The Riverview Psychiatric Center is so understaffed that it has stopped admitting patients, leaving them to be housed in jails and hospital emergency rooms. Not only is this inhumane, it violates a decades-old consent decree, according to the retired Maine Supreme Court Judge who oversees the Augusta facility’s compliance with the decree.
Riverview needs to hire more staff to care for the patients it currently has and those who should be admitted there, Judge Daniel Wathen wrote in an April 24 recommendation to the Kennebec County Superior Court. To do this, it needs approval of more funding from the Legislature. But, as happened last year, Riverview has become a political football, with Republicans and Democrats blaming each other for the ongoing problems there. Politics must be set aside so the focus is on serving and treating the people who live there along with ensuring the safety of those who work there.
Lawmakers have agreed to a boost in spending at Riverview in the supplemental budget, but that would only carry the hospital through the end of June, so the Department of Health and Human Services hasn’t begun hiring the needed additional staff.
Along with the funding, the Legislature required monthly reports on the situation at Riverview. But Gov. Paul LePage did not sign the supplemental budget, despite sending a threatening letter to the Democratic leaders on the Health and Human Services Committee telling them that approving the additional funding “is the best thing you could do to help improve the situation at Riverview.” The lack of LePage’s signature delayed its implementation, and the first report on Riverview has already been missed.
In his proposed two-year budget, LePage included $5.8 million in each of the next two fiscal years to keep Riverview in compliance with the consent decree. That funding was not approved by the HHS Committee due to a disagreement about what type of staff should be hired, and it has yet to be approved by the Appropriations Committee, the final arbiter of state funding decisions.
DHHS is strongly advocating for this funding, as it should. And recent history shows that the Legislature has approved every Riverview-related request made by the department, so it should begin the hiring process. Since 2013, lawmakers have approved three emergency funding requests totalling $4.3 million.
As has been the case for decades, the problems at Riverview (previously the Augusta Mental Health Institute) go well beyond funding. Riverview lost its certification from the federal Centers for Medicaid and Medicare Services in September 2013 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.
Beyond this, the facility must fulfill a 1990 agreement, the AMHI consent decree, which settled a class-action lawsuit by patients at the facility 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, now called Dorothea Dix Psychiatric Center, which has been dramatically downsized) while continuing to shift more patient care to community settings.
A November 2014 report requested by Wathen highlighted basic, continuing problems at Riverview. For example, the center remains short-staffed, and the staff lack a basic understanding of its “recovery model,” which governs treatment, the report said.
In its request for additional funding for Riverview as part of the biennial budget, the LePage administration focused on increased staffing with mention of improved staff training and safety improvements such as more surveillance cameras and more shatterproof windows.
These are likely important changes, but it is abundantly clear that a renewed commitment from lawmakers and DHHS is needed to end the crisis-to-crisis management of Riverview.