October 1st, 2013

Bill authorizes on-site behavioral health treatment at prison

When legislators from Maine toured the Riverview Psychiatric Center (RPC) in Augusta, as they do every two years, they witnessed firsthand a dangerous situation that promises to get worse. To address the problem, “An Act to Increase the Availability of Mental Health Services” (LD1515/HP1087) was introduced to the legislature this past April.

Mary Louise McEwen, BSN, MBA, Riverview’s superintendent reports that the facility, which comprises 44 forensic and 48 civil beds, has experienced a tremendous jump in referrals. “The non-criminally responsible population has steadily grown in the last 10 to 12 years. We have a net gain of five patients every year,” she says. “We only have 44 [forensic] beds and we’re reaching a critical mass.”

Moreover, state statute allows patients to stay at Riverview for as many as 365 days, which restricts the number of short-term referrals the facility can accept. When appropriate, other hospitals have accepted patients who have not committed major crimes, according to McEwen, which offers some relief.

This overcrowding has led to a significant increase in physical harm to staff and patients. “In 2012, there were 65 injuries as a result of forensic clients. We’ve had psychotic patients who have no recollection of the violence. Some have dementia, but those who come from the correctional facility and intentionally assault have Axis II personality disorders and are difficult to manage,” says McEwen. “The treatment milieu is impacted if someone assaults others. Unfortunately, with 54 forensic patients there is some overflow to the civil side. We screen carefully, but it’s a challenge.”

McEwen notes that another major concern is the possibility of escape. If someone commits a heinous crime and is referred to Riverview, the lack of prison cells would not prevent patients from leaving the facility. McEwen says, “We would rather they go to prison.”

These factors in combination became the impetus to make some changes, according to McEwen. The proposed arrangement would utilize pre-existing space at the prison in Warren. “Staff there would be supervised by Riverview, almost like a fifth unit. There would be the same level of staffing: psychiatrists and psychologists, a social worker, recreation therapist and nurses,” she says.

As a first step, Gov. Paul R. LePage asked Rep. Richard Malaby (R-Hancock) to sponsor the bill, which was originally filed on May 13, 2013. Although the bill has gotten support from many groups, including the Sheriff’s Association, the Maine Hospital Association and the National Alliance on Mental Illness (NAMI), not everyone was pleased with the original language. The ACLU objected on the grounds that the prison would have license to administer medication at will.

Malaby says, “The language was changed to mimic the wording on the civil side of the law to the satisfaction of all. The committee saw the amendment and passed it unanimously.”

One of the biggest stumbling blocks though is a fiscal note of $3.3 million/year to finance the project, Malaby points out. “It’s a governor’s bill and I don’t know if he will be able to fund it.”

The plan makes sense to Malaby who says that the prison has two 16-bed units, but only two to four prisoners are there at any given time, usually for medical reasons. “If we devote that space to psychiatric patients, we could accommodate 30+ people,” he adds. “This has been a brilliant collaborative effort [between the Department of Corrections and Riverview]. It might not be a long term solution, but it’s a good start.”

The last action on the bill took place July 9 and 10 in the House and Senate, respectively. “We should vote on it in the fall for fiscal year 2014,” Malaby says. “The program would start July next year.”

By Phyllis Hanlon

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