AUGUSTA, Maine — Maine’s psychiatric hospital in Augusta is fully staffed for the first time in 20 years, though the state’s mental health system still faces challenges in housing patients in community settings and with staffing at a Bangor psychiatric facility that’s in a state of transition, according to a state watchdog.
The report filed Wednesday by former Maine Supreme Judicial Court Chief Justice Dan Wathen marked a milestone for the long-embattled Riverview Psychiatric Center and found that while Maine is making progress toward solving some problems with its mental health system, others remain.
The mental health system is largely governed by a 1990 consent decree that settled a lawsuit patients brought against the state motivated by overcrowding at the former Augusta Mental Health Institute, a lack of capacity in the community mental health system and other problems.
The consent decree is aimed at ensuring the availability of mental health services in the community so the state can lean on hospitalization as little as possible. Wathen has long been the courtmaster appointed to determine whether the state is complying with it.
The 92-bed Riverview opened in 2004. It was decertified by the federal government in 2013 for overcrowding, inadequate staffing and the use of stun guns by corrections officers in the hospital. It won recertification this year, but it had to repay $72 million to the federal government in Medicare and Medicaid money that hospital billed while it lacked its federal certification.
In recent years, Wathen has noted improvements at Riverview. He said in his Wednesday report that the facility is fully staffed and is operating at more than 90 percent of capacity without an “undue reliance” on overtime or mandated shifts. The use of confinement — including seclusion and the use of mechanical restraints — is at normal levels.
“Obviously, waitlists come and go, but they’re doing a very good job,” Wathen said in an interview.
Wathen raised concerns that two factors outside of Riverview’s walls, and outside the control of the facility’s employees, could get in the way of further improvement at the psychiatric facility.
A lack of capacity in the state’s system for caring for adults with intellectual and developmental disabilities has meant that those adults sometimes end up at Riverview following crisis situations. As of the end of May, more than 1,500 adults with intellectual disabilities who were eligible for housing in group homes were on a state waitlist for housing.
When people end up at Riverview for reasons that don’t primarily have to do with mental illness, Wathen notes in his report, it’s an inappropriate use of the state’s “scarce mental health treatment resources.” A shortage of community housing placements “is having a serious negative impact on the mental health system,” he also wrote.
In addition, according to Wathen, a shortage of staffing and leadership transitions at Dorothea Dix Psychiatric Center in Bangor could impede Riverview’s improvement, limiting the number of patients it could accept from Riverview. Wathen also noted that Riverview “urgently” should replace an antiquated electronic medical records system.
The former chief justice’s latest report on the state’s mental health system comes as he has started working with Gov. Janet Mills’ administration to wind down the consent decree and the outside oversight that goes with it. A bill in the Legislature that would put Maine on that path was carried over to the 2020 session earlier this year.