For whatever reason, Mark Murphy didn’t get the treatment he needed nine years ago, before he broke into a neighbor’s home and was stopped by a bullet to the chest.

That incident, and the mental illness that precipitated it, set in motion a series of events with far-reaching implications and significant costs, both financial and emotional.

Found not criminally responsible because of mental illness, Murphy was sent to Riverview Psychiatric Hospital in Augusta, where in the following seven years he frequently attacked staff members. In March, he seriously injured a 26-year-old mental health worker, punching her and stabbing her with a pen before he was subdued by another patient.

That attack, and other incidents at the hospital that have led to injuries, show why patients like Murphy have no business being there.

At the same time, Riverview has been feeling the brunt of a mental health system beset by budget cuts and short-term thinking at a time of increasing illness. At each step, patients are falling through the cracks. Their state of mind worsens, rehabilitation grows more unlikely and the social costs mount. Absent a comprehensive solution, all the mental health system can do is stop the worst from happening. And the cracks are showing.

Federal review

An audit conducted following the assault by Murphy found the hospital out of compliance in an alarming number of areas related to the handling of forensic patients such as Murphy who are mentally ill and pose a significant risk to themselves or others.

The hospital had too many of these volatile patients, and too few staff members. Designed for 44 forensic patients, the hospital has had more since January 2012, with an all-time high of 62 in April of that year.

Sheriff’s deputies called in to keep the peace were essentially put in charge of treatment, the audit said. Tasers, restraints and extended patient seclusion were used frequently and casually, and the hospital staff had little chance to soften confrontations and change patient behavior. Self-preservation took precedence over patient care and rehabilitation.

The people in charge of Riverview lost control of the institution. A Taser was used on a patient in a “non-threatening position.” Officers acted on their own in cases when nursing staff were attempting to de-escalate a situation, using the Taser instead of less harsh interventions.

In addition, patient assessments were not completed in a timely manner, and patient grievances were not handled correctly. Records were incomplete or nonexistent. There appeared to be lax oversight and quality assessment, the audit said.

Human toll

Riverview was worn down by the presence of the forensic patients. Staff members were overwhelmed in an increasingly dangerous hospital. According to the audit, some nurses bristled at the methods employed by the officers.

Patients became anxious and afraid amid the tense atmosphere. Treatment that may have improved the condition of the patients so that they could leave the hospital, improving their lives and erasing a social cost, went by the wayside. Officers were put in an unfamiliar and difficult situation.

Put another way, patients and workers whose well-being is an obligation of the state were put in danger.

Riverview officials say they have trouble attracting qualified candidates because of an inability to offer competitive pay. All of the problems at Riverview cannot be blamed on a lack of funding, but nationwide spending on mental health in general is part of the story.

According to the National Association of State Mental Health Program Directors, spending at the state level for mental health services was reduced by $4.35 billion from 2009-2012. At the same time, an additional 1 million people sought services. That means fewer care providers and case workers handling fewer programs. It means fewer beds at fewer residential treatment centers.

At Riverview, the overflow of forensic patients means other patients are rejected. If care is not available elsewhere, the patients end up on the street, or perhaps at county jail. Elsewhere, cutbacks eliminate the opportunity for early intervention, which can lessen the severity of mental illness, lowering a patientís suffering as well as the future cost of providing care.

In any case, their condition worsens and the costs associated with their care increase.

Legislative action

A legislative committee on Thursday agreed to have a panel of mental health interests, legislators and state officials to address the problems at Riverview. On the table is L.D. 1515, proposed by Gov. Paul LePage earlier this year to create a new mental health unit at the Maine State Prison in Warren.

It is clear the forensic patients should be in their own unit at the prison, a setup that has worked in other states. The unit would cost more than $3 million, but maintaining the current structure is not an option, and if it were, it would prove more costly in the long run.

As for Riverview, it’s hard to say how much damage has been done to the culture there. It is concerning that two plans proposed to solve the problems that surfaced in the audit were rejected. A third plan must be approved by Sept. 2 to save the funding.

It bears watching how the hospital responds, and if the legislation attention shifts in any way the government approach to funding mental illness treatment.

There is no doubt that budget conditions are challenging, but it makes little sense to spend less now only to be forced to pay more later.

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