With the election over, state leaders can return their attention to pressing state problems. The Riverview Psychiatric Center in Augusta must be near the top of the list.
A new report, requested by Daniel Wathen, the retired Maine Supreme Court Chief Justice who oversees a consent decree that governs the hospital, highlights basic, continuing problems. For example, the center remains short staffed and the staff lack a basic understanding of its “recovery model,” which governs treatment.
A key area for lawmakers to address, Wathen said Thursday, is to increase funding so Riverview can hire more staff. The severity and complexity of mental health problems faced by Riverview clients have increased, as Wathen noted in a report to lawmakers last month. As a result, staffing should be based on patient acuity, not just the number of patients. In addition, specially trained staff should be devoted to the units with patients with the most needs. Wathen also recommends consideration of premium pay for these staff members.
These recommendations should quickly get attention when the Legislature convenes in January. Before then, administrators at Riverview and within the Department of Health and Human Services must ensure progress is being made in getting the facility to meet standards.
Riverview lost its certification from the federal Centers for Medicaid and Medicare Services in September 2013. The decertification was due to a range of issues, the most serious of which involved the use of Tasers and restraints on patients. Riverview houses both civilian patients and those referred for treatment by the Department of Corrections and judicial system, many of whom were involved in violent crimes, but found not responsible because of mental illness.
The decertification could eliminate $20 million in annual federal funding if legal challenges by the state are unsuccessful, complicating Maine’s ability to provide the increased funding Wathen recommends.
Beyond this, the facility must fulfill a 1990 agreement, the AMHI consent decree, which settled a class-action lawsuit by patients at the Augusta Mental Health Institute after several deaths at the state-run facility. The decree called for improving services and reducing the number of patients at the state’s two mental health hospitals (the other being the Bangor Mental Health Institute, which has been dramatically downsized) while continuing to shift more patient care to community settings.
As part of his work ensuring the state complies with the consent decree, Wathen had Elizabeth Jones, who was appointed to run AMHI for about a year in 2004, visit the hospital for three days in early October.
“There is sufficient reason to question whether the state is in compliance with the consent decree provisions regarding individualized treatment and adequate staffing,” Jones wrote in her report. While Jones praised staff for much of their work, she noted that not all fully understood the center’s “recovery model,” an approach that emphasizes individualized treatment and having patients fully understand and take responsibility for their actions. Instead, Jones found an overreliance on seclusion and restraint without full consideration of alternatives.
Wathen was encouraged that some corrective steps have already been taken. A unit for some of the facility’s most difficult patients was previously segregated from the rest of Riverview, and patients were not allowed to access the cafeteria and exercise facilities. This week, that unit was reintegrated with the rest of the facility, as Jones had recommended.
It is encouraging that improvements have been made. But, to ensure compliance with the consent decree and regain federal accreditation — and best serve patients and staff — work remains to be done at Riverview. Lawmakers must add their oversight and support to these efforts.