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Mental Health Care in Prison: Maine Bill Seeks Solution
05/13/2013   Reported By: Patty B. Wight

The number of Maine inmates who are court-ordered to receive mental health treatment is growing, but the state's psychiatric hospitals don't have enough capacity to meet the demand. A proposed bill seeks to alleviate the bottleneck by providing mental health care within the walls of the Maine State Prison in Warren. Supporters call it an innovative solution to the lack of pyschiatric beds in the state, but opponents are waving red flags. Patty Wight reports.

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Mary Louise McEwen, the superintendent of Riverview - the state mental hospital in Augusta - says she's concerned by what she's observed over the past few years. It used to be that half of Riverview's patients were civilian, half forensic - or criminal. Now, she says, two-thirds of the patients are forensic, and there are still more in line to be admitted. But the existing patients are challenging - they caused 65 injuries to staff last year.

"Riverview does not have the same tools as corrections facilities to manage aggressive, assaultive and violent behavior," McEwen testified. "And this behavior has seriously injured hospital staff, causing them to be out of work for long periods of time - and, in some cases, out of this line of work forever."

With Riverview's hands already full, the Department of Corrections, or DOC, is forced to hold forensic inmates for days, weeks, or months, even when there's a court-order that they receive treatment.

But Gov. Paul LePage thinks he has a solution to this problem: He's supporting a bill that would allow treatment for forensic patients at the Maine State Prison. It's sponsored by Republican Rep. Richard Malaby, who presented it to the Criminal Justice and Public Safety Committee on Monday.

"The DOC provides space, security, and correctional officers, and the Riverview Psychiatric Center will provide mental health staff, programming, and services," he said.

Basically, the bill brings a miniature Riverview into the Maine State Prison, which has the capacity for 32 forensic patient beds. It sounds like a win-win, especially to organizations like the Maine Hospital Association and the Consumer Council System of Maine, which advocates for consumers of mental health services. Spokesperson Charlie Ames sees two major benefits:

"One is to help people in the criminal justice system to get the treatment and evaluation they need. And the second is to restore the civil beds that are desperately needed and have been shrinking with the overflow of forensic bed use in the hospital."

But the devil's in the details with a plan like this, and both the Maine ACLU, and Helen Bailey of the Disability Rights Center, say one provision in particular is worrisome. It allows involuntary medication of a forensic patient, which, Bailey says, paves the way for abuse.

"I'm concerned about that because I think that's how I think anti-psychotics are used anyway," she said.

Though the bill stipulates involuntary medicating can only be done in emergency situations, Bailey says the language is vague enough to justify it in nearly any situation.

"I think prescription practice in a correctional setting is going to have the potential for worse abuses," she said, "because we that know individuals in corrections centers have behavioral issues - at least, they were not able to conform their behavior to the law."

Bailey says there's no doubt there's a severe lack of access to adequate mental health treatment in Maine. Just last week she testified on a bill that would increase the number of psychiatric beds in the state. But she sees these proposals in front of lawmakers as short-term fixes, and says there needs to be more intervention at the community level.

Still, once the hearing was over, both supporters and opponents of the bill agreed to meet to craft a version they can all support - and put at least a small dent in the problem of mental health treatment in Maine.



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