Gov. Paul LePage last summer blamed the state’s failure to regain certification for Riverview Psychiatric Hospital on the U.S. government. Speaking to Maine Public Broadcasting, the governor said federal standards were too restrictive and a poor fit for Maine. The state, he said, should “just go at it alone and not take the federal money” that makes up roughly two-thirds of Riverview’s budget.

Despite the governor’s rhetoric, however, officials at Riverview and the Department of Health and Human Services have been working all along to regain federal certification and the $20 million annually that comes with it. LePage appears to have come around now, as his two-year budget proposal presupposes the federal funding, while also adding $2.7 million in state money for Riverview.

The governor’s proposal is a strong, substantive step in addressing the problems at Riverview. After years of insufficient staffing and training, the additional funding will help make Riverview a safer, more therapeutic hospital, and remove any excuses for not regaining the federal government’s OK.

WELCOME NEWS

That should be welcome news to the Riverview staff members who testified in front of a legislative budget panel earlier this month. The employees said the hospital has failed to respond to an increase in the number of difficult and dangerous patients in recent years, resulting in high turnover and unsafe conditions, a point of view supported by a series of investigations and reviews completed by outside parties.

In 2014, staff union representatives told the panel, 199 staff injuries were reported, including 103 to mental health workers. At the time of the hearing, 11 mental health workers and two nurses were out of work because of injuries.

Making matters worse, employees were forced to work more than 18,000 hours of mandatory overtime last year as the hospital shuffled to fill shifts. This increasingly put employees, particularly new ones, in contact with unfamiliar patients, many of whom have challenging behaviors and require specific, delicate handling.

That scenario raises the likelihood that a crisis will be created or exacerbated, making an atmosphere that is difficult by nature even more so.

“The extreme number of overtime and mandated hours shows how understaffed we are, and this leads to an unsafe workplace and an unsafe environment for our patients,” said one of the employees.

The governor’s budget proposal addresses that understaffing. It would pay for several additional mental health workers, more than a half-dozen nurses, and 12 acuity specialists, or mental health professionals who are trained to deal with agitated or violent patients.

ADDITIONAL PRESSURES

If the right people are hired, the extra personnel should address many of the charges levied at Riverview. But it likely won’t relieve the pressures on the hospital caused by a relative handful of the most difficult and dangerous patients, where civil patients comingle with patients ordered there by the court system after committing crimes.

Their behaviors, at the very least, create tension and cause disruption. At worst, they cause harm to themselves, staff members and other patients.

These patients often are shuffled back and forth between the hospital and jail. Indeed, a Kennebec County grand jury in January indicted three Riverview patients, two for attacking employees and one for a rampage that caused more than $4,000 worth of damage at the hospital. The latter patient was given a suspended sentence and returned to Riverview.

If the state is going to solidify operations at Riverview, it must address the question of what to do with the most difficult patients.

In almost all cases, jail is not the answer. Neither, in most cases, is the new mental health unit at Maine State Prison, which does not offer the necessary level of treatment.

The best option may be to create a setting for a small number of difficult patients that is more secure than Riverview but similarly focused on treatment. Such a facility is the topic of L.D. 440, now before the Legislature’s Committee on Criminal Justice and Public Safety.

The bill will give lawmakers the opportunity to address what is, after staffing levels, the most pressing issue facing Riverview. More bodies is the right first step, but more room may be just behind it.