Mental health is a key indicator of a state’s overall well-being. Providing timely access to the appropriate level of psychiatric treatment in the appropriate setting for individuals living with a mental illness is a crucial and often difficult task.
An example of the challenge involved with meeting the needs of those living with a mental illness can be seen at Riverview Psychiatric Center in Augusta, operated by the Maine Department of Health and Human Services. Riverview houses forensic patients who have committed crimes for which they are deemed not criminally responsible because of their mental illness but are clinically stabilized. These individuals no longer require acute or long-term hospitalization, but they do not have court permission to be discharged back into the community. Boarding people at Riverview, who no longer need hospital level of care, presents a barrier to the state’s desire to receive re-certification by the U.S. Centers for Medicare and Medicaid Services.
The purpose of Riverview, much like the Dorothea Dix Psychiatric Center in Bangor, is to provide long-term, psychiatric inpatient hospitalization for the more chronically and severely mentally ill patients. Acadia Hospital, on the other hand, is licensed to provide short-term, acute psychiatric inpatient care. If a patient who qualifies for admission to Riverview can be transferred in a timely manner rather than occupy a bed at Acadia, then more Acadia bed days could be available to serve more people. Proper use of psychiatric beds in high demand at Riverview and Acadia would ensure that patients who require hospital level of care can receive the right treatment in the right setting at the right time.
There is a domino effect when Riverview is not able to accept patients. As the CEO of one of Maine’s two freestanding psychiatric hospitals, I see it firsthand when emergency departments struggle with caring for psychiatric patients who are waiting for admission to an appropriate facility. This also affects the emergency department’s ability to serve patients who are very ill. Frustration occurs when Acadia is at maximum inpatient capacity with limited access for other patients because there is no capacity at the state hospitals to accept patients.
One of the consequences of the deinstitutionalization of the mentally ill has been the elimination of state psychiatric hospital beds without putting in place alternative support services for the mentally ill. Riverview is boarding forensic patients who are utilizing beds that were intended for civil patients. A 2016 Treatment Advocacy Center survey of public mental health hospital capacity in all 50 states, plus the District of Columbia, found that Maine had 3.5 forensic beds per 100,000 people, compared with 5.5 nationally. Arguably, state-operated civil and psychiatric beds have been repurposed to meet forensic demand because of the underinvestment in public forensic beds in Maine.
A small step forward for Maine is a plan developed by DHHS staff to construct a 21-bed secure, forensic step-down facility on the Riverview campus that will provide rehabilitation services, similar to what is provided in community-based psychiatric step down programs. It is my understanding that this is not a prison facility. I believe DHHS intends to provide a recovery-based program designed to prepare forensic clients who do not require hospital level of care for reintegration into the community upon approval by the court.
In my view, the most compelling reason to move forward with this plan is that transitioning forensic patients who no longer need hospital level of care to a secure rehabilitation facility should allow more proper utilization of state and private psychiatric hospital beds in Maine. Based on information provided to date, I support this initiative being undertaken by DHHS in their pursuit of an alternative intended to improve access to services for those with mental illness in Maine.
Daniel Coffey is president and CEO of Acadia Hospital in Bangor. He also is a senior vice president of Eastern Maine Healthcare Systems.