When it was set to open in 2004, the Department of Health and Human Services boasted that “the new facility, Riverview Psychiatric Recovery Center, will offer a state-of-the-art treatment environment that supports healing, respect, and safety.”
How, a decade later, has Riverview failed not only to live up to expectations, but not even meet basic standards for accreditation? The Centers for Medicare and Medicaid Services pulled Riverview’s federal accreditation in 2013 for reasons that included overcrowding, inadequate staffing and using handcuffs and Tasers to subdue violent patients. The state lost $20 million in annual federal funding with the loss of accreditation.
The situation is so bad, the LePage administration says, the only solution is to open a new facility, just for forensic patients — those found not criminally responsible for crimes they have committed and sentenced to a mental health facility rather than jail.
Creating a de facto jail, which putting all forensic patients into one facility would do, is the wrong approach.
The department, in part because of how federal funding is allocated, is wrongly focused on lumping patients into groups based on how they came to Riverview, rather than based on what services they need while at the Augusta facility.
“The decision [on where to place patients] should be based on their illness and behavior, not what they did to get to Riverview,” Jenna Mehnert, executive director of NAMI-Maine, told the BDN.
There is a perception that all forensic patients are violent and dangerous to staff and one another, which is not true. Similarly, not all civil patients are docile, and some can be more violent than forensic patients.
But forensic patients present unique challenges for mental health facility managers. The managers often don’t know they are coming and can’t plan for their arrival. Then, their departure is decided by a court. In addition, judicial standards for admittance and release differ from medical standards.
Moving Maine’s forensic clients to a new facility, especially if it is under the supervision of the Department of Corrections, rather than DHHS, would relieve the state of a major burden and would make it easier for Riverview to regain accreditation. Correctional requirements are easier to meet than those of CMS.
But that doesn’t mean it is the right thing to do, especially from a treatment and recovery perspective. Plus, it would likely cost the state more money.
Daniel Wathen, the retired Maine Supreme Court justice who oversees Riverview as part of a court-ordered consent decree with its predecessor, the Augusta Mental Health Institute, said he does not object to a new state facility, as long as it meets a hospital, not prison, level of care. Mental health advocate Mehnert agrees.
But erecting an entirely new facility sounds a lot like duplicating what Riverview is already supposed to be doing.
St. Elizabeths Hospital in Washington, D.C., which was once so badly managed it was placed under federal control, is now viewed as a national model of mental health treatment. A key element of its new approach is combining forensic and civil patients
Patrick Canavan, who had previously worked at St. Elizabeths, was asked by the city’s mayor to take over management of the facility in 2007, after it had been placed under federal oversight due to patient civil rights violations, unsafe conditions and the overuse of restraints and seclusion. One of Canavan’s first goals was to mix forensic and civil patients. Dubbed the “one hospital” policy, it was based on grouping patients with similar treatment needs, regardless of their path to the facility. Patients are either placed in intensive or transitional housing based on their treatment needs and plans. John Hinckley Jr., who shot former President Ronald Reagan, lives in the transitional housing unit.
“My philosophy is we’re a psychiatric hospital. We’re not a jail or a prison. Clinically, I want people with more intensive needs to be housed together,” he told the American Psychological Association in 2012.
Maine should not essentially create a mental health prison for its forensic patients. It should instead focus on fixing the problems at Riverview so the hospital can regain accreditation and better care for its patients based on their treatment needs, not how they entered the facility’s doors.