Michael Simpson suffered from depression and anxiety and had attempted suicide at least twice.

Last month, shortly after being discharged from a psychiatric hospital, the 37-year-old merchant mariner took his own life. He was found hanging in Portland’s Fort Allen Park on Oct. 26.

Simpson’s belongings included a note in which he said the rope he used was the same one he had bought for the task and had brought with him to Mercy Hospital on Oct. 23 when he checked himself in because he was feeling suicidal.

Simpson wrote that he told hospital staff what he intended to do with the rope. Mercy transferred him to Spring Harbor Hospital, which discharged him within two days. When he checked the bag that held his clothes, he found the rope still inside, his note said.

“Would you give a suicidal man back his shotgun?” he wrote.

The note was described in the police report on the incident. The report was obtained from the Portland Police Department under the Freedom of Access law.

Portland Police Chief James Craig said the tragedy underscores the need to improve the way the mental health system responds to people who are suicidal.

“I know we can’t always predict when someone is going to commit suicide or cause harm to someone else, but when we have good knowledge, evidence of a problem, it would seem we should do more,” he said.

Hospital officials, meanwhile, say they try their best to assess patients’ risk of hurting themselves or others. Confidentiality laws bar them from talking about the specific factors relevant to Simpson’s case, they said.

Craig acknowledged that mental health is not his profession and said he did not intend to criticize the doctors who treated Simpson. But he said the mechanism for responding to such people needs improvement.

“When he writes a letter expressing dissatisfaction with the system, I think the young man was sending all of us a message (that) the system is broken,” Craig said.

POLICE RESPOND TO ATTEMPTS

Police had dealt with Simpson following a previous suicide attempt this summer. Officers were called to the Eastern Prom, where they found Simpson bleeding from a self-inflicted wound. He told the officer he had tried to kill himself by cutting his carotid artery with a box cutter, even doing pushups beforehand to make it more pronounced.

Craig’s criticism of how suicidal people are often released back into the community stemmed originally from an incident a year ago. A woman who had been threatening to jump off Casco Bay Bridge almost caused an officer to fall as he was trying to grab her. She was taken to the hospital for evaluation, was released and was back at the bridge the following night, police said.

The hospitals referenced in Simpson’s letter declined comment on the case specifically.

“If a patient is in need of acute psychiatric care,” said Mercy spokeswoman Diane Atwood, “we make an evaluation and transfer the patient safely as soon as possible to an appropriate provider or facility.”

INCIDENT TRIGGERS ANALYSIS

Spring Harbor officials said an incident such as that involving Simpson would invariably prompt an immediate review.

“I can assure you, whatever the facts are of this situation, it will be part of a root-cause analysis and we will create some sensible solution to prevent it from happening again,” said Brian Rines, chairman of the board of directors for Spring Harbor and chairman of the advisory council on health systems development for Dirigo Health.

Spring Harbor staff do check patients’ belongings and they have a list of items, such as guns and knives, that are to be removed, said Dr. Girard Robinson, chief medical officer at Spring Harbor and chief of psychiatry at Maine Medical Center.

But there are many items not normally thought of as dangerous that someone could use in a suicide attempt. A death like Simpson’s could persuade the hospital to expand its list.

Most of Spring Harbor’s 2,200 adult admissions each year come from other hospitals, and most of the patients have exhibited some suicidal intent or thoughts, Robinson said. When they are discharged — the average stay is eight to 10 days — the overwhelming majority do not commit suicide.

Clinicians analyze patients’ symptoms, their medical history, their support network and social situation when deciding on the best treatment plan and whether it requires a stay in the hospital, Robinson said. The assessment includes an evaluation of the risk a person poses to himself or others.

Robinson said a person’s condition may improve in an institutional setting, but it is difficult to predict what will happen when he or she returns to the community.

In response to Craig’s criticism, Robinson said there is always room for improving the system.

“But I think the hospitals play a very small role in people’s lives. Most people (with mental illness) spend the vast majority of their time outside of the hospital,” he said.

Psychiatric hospitals are designed to stabilize patients. But since the state closed the major psychiatric hospitals it ran, and de-institutionalized most mentally ill patients, those people mostly rely on outpatient services, peers and family members for their day-to-day treatment and support.

“Everything is a big rush to get them in the hospital and out of the hospital, especially if it’s a payment issue,” said Carol Carothers, executive director of the Maine chapter of the National Alliance on Mental Illness. “There’s a million places where things can go wrong.”

The outpatient system, which was never robust, has been frayed by $50 million in spending cuts over the past two years, said Carothers. She said laws make it difficult to require that someone be hospitalized, and it’s hard to know when that is best.

“I am so reluctant to second-guess anybody working in a system that is this difficult to navigate,” she said. “It is difficult for treatment providers. It is difficult for families. It is difficult for people trying to get services.”

Rines, of Spring Harbor, said he has evaluated thousands of people to determine whether to discharge them or go to court to keep them hospitalized involuntarily.

Often it is a very difficult assessment, one that could have life-or-death consequences, and it is taken very seriously by the medical staff involved, he said.

“Nobody wants this kind of situation on your conscience or your personal record,” Rines said. At the same time, depriving somebody of his or her liberty is not something to be done lightly, he said.

Most of these patients are discharged. Most of the time, someone who says they plan to harm themselves does not do it, he said.

OUTSIDE SUPPORT IS CRUCIAL

The difference is often the support they have outside the hospital, a counterbalance to hopelessness.

“It may take a village to raise a child, but it takes community to keep somebody engaged and alive,” Rines said.

Spring Harbor is part of a new group called Maine Mental Health Partners, which seeks to integrate community education, peer support, drop-in counseling and crisis intervention in one hospital to provide better services in southern and coastal Maine.

Still, that is no guarantee.

“There are determined people who want to die, who ultimately do,” Rines said.

Rines does not believe the decision to discharge someone is influenced by whether hospital beds are available or whether someone has insurance.

Robinson said when Spring Harbor’s 48 adult beds are full, it informs other hospitals that it is at capacity and cannot take any more patients, he said. The patients then either stay at the hospital that made the referral or are referred to another psychiatric bed elsewhere in the state.

Craig said in other parts of the country, police can request a person be held for 72 hours if the officers feels the person poses a threat to himself or others. Often, in Maine, by the time the person is evaluated at a hospital, he or she is no longer showing those symptoms and is released, he said.

“What are we going to wait for?” Craig asked. “Another tragedy? A police officer getting killed by somebody who has been in and out of a facility?

“What could we do differently to prevent or at least minimize this kind of situation?” he asked.

Staff Writer David Hench can be contacted at 791-6327 or at:

dhench@pressherald.com