Arlene Edson — a Riverview Psychiatric Center patient who was pepper sprayed and found to have been abused by hospital staff a year ago — is being held in the Kennebec County jail in Augusta awaiting prosecution for two misdemeanor assault charges. But the county sheriff says jail is not the place for Edson and most Riverview clients charged with crimes.

Sheriff Randall Liberty described the overcrowded jail as a “pressure cooker” that’s not suited for the mentally ill.

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Edson

“We call ourselves, ‘Riverview West,'” Liberty said. “It’s like one big merry-go-round here. They bounce back and forth between the jail, Riverview and prison.”

The Maine chapter of the National Alliance on Mental Illness joined Liberty in criticizing the system, but others, including the Kennebec County district attorney, were more sympathetic to the challenges Riverview faces in dealing with difficult patients. Edson was charged after punching two staff members last week, one of several high-profile assaults by patients on staff members in recent years.

The debate reflects the difficulty of determining when a person with mental illness can be held responsible for his or her behavior, and whether the most appropriate response is punishment or therapy.

Riverview Superintendent Jay Harper did not respond to several requests for comment this week.

A CYCLE

Edson was a victim of abuse by Riverview staff in December 2013. She was nude and alone in her room after a verbal confrontation with a nurse when a corrections officer burst in, coating her with pepper spray. She was subsequently held against her will in restraints for several hours, despite not threatening employees or trying to harm herself, according to a state investigation.

Staff members attempted to cover up and minimize what occurred, the investigation concluded.

Edson, 30, of Fryeburg, told the Portland Press Herald in September that she doesn’t feel safe at the 92-bed hospital, that she has been restrained numerous times against her will, and that she doesn’t trust the staff. She has notified the state that she intends to file a million lawsuit over her treatment.

One nurse was fired over the incident, and Harper, who was hired in March, has said a number of reforms are ongoing at Riverview, including training employees how to de-escalate volatile incidents with patients.

Edson’s attorney, Dan Lilley of Portland, would not permit a reporter to interview her in jail this week.

Lilley said that the pepper spray abuse should be factored into whether Edson should be criminally charged.

“The incident appears to be a reaction to how she’s been treated,” he said.

Liberty said the jail does not have comprehensive mental health services, only crisis counseling. Many of the inmates end up back at Riverview, or in prison. Without proper treatment, if they are released into the community they are more likely to reoffend, he said.

A count of how many Riverview patients circle through the Kennebec County jail wasn’t immediately available, but Liberty said the jail sometimes houses dozens of mental health patients at a time.

Jenna Mehnert, president of the Maine chapter of the National Alliance on Mental Illness, said Riverview patients are not criminals and should not be incarcerated.

“They have a chronic, persistent mental illness, and they shouldn’t be in prison. They need treatment,” she said.

NO EASY ANSWER

But Capitol Police Chief Russell Gauvin said the situation is more nuanced than what Liberty portrays, and that mental health patients do not acquire blanket immunity from criminal prosecution. Gauvin said many patient assaults at Riverview do not result in criminal charges, but Edson’s punches injured two people, giving a maintenance worker a chipped tooth and bloody mouth and concussing a mental health worker.

“She was aware of what she was doing. Her actions were criminal,” Gauvin said. A Riverview psychiatrist concluded that Edson was not having a psychotic episode before the attack on the maintenance worker.

Gauvin said Edson’s motive could be a desire to leave Riverview.

“She has told people on many occasions, ‘I am going to be assaulting people until I get out of here,'” he said.

After the first assault on Dec. 3, Edson was released back to Riverview, where she punched the mental health worker in an unprovoked attack on Dec. 11. Edson was sent to the Kennebec County jail to await prosecution for violating conditions of her bail.

Maeghan Maloney, Kennebec County district attorney, said the safety of staff at Riverview should also be a priority.

“The assaults at Riverview are terrifying to the people who work there, and for the other patients who live there,” Maloney said, describing the hospital as a “college dormitory” setting where free-roaming patients so inclined can find ways to assault staff members.

Gauvin said Maine does not have the proper facilities for mental patients who present dangers to staff members. Other states have facilities that have more security than a hospital but are not prisons.

“We don’t have a place that’s a blend of a correctional setting and a hospital setting to handle these patients,” he said.

Mehnert, the NAMI chapter president, said the group will propose to the Legislature that Riverview open a small facility — probably about 6 to 10 beds — operated by medical professionals as a place for the most troublesome patients.

But she said she’s had conversations with Harper, the Riverview superintendent, that lead her to believe he will advocate for such patients to be housed in a newly established mental health unit at the Maine State Prison in Warren. Mehnert said she’s vehemently opposed to such as move because it’s putting those who are found “not criminally responsible” into prison and may be illegal.

She said Harper has a financial motive to move hard-to-manage patients out of Riverview because it would make it easier for Riverview to regain federal certification. The U.S. Centers for Medicare and Medicaid Services decertified the hospital in 2013, making it ineligible for about $20 million in federal funding, because of deficiencies in patient care.

Riverview has yet to regain its certification, although Harper has instituted reforms that included removing corrections officers from the premises to emphasize the hospital setting. He has also reduced Riverview’s use of seclusion, which was much higher than the national average in recent years.

An attempt to place such patients in the prison was removed from proposed legislation in 2013, after objections by NAMI and others.

Mehnert said the prison’s mental health unit is better suited to stabilize patients, and is not best for long-term treatment of the mentally ill. The unit only houses men, so Edson, if incarcerated, would presumably be in with the general prison population.

Liberty said that would not be the best place for Edson.

“The chronically mentally ill should not be in a correctional facility.We have a moral obligation to take care of them,” Liberty said.

Maloney, the district attorney, said the prison mental health unit could be a stopgap setting for difficult patients until a permanent solution is found.

She said she sometimes has trouble finding proper placements for the mentally ill who are awaiting the disposition of criminal cases, including but not limited to Riverview patients.

“We are going to have to address this in the Legislature,” when lawmakers convene in January, Maloney said.