When Riverview Psychiatric Center lost federal Centers for Medicare and Medicaid Services certification and funding in 2013, the adequacy of our institutionally and community-based behavioral-mental health services came under a dark cloud of lack of credibility. The erosion of financial and clinical support in the community – made worse by the backup in outplacement from Riverview – has resulted in many individuals winding up in the county jail system for lack of alternatives. And although it was announced Friday that Riverview has regained certification, it will take time to make up lost ground.
The topic of mental illness in the county jails was depicted in a December Portland Press Herald article, “Attorney files motion for contempt against Maine DHHS commissioner,” demonstrating what has been a continual problem for Maine’s jails: the state of Maine’s limited resources for the mentally ill.
In January 2014, Cumberland County Sheriff Kevin Joyce authored an op-ed for the Press Herald called “Inmate mental illness – an issue of supply and demand.” Unfortunately, though this was published five years ago, it remains a problem. It is estimated that nearly 70 percent of all inmates nationwide have both mental illness and substance use disorders. So this is not just a Maine issue. However, resources in Maine to provide mental health services to everyone who needs assistance are extremely limited.
Here is one of the major problems. Riverview Psychiatric Center in Augusta and Dorothea Dix Psychiatric Center in Bangor are the only Maine mental health facilities with designated forensic beds: that is, beds for inmates. All correctional facilities in the state must rely exclusively on Riverview and Dorothea Dix for their critical mental health care and court-ordered competency exams. There are a limited number of forensic beds, yet the demand for those few beds far exceeds the number available. The few forensic beds that exist are often occupied by inmates who have been ordered to undergo a “competency to stand trial” exam. Furthermore, a typical competency exam can take 30 to 60 days to complete, causing the turnover for the limited number of beds to be quite slow.
In 2014, at the suggestion of Sheriff Joyce, I submitted legislation that would have been a temporary solution. The Cumberland County Jail currently has two empty pods that could be utilized to hold and conduct competency exams for those inmates throughout Maine who are in jail and on a waiting list for a court-ordered competency exam.
This target population consists of inmates who have not necessarily exhibited behaviors inclined toward violence or are a danger to themselves. However, these inmates have been designated by the court to undergo specialized testing and observation periods to determine their competency to stand trial and/or to determine whether or not they knew what they were doing when they committed the crime with which they are being charged.
By utilizing the Cumberland County Jail as a temporary location to conduct statewide competency exams, all of the inmates who require court-ordered competency exams could be transferred to a therapeutic unit at the Cumberland County Jail. This would reduce the pressure on Riverview so that they could care for the inmates who do have serious mental health issues and who are in need of immediate medical and mental health treatment.
While my 2014 proposal was not approved, Sheriff Joyce has continued to keep alive the idea with his contacts at the Maine Department of Health and Human Services. The therapeutic unit would be staffed with mental health professionals and state forensic examiners who would conduct the court-ordered exams at the jail. The cost of operating this specialized unit would be funded not by the citizens of Cumberland County but through the DHHS as a part of their oversight responsibilities related to Riverview.
In response to this issue, I have submitted L.D. 239, a bill that would direct the DHHS and the Cumberland County Sheriff’s Office to sit down and work out the details regarding how to turn this concept into a reality.
It is a new era for our administration in Augusta, and perhaps it may be a new day for those who have been waiting – many months, for some – to get a fair resolution to their cases. Let’s hope so.
Send questions/comments to the editors.
