For years, problems at the Riverview Psychiatric Center, a state-run facility in Augusta, have commanded our attention. Mistreatment of patients, reports of violence and a lack of appropriate staffing have plagued the facility and resulted in lost federal funding.
The hospital is home to patients with serious and persistent mental illness, including those charged with crimes but found not criminally responsible for their actions or incompetent to stand trial. These patients cannot be jailed, as they’ve not been convicted of a crime, but they also cannot be allowed back into the community until they have been rehabilitated.
In an effort to relieve the pressure inside Riverview, Gov. Paul LePage proposed a “step-down facility” for patients who no longer need the high-security environment of Riverview but who are not yet ready for release into the community.
The governor originally wanted to construct the unit alongside Riverview, a logical location given the staff and resources available there. However, his refusal to answer even basic questions about the new facility spurred the Legislature to reject his initial plan. Now, the governor hopes to build the new unit in Bangor where he argues he doesn’t need legislative approval — and thus doesn’t need to answer pesky questions about who will run this facility, who will pay for it, and whether it’s really a hospital or more like a jail.
The governor’s evasive action and refusal to be held accountable is muddying the water for what really matters: What’s best for these patients?
These are exceedingly difficult patients, carrying diagnoses such as bipolar disorder and schizophrenia. Riverview is the only forensic psychiatric treatment center in Maine that provides services for those who require a safe, secure involuntary setting for extended treatment and rehabilitation.
The care that these patients currently receive at Riverview recognizes that what they need is treatment, not punishment. This is a humane advancement; for most of our history, we have locked up the mentally ill indefinitely, leaving them to cycle in and out of jails, lost to themselves and a drain on our legal and medical systems. Thankfully, that time is gone. With medication, psychiatric treatment and ongoing support, a significant number of them can be rehabilitated and able to re-enter society.
They need understanding, compassion and a helping hand as they transition to the outside world. Currently their only option is continued hospitalization in Riverview, taking up beds that might be better used for sicker patients.
So I don’t dispute the need for a “step-down” unit. But compelling logic demands that it be built beside Riverview where ample space is available. As a doctor, I can tell you that whether an ailment is physical or mental, continuity of care is paramount, absolutely essential. The safety of both patients and our communities depends on the professionals who have come to know these patients over time. At Riverview, support structures are already in place and the staff already provides stability in many of their lives for the first time.
The governor’s decision to move ahead in Bangor, and his continued dodge about his plans for these patients, presents a real risk to their care and well-being. Running a psychiatric facility for forensic patients raises many, many questions. Will this facility be run by the state or by a private contractor? If the latter, how will the contractor be chosen? How will the cost of private operation compare with that of the state running the hospital, as it runs Riverview? What are planned staffing ratios? Who will make decisions about admission criteria and medication management – psychiatrists or administrators? How about costs?
The governor, who at one time promised that his administration would be the “most transparent ever,” has not answered these questions. Now, the City of Bangor is in the unenviable position of being asked to accept this facility without any real information about what will happen inside.
The people of our city deserve answers. After all, it’s entirely possible that when patients are released, they will end up on our streets and in our community. We need the input of mental health advocates, families, courts, law enforcement and other stakeholders to know what we’re getting into. How will the state help the city serve patients once they are released? What safeguards are in place to protect our security if problems arise?
There may yet be legal options available to ensure that Bangor is given the voice it deserves in considering the future of these patients. If you share my concerns, please join the Bangor City Council this Tuesday, Sept. 19, for a 5:30 p.m. workshop to consider our city’s options as the governor’s proposal moves forward.
Bangor can be a major asset in helping these patients, but we must have a seat at the table.
Geoff Gratwick, a retired physician, represents Bangor and Hermon in the Maine Senate.