Wednesday, April 16, 2014
About a year ago, talks about how best to care for aggressive, mentally ill patients in Maine were under way by the Legislature, Riverview Psychiatric Center, the Governor’s Office, news outlets and the departments of Health and Human Services and Corrections.
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.
The unit bridges the treatment divide that existed between Riverview and the state prison. It allows county jails a place to place prisoners who need psychiatrict treatment even if they can’t get prisoners into Riverview. The 15 to 20 beds in the intensive mental health unit most will likely house county jail prisoners. Individuals will have access to medications and treatment they might not have in county jails. I’ve met with county jail officials. They’re excited about the resource as a major step forward.
The unit’s mission is to stabilize patients and allow them to return safely to county jails. Patients must meet Riverview’s admission criteria and also be individuals Riverview can’t manage. The unit referral process is a treatment and management safeguard.
A county jail with an unmanageable, very mentally ill prisoner makes a referral to Riverview, which then screens the referral. If hospital officials decide the prisoner is eligible for the state prison’s intensive mental health unit, Riverview makes that recommendation to the Department of Corrections. The prisoner is reviewed by the unit’s clinical team, which then decides whether to accept the prisoner.
If accepted, the team works with that prisoner at the unit until the prisoner is stabilized and able to return to county jail.
Upon arrival at the unit, the prisoner is evaluated by the treatment team, which includes psychiatric, psychological, medical and social work staff. An individualized treatment plan is created. The prisoner receives services fitting the 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 try to adhere to those 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 from the unit. Finding resources within some of Maine’s communities can be extremely 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 Department of Corrections’ 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 Department of Corrections the ability, in emergency situations and under court order, to use psychiatric medications involuntarily. The department will take all the steps and 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 has to weigh in.
Those two advances — specialized staffing and use of medications — in the treatment capacity of the state prison and the Department of Corrections are significant.
The Department of Corrections oversees the running of the unit. The Department of Health and Human Services provides unit 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 about challenging cases. 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 its Quality Assurance program. The Department of Corrections’ Quality Assurance Division also will monitor the success of treatment on the unit.
We anticipate the unit will be a successful resource, providing intensive and extensive mental health care, as compared to current practices used within the Maine criminal justice system.Dr. Joseph Fitzpatrick is associate commissioner of the Maine Department of Corrections in Augusta.