of the sickest people and we’re treating them like they’re disposable.”
At the work group’s Sept. 9 meeting, a handful of current or former patients of Dorothea Dix spoke about their experiences.
David Eldridge said he has been a consumer of psychiatric services for 13 or 14 years and has used nearly every service offered by Dorothea Dix. Currently, he is an outpatient. He said the hospital saved his life and many other lives and should stay open.
Ken Johnson said he has been a patient since 2004 and has spent time at Dorothea Dix as well as private facilities, such as Spring Harbor in Westbrook. He said the differences between the two types of psychiatric centers is stark and he much prefers the care at Dorothea Dix.
Similarly, Lonnie Gould has spent time in and out of psychiatric facilities for 20 years and said Dorothea Dix is the best.