It’s been a year since an attack on a staff member by a patient at Riverview Psychiatric Center raised concerns about operations there, and six months since those concerns led regulators to pull $20 million in annual funding from the facility.

Now, Riverview officials are ready for the regulators to return, so that the hospital can be recertified and again receive federal funding, which accounts for half of its budget.

But the work can’t end there. The discussions following the attack and subsequent decertification have revealed complex, systemic problems at Riverview, and setting up the facility for long-term success will require a comprehensive approach with input from hospital staff, law enforcement, the courts, mental health advocates and lawmakers.

The problems at Riverview centered around a small number of aggressive patients, mostly held in the forensic unit after having been found not criminally responsible for a crime.

Training in dealing with those kinds of patients had lagged at Riverview, and some shifts were understaffed. When the staff could no longer handle the patients’ violent outbursts, sheriff’s deputies were brought in, creating an atmosphere that put patient care in jeopardy. That atmosphere was one of the main issues cited in decertification by the regulators.

Riverview has since increased training on avoiding and de-escalating violent episodes, and a new acuity specialist works one-on-one with the troublesome patients, so that other members of the staff can do their work unimpeded.

But while that may be enough to appease the federal regulators for now, it doesn’t solve the heart of the issue.

According to Jay Harper, a longtime patient advocate who was recently named acting superintendent at Riverview, the facility receives too many forensic patients with behavioral issues unrelated to mental illness. Those patients would be better served elsewhere, and their presence at Riverview interferes with the treatment of those with significant mental illness.

So Harper is arguing for better assessment of the patients before they are sent to Riverview, so that hospital resources can be pointed where they will do the most good.

“Everyone gets in the door,” he said last week, “(so) no one gets what they need.”

However, as Harper points out, the problem is not quite so simple. Patients enter the system with a variety of issues, and diagnoses are rarely cut and dry.

And there are many issues regarding the patients that raise valid concerns over civil liberties, and how best to balance safety and treatment.

The difficulty of addressing all these issues was clear last week when the Legislature’s Criminal Justice and Public Safety Committee considered a bill that would have set up a forensic unit at jails in either Cumberland or Somerset County. The bill was widely criticized, then quickly dismissed.

The challenge moving forward will be formulating a plan that satisfies all the parties that have an interest in Riverview. But the result will be a facility that provides the right level of care in a safe environment.