Sunday, March 9, 2014
By Dr. Joseph Fitzpatrick
AUGUSTA — About a year ago, talks on how best to care for aggressive mentally ill patients in Maine were under way in the Legislature, Riverview Psychiatric Center, the Governor’s Office, news outlets and the departments of Health and Human Services and Corrections.
Dr. Joseph Fitzpatrick is associate commissioner of the Maine Department of Corrections in Augusta.
The basics: Riverview was providing mental health services to individuals with psychiatric needs. Some patients at Riverview present a level of aggression beyond Riverview’s management capability. The Maine State Prison’s Mental Health Unit could manage aggressive behavior but was unable, by law, to provide such patients intensive mental health services necessary, given the need of the patient population.
Result: a new Maine law and an Intensive Mental Health Unit that opened Feb. 15 at the state prison. It is useful, I think, to describe the new unit’s mission and function.
The unit bridges the treatment divide between Riverview and the state prison. It allows county jails a potential place to place prisoners even if they can’t get prisoners into Riverview. The 15 to 20 Intensive Mental Health Unit beds will most likely house county prisoners. Individuals will have access to medications and treatment they might not have in county jails. I’ve met with the county jails and they’re excited about the resource as a major step forward.
The unit’s mission: stabilize patients and allow them to safely return to county jails. Admission to the unit is not just about mental illness. Patients must meet Riverview’s admission criteria and be individuals Riverview can’t manage. The unit referral process is a treatment and management safeguard that works this way:
A county jail with an unmanageable, very mentally ill prisoner makes a referral to Riverview. Riverview screens the referral. If they decide the prisoner is eligible for the state prison’s Intensive Mental Health Unit, Riverview makes that recommendation to the Department of Corrections. It is reviewed by the unit’s clinical team. As designees of the corrections commissioner, the team can accept the prisoner.
At the unit, the team works with that prisoner until the prisoner is stabilized and able to return to county jail.
When a prisoner arrives at the unit, they receive an individualized approach, evaluated by the treatment team, including psychiatric, psychological, medical and social work staff. An individualized treatment plan is created. The prisoner receives services fitting their treatment plan.
The idea is, over time, for the unit team and county jails to get stronger. So, when the unit returns a prisoner with treatment recommendations, county jails will really try to adhere to unit recommendations. Doing so is in everyone’s best interest.
The real challenge will be the communities’ ability to support the treatment plan when a prisoner is released from a county jail or the unit. Finding resources within some of Maine’s communities can be challenging.
The unit’s staffing is significant. We interviewed and hired staff who want to be there, and who we want to be there. The unit is under a contract with the DOC’s health care provider, Correct Care Solutions. We have a full-time psychiatrist, full-time psychologist, clinical social workers and mental health technicians. The unit’s corrections officers, with their extra training, are correctional care treatment workers. They serve as custody/security staff and case workers.
The unit has full-time, around-the-clock nursing and physician time dedicated solely to the unit. A treatment coordinator oversees all unit treatment; the unit also has its own manager.
The new law gives the DOC the ability, in emergency situations and under court order, to use psychiatric medications involuntarily. The department will take all the safeguards used by Riverview in these situations. Such use of medication requests must be reviewed, and recommended by an outside psychiatrist. A Riverview psychiatrist or a nontreating psychiatrist have to weigh in.
Those two advances in the treatment capacity of the state prison and the DOC – specialized staffing and use of medications – are significant.
The DOC oversees the running of the unit. The DHHS provides audits, involving examining records and conducting patient and staff interviews. DHHS auditors report back to the DOC.
Through videoconferencing, the unit’s clinical team has ongoing discussions with Riverview staff on challenging case reviews. The team can get a consult – either in person or by phone – anytime on any unit case. Correct Care Solutions will have daily, monthly and yearly unit checks, and their Quality Assurance program. The DOC’s Quality Assurance Division will also monitor the treatment on the unit.
We are anticipating the unit will be a successful resource. The unit will provide intensive and extensive mental health care, as compared to current practices utilized within the Maine criminal justice system.
— Special to the Press Herald