The state has an obligation to care for residents who suffer from serious, persistent mental illness. When that illness causes a person to act out in violent ways, it may complicate the obligation, but in no way does it lessen it.

So with other options available for dealing with the most challenging patients at Riverview Psychiatric Center, it is curious that Gov. LePage would choose one that certainly puts the level of care for those patients at risk, and possibly both abdicates the state’s obligation and violates the patients’ constitutional rights.

Where to house people with mental illness who act out in violent ways has been a matter of debate at the state level for over two years. sfam_photo/Shutterstock.com

The governor’s plan to move those patients to the mental health unit at Maine State Prison has been rejected once by the Legislature, and lawmakers should reject it again. Patients, regardless of the trouble they cause as a result of their illness, should be in hospitals, not prisons.

The disposition of this small number of patients has been a matter of debate for more than two years as state officials have worked to improve conditions at Riverview, which has been beset by staffing and safety issues.

Like other forensic patients at the flagship state psychiatric hospital, they have been found incompetent to stand trial or not criminally responsible by reason of insanity.

In addition, a very few exhibit frequent violent behaviors, putting them at risk to themselves, staff members and other patients. That disrupts treatment across the entire hospital and makes it a difficult place to work at a time when Riverview must attract new nurses and mental health providers. It also ties up beds and other resources, which creates a logjam of people who require care, many of whom wind up in county jails or hospital emergency departments.

(Not all problem patients at Riverview, however, are forensic; thus, not all would be covered under this proposal.)

The 32-bed unit at the prison in Warren, as proposed in 2013, would have housed the most challenging patients, but now it serves as a treatment facility solely for prisoners whose mental illness makes them a liability in the general population.

The proposal was changed then for the same reason it should be shelved now: Prisons are for prisoners, and are concerned ultimately with issues of security and behavioral management.

People who have not been found guilty of any crime, on the other hand, should be in a hospital, where the focus is on the individual’s treatment. Their illness compels them to commit acts of aggression that would otherwise be considered crimes, but they are not criminals, morally or legally.

In short, they belong under the care of the Department of Health and Human Services, not in the custody of the Department of Corrections.

That doesn’t mean that the backlog of patients shouldn’t be erased, or that the safety concerns at Riverview aren’t real.

A small, separate, treatment-focused facility for only these patients, operated by the DHHS, could work.

So could a similar proposal to create such a facility in empty space at either the Somerset or Cumberland county jail – as long as it is set apart in all ways from the jail operations, and under the control of the DHHS, not the DOC.

Along the same lines, a facility could be part of LePage’s as-yet-undetailed plan for renovating the Maine Correctional Center campus in Windham.

Or Riverview could be reconfigured to better handle these patients, which is part of the hospital’s mission in the first place.

Each of those could satisfy the goal of placing challenging patients in a therapeutic and secure setting, and lessening the pressures at Riverview, and each would do it without turning patients into prisoners.

Related Stories