AUGUSTA, Maine — The courtmaster who oversees the state’s administration of mental health services said the need for a forensic psychiatric unit that is under debate by lawmakers and Gov. Paul LePage is “evident and urgent.”
Former Maine Supreme Judicial Court Chief Justice Daniel Wathen wrote in his latest progress report that the state is making progress at Riverview Psychiatric Center in Augusta and in other community mental health facilities but that more work remains.
Wathen’s progress report, which covers March and November of this year, is part of his duties as the court-appointed overseer of the AMHI Consent Decree, an agreement that resulted from a class action suit filed by families of patients of the former Augusta Mental Health Institute. The consent decree identifies parameters the state must meet in administering the mental health system.
Wathen urged quick action on a proposal to build a forensic mental health “step-down” unit for patients in state custody because of court orders who don’t require hospital-level care but said he is watching developments on that front closely.
“The need for increased capacity at Riverview remains evident and urgent,” wrote Wathen. “If plans for the new facility progress, it will be necessary to insure that the operator is bound by the relevant provisions of the consent decree, that the rights and protections are afforded clients are honored and that adequate access and reporting is afforded to ensure compliance.”
Wathen has been critical of the state’s handling at Riverview in the past. In February 2016, he ordered a series of immediate staffing changes in a filing in Kennebec County Superior Court. In June of this year, he criticized Gov. Paul LePage’s stated implementation of a hiring freeze — though LePage later denied there was any hiring freeze — because Wathen feared staffing shortages would unravel months of progress.
Wathen’s latest progress report was much more positive, though not without reservations. He said the situation has improved since the resignations of Riverview’s superintendent and clinical director in April 2016.
“Since that time, the hospital has undergone significant changes in major areas of its operations, with many changes still underway and other planned for the future,” wrote Wathen. “Most if not all of the changes, such as a new work schedule for direct care workers, have resulted in improvement.”
Wathen’s report comes as a dispute between legislative leaders and the LePage administration about the creation of a forensic unit on the Riverview grounds rages. LePage has attempted to bypass legislative approval to build the facility with funding in the Department of Health and Human Services budget, and have it run by a private company. But lawmakers — led by House Speaker Sara Gideon of Freeport — have blocked that effort and called for legislative review of the proposal.
Wathen told the Bangor Daily News last week that he has been fully briefed about LePage’s proposal and is satisfied, for now, that it conforms to the consent decree.
In his report released Tuesday, Wathen said vacancies in acuity specialists and mental health workers at Riverview have been “virtually eliminated” and that the use of forced overtime, which he had criticized in the past, has been reduced. He also hailed “meaningful improvement” in the use of seclusion and restraint at the hospital.
Wathen said vacancies in nursing positions remain a problem, despite the pay scale for those positions being increased earlier this year and a subsequent recruitment and advertising campaign.
Wathen said one problem is the existence of waitlists, particularly for forensic clients, that have averaged around nine in recent months. The patients on that waitlist have been kept in jail or housed at Dorothea Dix Psychiatric Center in Bangor.
Wathen also oversees Maine’s community mental health system. He said the waitlist for MaineCare and grant-funded clients, which stood at 610 patients at the beginning of 2015, plummeted to 135 as of September of this year. In that same time span, the number of clients who waited more than 60 days for treatment was reduced from more than 150 to fewer than 10.
“By way of summary, I would observe that Maine’s mental health system remains challenged but the last several months have produced encouraging signs of improvement,” wrote Wathen. “The parties and I are focused on the steps necessary to achieve compliance both at Riverview and in the community mental health system.”