March 1st, 2016

Some Riverview patients could be placed in prison unit

Certain Riverview Psychiatric Recovery Center patients determined not criminally responsible and incompetent to stand trial could be placed in the Intensive Mental Health Unit (IMHU) at the Maine State Prison.

Under legislation introduced in February, that situation would occur when deemed necessary to maintain the safety of patients and staff and to meet the treatment needs of those forensic patients.

The bill (LD 1577), submitted by Gov. Paul LePage, (R), has raised concerns among mental health advocates.

“This is the best example I could dream up of criminalizing mental illness,” said Jenna Mehnert, MSW, NAMI Maine’s executive director.

Mehnert said she supports the unit’s creation, for people who have been found criminally responsible for a crime. “But clearly, taking folks that are not criminally responsible as determined by a judge and placing them in Maine state prison is incredibly problematic as a concept,” Mehnert said. “These are people who have been found not guilty of committing any crime, but because of the severity of their illness, we’re now going to incarcerate those who are harder to work with? It just doesn’t make sense.”

State officials say the plan would help put Riverview back on track for federal certification. Riverview lost certification in 2013. Department of Health & Human Services (DHHS) Commissioner Mary Mayhew says one of the concerns raised by the federal Centers for Medicare and Medicaid Services was around the safety of hospital patients and staff.

Mayhew said Riverview has struggled with a small number of forensic patients (those referred from the criminal justice system for a variety of reasons including being deemed not competent to stand trial or not criminally responsible because of a mental illness) whose needs exceed what the hospital can provide and who pose a safety threat. The IMHU would offer another option for their care.

“We’ve got to make sure that Riverview can function as a hospital, that it can effectively meet the needs of patients at the hospital, that we can protect patients and staff and provide a safe environment for their care and their treatment,” Mayhew said.

Regarding the problems at Riverview, Elise Magnuson, Psy.D., LCSW, president of the Maine Psychological Association, said, “That’s always a big concern – you want people who are providing care to be safe.

“At the same time – we’re concerned that by moving patients from a hospital to a prison system, that the prison system is going to influence the care that’s given at the hospital,” Magnuson said. “It all depends on who runs it and what their philosophy and their goals are. And in the prison, one of your goals has to be safety. In a hospital, your goal should be taking care of your patients. It’s the difference between being an inmate and a patient.”

Magnuson is also concerned about the perception of the criminalization of mentally ill people. “They’ve not been convicted of a crime and are being held in a prison system,” Magnuson said.

The IMHU unit was created in 2013 by the Department of Corrections and thus far has been primarily serving individuals who are in the county jail in need of mental health services. But if a patient at Riverview commits an assault and is charged with a crime, they can be sent to the IMHU.

“The reason I introduced this bill is I don’t want to wait until something very tragic occurs until we have the right structure in place,” Mayhew said.

Mayhew said if the legislation is implemented, a panel would decide if a patient should be transferred from Riverview, based on their clinical needs and the level of safety risk that they present. The patients will remain under the care and custody of the DHHS, she said.

Mehnert said she understands that the issues at Riverview need to be resolved. “The underlying issue needs to be addressed of how to treat individuals in a treatment setting best for all parties involved, but it’s a cop out that we’ll just use prison,” Mehnert said. “It’s just not fair or appropriate or legally sound or morally right. On so many levels, it sends the wrong message.”

Mehnert said she’d like to see better staffing levels at Riverview, or explore the staffing of a small unit that is part of Riverview to be designated for forensic patients and offer hospital-level care.

“We just don’t support that any part of that continuum can be prison for people who have not been found guilty of any crime,” Mehnert said. “It’s a simplistic answer to a complicated problem.”

By Pamela Berard

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