Maine proposals aim to house former forensic patients with MI

As Maine Gov. Paul LePage moves forward with plans to build a privately run, state psychiatric residence in Bangor without legislative approval, lawmakers have released their own proposal that calls for a residential, step-down facility in the Capitol Area of Augusta.  The executive and legislative proposals would house residents who have been ruled by the courts to not be responsible for their crimes due to a mental illness.

LePage has released a request for proposal (RFP) through the Maine Department of Health and Human Services (DHHS).  The RFP says the 21-bed building would be completed by March 2019, with a developer chosen by mid-August, according to local media reports.  A private operator would run the facility under a 10-year contract.  (Calls were not returned by the governor’s office.)

The House bill, L.D. 162, calls for the commissioner to operate and maintain a 21-bed residential forensic step-down facility in Augusta in the Capitol Area called the Riverview Forensic and Treatment and Rehabilitation Center to provide treatment and rehabilitation that continues the treatment of patients from a state mental health institution who would no longer require hospital-level service.

The legislation also creates an advisory committee to participate in and guide the planning process for the facility and to report to the Joint Standing Committee on Health and Human Services.  It authorizes the committee to report out a bill based on the advisory committee’s report.  It also requires the department to report to the committee on the progress of creating the facility and developing rules.

Simonne Maline, executive director at the Consumer Council System of Maine, a state-funded advocacy group for people with mental illness, said she welcomes the input of patients, staff, consumers and other stakeholders as part of an advisory committee.

“Our organization was written in statute,” Maline told MHW.  “We’re the voice for the consumer.”  The organization was created out of a consent decree issued in 2006 by the Maine DHHS in regard to a settlement agreement in Bates v. DHHS.

Maline notes that patient and staff input is vital to making up for mistakes made 12 years ago when the Riverview facility was built.  For example, at that time, hinges on the door were not correct, which posed a safety issue, she said.  “They had to replace every door in the hospital,” Maline said.  That could have been avoided if an advisory body was privy to what the new facility would look like, she said.

Maline noted that the 92-bed Riverview hospital had been decertified by the U.S. Centers for Medicare & Medicaid Services (CMS) in 2013.  Hospital forensic patients had no need for hospital care; however, the CMS was still funding the facility, Maline said.  “The federal government has asked for more than $50 million returned,” said Maline.  “The state has taken the money since 2013.”

Local news reports indicate that the CMS cited a number of deficiencies, such as the use of stun guns and pepper spray, the improper use of restraints and seclusion of patients, poor record-keeping and medication errors.

Consent decree

The consent decree plan, approved in 2006, describes the development and monitoring that the DHHS must undertake in its adult mental health services system to enable the DHHS to demonstrate substantial compliance with the settlement agreement in Bates v. DHHS.  The plan focuses on three major themes: providing flexibility, ensuring continuity and managing care, according to the DHHS.

One of the objectives of the plan is to “coordinate with community providers the timely transition into appropriate community placements of civil and forensic clients who no longer need hospitalization.”

Plans for the proposed facilities have been politicized, she said, and patients are becoming anxious.  Whether patients are able to move to Augusta or Bangor, the transition still has to be approved by the court, and it has to meet the requirements of the consent decree, said Maline.

More information needed

“We’re in a wait-and-see mode of what’s going to be proposed,” Mark Joyce, managing attorney for Disability Rights Maine, told MHW.  “When something is substantive, I’ll take a look,” said Joyce.  “Any facility that is built would have to be one that is community-based,” he said. “The judge is the final arbiter of where the former patients would reside.”

Joyce added, “There’s no real substance; the proposals haven’t come back yet.  Will the state run it?  Will it be run by a private party?”

Joyce said he doesn’t know if the bill will pass.  “We are still advocating for community resources so folks who don’t need care can still get out into the community with an appropriate court order,” he said.

Disability Rights of Maine does not represent individuals, said Joyce.  Rather, the organization represents class counsel for Riverview patients, whether forensic or civil, who have been in the hospital since 1990.  “We’re making sure their rights are protected on a systemic level,” he said.

Political differences

Democratic Rep. Drew Gattine said it’s time to put political differences aside, The Washington Times reported.  His bill would direct the state to operate and build the home near the Riverview Psychiatric Center in Augusta, as the LePage administration originally proposed. 

“There are people in the hospital who are actually success stories” following years of treatment, Gattine said.  “Some have recovered, some have been there for decades.  They have recovered to the point where they don’t need to be in a hospital anymore and could be treated in a lesser setting.”

Meanwhile, the federal government recently ordered Maine to repay $51 million spent on the center since it lost certification.  Gattine and LePage have said that building the facility could be a key step to addressing the CMS’s concerns about mixing psychiatric patients with residents who could live at the new secure home.

Reprinted with Permission

Source: Mental Health Weekly, Volume 27 Number 27, July 10, 2017