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Critics Take Aim at Maine's New Forensic Patient Policy
09/30/2013   Reported By: A.J. Higgins

As state officials move forward with a plan to redirect some forensic patients from the Riverview psychiatric hospital to a mental health unit at the Maine State Prison, growing numbers of health care advocates are voicing criticism about the policy change. The new protocol was approved by lawmakers last month in an effort to help the state resolve federal compliance issues at Riverview. But as A.J. Higgins reports, forensic psychologists say that the prison does not meet the best practice standards needed to determine a person's mental competency.

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Beginning next year, those charged with crimes who are also seeking mental competency evaluations will be sent to the Maine State Prison's mental health unit rather than to a hospital setting, such as the Riverview Psychitaric Center in Augusta.

But Dr. Kim Gorgens, a forensic psychologist and professor at the University of Denver's Graduate School of Professional Psychology, says that's the wrong therapeutic setting for a psychological assessment. And she says it will make Maine an outlier. That's because most states treat those requiring psych evals for competency hearings in a hospital setting, not a correctional one.

"It's certainly in the minority of states," Gorgens says. "Most states have a forensic hospital system."

Lawmakers signed off on a plan supported by the state Department of Health and Human Services and Gov. Paul LePage as part of a policy to bring Riverview into compliance with the federal Centers for Medicare and Medicaid Services. The action was taken after a federal investigation uncovered insufficient safety measures to protect patients and staff.

Investigators were also critical of control and restraint methods used at the hospital, which also treats non-forensic patients. CMS has begun th eprocess to cut off $20 million in funding to the state. In response, the state has decertified 20 beds at the hospital and opened up a segregated forensic wing there.

In addition, the hospital will now send those seeking psychiatric evaluations to determine competency, and prisoners with mental health issues at the county jails, to the Maine State Prison's mental health unit. Gorgens says while Maine's response may provide a short-term solution, it may not meet patients' mental health needs and is far from ideal.

"To the degree that you want all of the elements of the environment to operate in the same direction - that is, to point someone as quickly as possible and support the restoration of mental health - then you really want all the pieces to work together well," Gorgens says. "And if one of those pieces is staying in a cell, for example, then it's working at cross purposes with the state's aim to restore competency."

"All this is doing, from my perspective, is treating mental illness as a crime," said Rep. Joe Brooks, a Winterport independent. Brooks was among the few lawmakers who objected to the change in policy. He says it's nothing less than an attempt to criminalize mental illness.

The American Civil Liberties Union of Maine also opposes the policy. Justice organizer Grainne Dunne calls it a band-aid effort whose end result will be to warehouse those with mental illness.

Jenna Mehnert, the new executive director of the Maine chapter of the National Alliance on Mental Illness agrees. She says even those in the state Corrections Department acknowledge the agency has neither the capacity nor the resources to operate a mental health hospital.

"Individuals whose mental illness is severe enough to need hospital level care need to get hospital level care," Mehnert says.

"I see nothing wrong with placing people for evaluation at the prison, in the prison plant, in a clinical setting," says Maine Attorney General Janet Mills. Mills takes issue with mental health and civil rights advocates' portrayal of the new policy.

Mills says several states, including Rhode Island, send those charged with criminal offenses and making mental competency claims to correctional facilities for treatment. The quality of the care, Mills says, is more important than where those services are being provided. She also points to New Hampshire as another state that performs its evaluations at a correctional facility.

But New Hampshire maintains a free-standing forensic unit on the grounds of its corrections department. And while it's not a hospital, it does allow for separation from the general prison inmate population. Maine Department of Health and Human Services Commissioner Mary Mayhew says the New Hampshire model also faces significant short-term hurdles.

"There are extensive costs associated with creating a free-standing facility that would have to be factored into that equation," Mayhew says. "As I've said, this is a system-wide issue that affects not just those within the criminal justice system, but it affects all those who are in need of in-patient psychiatric services."

Beginning in February, forensic patients who had been treated at Riverview will be sent to the new mental unit at the Maine State Prison in Warren. The ACLU of Maine will monitor those developments and has not ruled out a legal challenge to the new policy.


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