As the clinical director of Riverview Psychiatric Center in Augusta, I see patients every day who are among the sickest in our state, afflicted with severe and persistent mental illnesses that couldn’t be successfully treated anywhere else in Maine. Patients are often referred to us because they have exhibited seriously dangerous behaviors unresponsive to treatment elsewhere.

These behaviors may have landed them in the headlines before they arrived at our doors. Riverview is the primary hospital in the state for patients referred through the criminal justice system, often for elevated and capitol offenses, including those deemed incompetent to stand trial or who have been adjudicated not criminally responsible, also known as not guilty by reason of insanity. Riverview serves all Maine people in need of intensive mental health treatment, including many with no justice system involvement, and some patients present unique challenges. We must always balance their health and safety with that of other patients and of our skilled and dedicated staff.

In limited cases, to ensure the best care for patients who pose a serious danger to themselves or others at Riverview, we transfer them to Columbia Regional Care Center (CRCC) in South Carolina for treatment. We are circumspect with these decisions, weighing clinical evaluations and recommendations for patients who have been deemed not criminally responsible and have previously demonstrated a high level of violence. In some cases, these patients have severely assaulted other patients or staff at our hospital. But for individuals who fit these stringent criteria, we do not wait for them to hurt someone at Riverview to take action.

As a certified hospital, we are under the same state and federal regulations as any other psychiatric facility in Maine, which appropriately limits our response to dangerous behaviors. As such, a small minority of patients exceed our security capabilities. This makes highly secure facilities such as CRCC a necessary and standard component of the continuum of inpatient psychiatric care. Since 2019, approximately 10 Riverview patients have spent time at CRCC.

While sending patients to CRCC is a last resort, our intent is always to restore their health to a point where they can safely come back and continue their treatment with us. Indeed, several individuals treated at CRCC have successfully returned to Maine. During their treatment stay at CRCC, care teams from Riverview and Disability Rights Maine check in regularly with patient care teams at CRCC. We focus on care and treatment and set goals as appropriate for the patient to return to Riverview whenever safely possible.

For context, we have successfully admitted, treated and discharged more than 1,000 patients since 2019. Prior to the pandemic, we achieved a record number of annual admissions and discharges, and we are on pace to do so again in 2024. We are serving more Maine people than ever before and significantly reducing the average length of stay, thanks to filling medical staff vacancies, improving training and educational opportunities, and advancing clinical care by consulting with international psychopharmacology experts.

This progress is even more remarkable considering that Riverview lost federal certification in 2013 due to failure to meet standards for patient care. We restored the hospital to federal certification in 2019, not only ensuring high-quality patient care but also returning tens of millions of federal reimbursement dollars to Maine.

Our progress is also reflected in the successes of patients deemed not criminally responsible. Thanks to our collaborative, person-centered treatment, dozens more of these patients are demonstrating significant progress in their recoveries, prompting the courts to discharge them from Riverview and allowing them to safely return to their communities with continued care and oversight.

When Riverview is the appropriate setting, we are here to serve the Maine people. The hospital’s excellent staff – including nurses, mental health workers, social workers, rehab specialists, physicians, psychologists, dental providers, advanced practitioners, personnel managers, dietitians, operations and facility management – make that possible. We welcome continued dialogue with our community partners about how best to meet our state’s needs and strengthen the system of care as we strive to keep our patients, our employees and Maine communities safe and healthy.