A small sign in Pam’s home in Farmington highlights the importance she places on family. Pam and her husband have been trying to find help for their 17-year-old son, who has a history of violence and mental illness. Andree Kehn/Sun Journal

Editor’s note: The last name of the family is not used to protect the identity of the minor son, who is being identified using a pseudonym. 

FARMINGTON — In the past five months, Pam’s 17-year-old stepson, who she considers her own, has had delusions that have made him violent. And paranoid. He believes people are pushing him to get a gun.

During that time, he was hospitalized three times, stayed at several homeless shelters from central Maine to Aroostook County, and had run-ins with police from several law enforcement departments across the state.

As a minor, he cannot legally obtain a gun, but when he turns 18 at the end of June his family fears there will be no way to prevent him from getting one. They worry that he will commit a serious crime in a delusional state.

“If he’s delusional or paranoid and thinks that you want to hurt him, he’s coming after you,” Pam said.

Concerned for their younger children’s safety, Pam and her husband, who is John’s biological father, were forced to kick him out of their home when he started becoming violent toward their 15- and 5-year-old daughters.


She has tried calling the police for help but unless he commits a crime, law enforcement cannot hold him. She tried getting him into a long-term, in-patient treatment program but there is no mental health facility for youth in the state that would agree to take him because of his violent outbursts. And emergency departments will only keep him until he is stable enough to be released.

She has spoken to Department of Health and Human Services caseworkers, legislators, advocates and other officials who told her they could not help with her situation, she said.

Before coming to live with Pam and her husband at age 6, John suffered trauma, Pam said. He was born with fetal alcohol syndrome and has since been diagnosed with an alcohol-related neurodevelopmental disorder, reactive attachment disorder, attention-deficit/hyperactivity disorder and oppositional defiant disorder.

Pam, who did not want her last name used, sits April 15 with her youngest child in her home in Farmington as she looks up details of her son’s hospitalizations. Her son is hospitalized because he has threatened to kill her young children and she cannot take the risk of allowing him to remain in the home. Andree Kehn/Sun Journal

His behavior has gotten progressively worse through his childhood, causing him to be kicked out of school several times. In their effort to get him help, he has been in and out of treatment facilities starting from a young age, she said.

John has spent time at Spring Harbor Hospital in Westbrook, Northern Light Acadia Hospital in Bangor and a facility in Florida for separate psychotic breaks, she said. He has also been in and out of Franklin Memorial Hospital in Farmington for emergency psychiatric treatment.

For Pam, it has felt like a revolving door of treatment for years that has never resulted in John getting meaningful help.


He went to SandyPines Residential Treatment Center in Jupiter, Florida, last fall for about two months because there were no facilities in Maine or New England that would admit him, according to Pam. The therapies and medications he received there seemed to be helping him.

He came home in November but at some point he stopped taking his medication and started spiraling into a delusional state last December, with behavior that was worse than Pam had ever seen from him, she said. He was exhibiting a disconcerting laugh while making violent threats.

She and her husband made him leave after an incident in February in which he was making threats to the family and damaging their home, she said. They have not allowed him to come back since, for fear that he might hurt someone in the household.

“I was like, that’s it, he can’t be here,” she said. “You know, we have a 5-year-old, and we have (a 15-year-old) and we can’t be up all night worried that something is going to happen.”

They called the Farmington Police Department and John was taken to the emergency department at Franklin Memorial, she said. They made the difficult decision to press charges against him for destruction of property in hopes that it might keep him off the streets and get him some help, but he was only summonsed.



Sometimes Farmington police officers are called to handle someone who is having a mental health crisis, according to police Chief Kenneth Charles. It can be scary not knowing what is on the other side of a door, so they must make quick risk assessments. It is a scenario that plays out frequently in the work they do.

“For all the issues that we deal with, the ones that often have some of the highest risk involve those that have a mental health component to it,” he said. “Second to that, they can be the most resource intensive and they can be the most time intensive.”

Over the course of Charles’ law enforcement career, he has seen an increase in calls involving a person in mental health distress, but that does not mean there are more people in the community with mental health issues. Rather, he said, it may just be more identifiable now.

Often the public looks to law enforcement for solutions or to help those experiencing serious mental health issues, but Charles said there is little that police officers can do to get an individual treatment, other than taking them to the emergency department.

When officers first answer a call where someone is in mental health crisis, they try to calm the situation without using physical force. Then they might call the local crisis team, he said. A crisis team consists of trained individuals who are called upon to help calm a situation.

If they are not available, police may ultimately make the determination that the person needs emergency treatment at a hospital or they may decide it is best to leave the person where they are with a safety plan in place, if that is possible, Charles said.


The goal is to get the person to go to the hospital or with an officer voluntarily, he said. Ultimately officers must use their training, experience and facts gathered at the scene or known facts about the person to decide if the person is an imminent threat to themselves or others, and if they need to be taken involuntarily to the hospital for an evaluation.

Usually, the department leaves it up to the doctors and hospital staff to determine if someone should be “blue papered,” which is a court-ordered involuntary hospital commitment for up to three days, he said.

It can be frustrating for officers when someone who they have serious concerns about is released from the emergency department hours later, he said. However the officers do not always know the information the health providers learn while they are treating the person.

If officers still feel the person is an imminent threat to the public or themselves after the hospital releases them, officers will sometimes get creative, which can involve charging them with a crime so they can be taken to jail for a short period of time.

Pam, who did not want her last name used, washes dishes April 15 at her home in Farmington. In the past five months, her 17-year-old stepson has had delusions that have made him violent and paranoid. He was admitted to Maine Medical Center last month. Andree Kehn/Sun Journal

In 2021, about two in five adults jailed or in prison in the United States had a history of mental illness, according to data compiled by National Alliance on Mental Illness. In that same year, about seven in 10 youth in the juvenile justice system had a mental health condition.

Sometimes there is a push to get people out of jails or hospitals before they are ready and they end up cycling through the criminal justice and hospital system over and over, he said. There are some people who cycle through the system so often that they are well known to officers — both youth and adults alike.


“I’m just concerned about people who get returned back on the street, so to speak, before they’re really ready to be,” he said. “And then we end up starting the cycle over again with that person very quickly.”

The Sun Journal tried to get the local hospital’s perspective on this problem, but spokesmen at Portland-based MaineHealth, which owns Franklin Memorial, did not respond to two requests for an interview.


For Sweetser President Jayne Van Bramer, the missing puzzle piece to treatment for youth with mental health issues is obvious and confounding: There are no residential psychiatric treatment facilities for children and young people in Maine.

These facilities typically serve youth up to age 22, providing a therapeutic and clinical environment that is also secure and locked, she said. The facilities are appropriate for longer lengths of stays, from less than a year to a couple of years depending on the level of need.

Only about 35 states have such facilities, she said. Not having a facility in Maine has resulted in dozens of youth a year being placed in facilities out of state, as far away as Arkansas, Georgia and Florida. This forces children to move away from their home and their natural support system.


Sweetser has been urging the Maine Department of Health and Human Services for years to get one of these facilities established in Maine, she said. For youth who need this level of care, families either send their children to a facility out of state or children go without adequate help. In many cases, youth suffer the latter.

“The result is … that kids end up cycling in and out of services,” she said. “They languish in an emergency room.”

Pam, who did not want her last name used, washes dishes April 15 at her home in Farmington. In the past five months, her 17-year-old stepson has had delusions that have made him violent and paranoid. He was admitted to Maine Medical Center in Portland last month. Andree Kehn/Sun Journal

Van Bramer sees two major reasons why there is no such facility in Maine: state reimbursement rates to private treatment facilities are too low to take on such difficult cases. And even if that were not the case, she said, the cost for constructing or renovating the necessary additional space that meets the standards required to operate such a facility is too high for many existing organizations to pay upfront.

Though the state recently came up with revisions to the reimbursement rate for such facilities, the capital costs to construct or renovate a space are still higher than many mental health treatment organizations can afford, she said.

Youth who need a high level of care end up cycling in and out of services and sit in emergency departments for extended periods of time, she said. The emergency department cannot provide them with the level of care they need, as hospitals are designed for short-term interventions, usually for five to 10 days.

She knows of one child who spent 180 days in a windowless hospital room because there was nowhere else to go, she said. They can also be exposed to things in an emergency department they should not see.


There is a disproportionate rate of youth in Maine who have serious mental health issues, she said. Instead of being stuck in emergency departments, they could be appropriately served at one of these facilities — if the state had one.

The average delay between the first symptoms someone in the United States with a mental health issue shows and when they get treatment is 11 years, according to information on the National Alliance on Mental Illness website. In 2023, the most prevalent mental health conditions were anxiety disorders, depression and co-occurring substance use disorder, and mental health illness.

One in 20 adults in the United States experienced a serious mental illness in 2023 and 17% of youth, ages 6 to 17, experienced a mental health disorder that same year, according to NAMI.

Pam, who did not want her last name used, looks April 15 at the damage her 17-year-old stepson has done to her front door in Farmington. With a history of mental illness and violence, he has ripped nearly every door off the hinges in her home and punched several holes in the walls. Suffering from delusions and paranoia, he was admitted to Maine Medical Center in Portland last month. Andree Kehn/Sun Journal

Children who get help earlier tend to be more successful later in life, Van Bramer said. That is why early intervention is important for children, she said, and a residential psychiatric treatment facility can give young people with the most severe mental health issues help earlier.

“Kids who go to a (residential psychiatric treatment facility) and then step down to an in-home wraparound service are more successful,” she said. “The earlier we can reach kids the better.”

Reached Friday for comment, officials with the Maine Department of Health and Human Services expressed the desire for more time to respond to the complexities of the problem. However, spokeswoman Lindsay Hammes issued a statement saying the department works with the broader medical and behavioral health community to support individuals with complex mental health needs and to protect the safety and well-being of Maine people. She said the department implements the progressive treatment program in accordance with the law.


“The department is always open to good ideas about how to help protect the health and safety of Maine people in conjunction with our partners,” Hammes said.


As of Friday, John was at Maine Medical Center in Portland and Pam was working to get him connected with adult services ahead of his 18th birthday at the end of the month, working to get him adult case management services and on Social Security disability.

Being on medication helps him and makes him less violent, though it does not completely prevent him from experiencing delusions, she said. But he does not like to take them because he has less energy when he does.

As an adult, he could not be forced to take medication without a court order. And as an individual with no adult criminal history, there is little stopping him from lawfully obtaining a firearm without intervention.

Former Leeds state Rep. John Nutting argues that more court-ordered treatment plans need to be in place for adults with the most severe mental illnesses in the state.


He cites Robert Card, who committed the October 2023 mass shooting in Lewiston, and Justin Butterfield of Poland, who murdered his brother in 2022, as examples of adults who should have gotten court-ordered treatment plans. The orders require individuals to comply with a treatment plan, which can include medications, therapy and other types of mental health treatments. These plans and their compliance are usually overseen by a group of professionals called an assertive community treatment team.

Nutting and a group of family members of people with severe mental health issues work as mental health treatment advocates through the Maine chapter of the National Shattering Silence Coalition. They are frustrated with a system in which people are slipping through the cracks and, they say, sometimes committing unimaginable crimes.

Patrick Maher killed his landlords in Turner in 2021 after having a delusional break from reality. A court-ordered medical evaluation found that Maher and Butterfield were unaware of what they were doing at the time, and both were found not criminally responsible for the crimes in court because of their severe mental health issues. Card had a documented history of serious mental health issues.

In all three cases, family members tried to seek help for the men before the incidents, but could not find effective help through existing systems.

Nutting said he thinks the crimes could have been prevented if the men had been on court-ordered treatment plans and each had a team more closely monitoring them. In many of these cases, family members did not even know about Maine’s court-ordered treatment plan law until after the crimes were committed. He has called on the state to make training available about the law to law enforcement officials.

However, not all advocacy groups feel that forced treatment plans are the answer.


Simonne Maline, executive director of Consumer Council System of Maine, thinks an expanded peer support network would help many people address their mental health challenges.

A court order does not ensure that the person will still comply, and hospitals can choose not to admit those individuals if they do violate that court order, she said. There are also few assertive community treatment teams in the state.

Before using the most restrictive means possible, such as a court-ordered treatment plan, all other options should be exhausted, she argues. Many people have found help for their mental health challenges through peer support, Maline said.

She would also like to see more peer respite houses, where someone experiencing mental health challenges can stay, usually for up to two weeks, to get support from their peers though an individualized recovery plan — completely voluntary. In these homes there are group meetings and shared common spaces. People are responsible for taking their own medications.

There are few houses in the state and there are few areas in the state where people have access to peer support specialist services, Maline said. Her organization would like to see more of those support services established in Maine.

Peer support specialists can help someone in psychosis who might not recognize they are in mental health crisis, she said. How people approach those in mental health crisis is important and people who want to help those in crisis need to learn the person’s wants and needs.


Though she can understand the appeal of a court-ordered treatment plan, Maline said they almost never work, something Nutting and his group disputes.

Extreme restrictions should be saved for the most extreme cases, which tends to be a small number of people, she said.


Pam said she wishes there was a program or facility similar to a group home setting staffed with people who could stay with her son all the time, ensuring that he takes his medications, correcting inappropriate behavior and teaching him life skills that could later lead to more independence or a job.

John is not capable of taking his medication, seeking counseling or seeking other mental health services on his own, so she is nervous about what he might do while in a bad head space, she said. Pam and her husband must both work and cannot provide him with the constant oversight they feel he requires to ensure that he is taking his medication.

She fears he will seriously hurt or kill a person if he perceives them as a threat during an episode of psychosis.

Since he was admitted to Maine Medical Center last month, his behavior has been safer, with no violent outbursts while taking medication, she said.

For now, she and providers at Maine Medical Center are trying to get him into a crisis stabilization unit where he can be monitored, even if it is just for about a week, she said. She worries he will be in and out of hospitals until he can either get meaningful help or he has committed a serious crime.

“What happens when something happens to all of us,” she said. “And everybody’s going to put their arms up in the air like they did for Lewiston and say, ‘Well it wasn’t caught — the system’s broken.’”

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