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Dorothea Dix Psychiatric Center Treating Mentally Ill Patients For More Than A Century
12/27/2013   Reported By: Patty B. Wight
Dorothea Dix Psychiatric Center

It was more than a century ago that Dorothea Dix Psychiatric Center opened its doors, a brick, mansion-like building perched on a hill overlooking Bangor. Its one of two state psychiatric hospitals that offer long term mental health treatment, and was named for a Civil War nurse and activist from Maine who worked to improve the lives of people with mental illness. As part of our series Mental Blocks, Patty Wight explored some of the challenges the hospital faces in carrying out its mission to improve the lives of its patients.

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Dorothea Dix Psychiatric Center Listen
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Dorothea Dix Rec Center

Above is the recreation room in the Dorothea Dix Psychiatric Center in Bangor.

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Only about 50 patients are treated at a time here, but to move through the building's seemingly endless supply of locked doors, it takes a lot of keys.

"Oh, 1, 2, 3, 4, 5, 6, 7, 8, 9. I have nine. And I'm only the librarian," said Ruth Mare. She has worked at Dorothea Dix for 13 years after working in a high school. "I'm not an important person here!"

"I came here and found it easier to deal with the patients than the high school students," she said. "High school kids are pretty bad these days." Patty Wight: "What was the difference?" Ruth Mare: "Well, the patients are a lot more polite."

Patients here struggle with severe mental health problems. They typically come here by way of a private psychiatric hospital, such as Spring Harbor or Acadia, when short-term treatment hasn't brought significant improvement. Medical Director Michelle Gardner said most of the patients at Dorothea Dix arrive involuntarily, through a court process.

"At Dorothea Dix, we treat patients primarily with schizophrenia," Gardner said. "50% of whom don't have insight into the fact that they have mental illness. So by nature of that, they don't see the need to take medications and engage in treatment."

And It can be a challenging population to work with, as evidenced by the need for certain structural renovations. Librarian Ruth Mare opens the door to a newly refurbished unit, which she said had been damaged by violent patients.

"They broke a lot of the door frames and doors, so they had to do quite a lot of work in here," said Mare.

The unit looks like a combination of hospital and dorm, with A nursing station to oversee patient rooms, and a common area with new chairs.

"They're all plastic, and they're weighted," Mare said.
PW: "And are they plastic because you can't break them like wood?" RM: "Hopefully."

An average stay at Dorothea Dix is about 80 days, and that allows time for medications to take effect and for staff to fully understand the needs of individual patients.

"They're on the floor with patients," said Mare. "They're talking to patients, they're sitting at tables talking to patients. And they're not scared of patients."

Dorothea Dix Lounge areaSuperintendent Sharon Sprague said some staffers have been at Dorothea Dix for 25 years. Some patients have also been here for years waiting for discharge Sprague said there's been a major gap in supported apartments in the Bangor area ever since funding cuts a few years ago.

"And they were very simple, they were supported apartments where staff was on site," Sprague said. "So if somebody got afraid in the middle of the night, and if that's when they heard voices, or that's when they struggled the most, they had a staff person elsewhere in the building on site that they knew that they could talk to."

But what's particularly frustrating for Medical Director Michelle Gardner is when staff create a good discharge plan for a patient, but it backfires.

"It's incredibly difficult for us and for the person that we're treating, when we've worked so hard to understand the patient as an individual, and what their hopes and dreams are, and we've worked to establish a treatment regimen that works, and we discharge them to the community, and it falls apart," said Gardner.

Gardner said there isn't enough high-level clinical expertise at the community level, and the mental health system in general is fragmented. But there are also challenges within Dorothea Dix. A few years ago, the legislature established a working group to decide how to redirect $2.5 million of the hospital's budget into the community. But the group couldn't reach an agreement, so effective 2013, the money was cut and not redirected elsewhere. It took with it $3.5 million in federal matching funds, in all, one-quarter of Dorothea Dix's budget. The hospital is licensed for 100 beds, but now only has staff for about 50. Superintendent Sharon Sprague said even though there is a wait list, at least two to four patients at a time, the cuts have been manageable.

"If you look at mental health statistics we offer a lot of mental health services per capita," Sprague. "Maine offers a lot per capita. So it seems to me that it isn't more money, it's all of us managing our resources more efficiently and effectively."

"I respect the fact that she is under the Administration of the Commissioner of the Department of Health and Human Services that advocated for and supported this cut," said Joe Baldacci, a Bangor City Councilor and Co-chair of an advisory committee for Dorothea Dix. He said the previous superintendent, who left in 2012, had a different take.

"When they cut came down, she told me point blank they were operating by the skin of their teeth," he said.

Despite a shrinking budget, Medical Director Michelle Gardner said Dorothea Dix is still strong at its core.

"Our clinical mission, we are the holders of the hope for those with serious and persistent mental illness," she said. "Because there is a huge stigma, and they can be very disenfranchised, and we need to infuse them with hope that their lives can be better, because this is a very debilitating illness."

And it's this mission, said Gardner, that ensures staff at Dorothea Dix strive not only treat mental illness, but also improve a patient's quality of life.

 

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