AUGUSTA — A man shot by police Monday after allegedly threatening an officer with a knife was in the care of a program created specifically to help those with the most severe and persistent mental illness live in the community.
Jason Begin was under the care of a Riverview Psychiatric Center outpatient services team, which is composed of a diversity of specialists who work together to help those who no longer need to be hospitalized but are unable to follow the path of many Riverview patients who ease back into the community with traditional counseling services.
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Begin, 36, was shot in the offices of the outpatient clinic run by Riverview’s outpatient services team in the Ballard Center, which is the former MaineGeneral Medical Center building on the city’s east side. Until last year, the outpatient team was a functioning assertive community treatment team, also known as ACT.
David Sorensen, spokesman for the state’s Department of Health and Human Services, said the group transitioned to an outpatient team last year because it was unable to meet the strict federal standards for an ACT team.
Sorensen said Riverview’s outpatient services team “is an alternative that fits our unique needs at Riverview and is fully staffed with the necessary specialists.”
Riverview’s outpatient team provides much the same services as an ACT team, which Jenna Mehnert, executive director of NAMI Maine, said is designed to help people who no longer need hospital-level care, but need extra support to transition into the community.
“Over the years, at Riverview and at Dorothea Dix (Psychiatric Center in Bangor), there have been people who are ready to leave, but not to say goodbye,” Mehnert said. “It’s the concept of a pretty extensive step-down. They’re ready for less restriction.”
Riverview’s outpatient services team was thrust into the spotlight after the incident involving Begin, who continued to be treated Friday at MaineGeneral Medical Center, where he was listed in “undetermined” condition. City Manager William Bridgeo, while briefing city councilors on the incident during Thursday’s council meeting, said Begin is expected to recover.
“We don’t have a fatal situation on our hands,” Bridgeo said.
Augusta police Officer Laura Drouin, who reportedly shot Begin when he threatened her and others with a knife, is on paid leave from the department while the Office of the Maine Attorney General investigates the shooting. The paid leave and the attorney general’s investigation are standard procedures in shootings involving law enforcement officers.
Bridgeo said Augusta Police Chief Robert Gregoire is forming a shooting review board, made of up law enforcement as well as private citizens, that will examine the circumstances of the shooting to make sure Drouin’s actions were warranted and appropriate. The shooting review board also is standard procedure, Bridgeo said.
FREQUENT HELP
The outpatient services team, like the assertive community treatment, or ACT teams, uses a multi-disciplinary team approach to provide intensive services.
Simonne M. Maline, executive director of the Consumer Council System of Maine, a consumer advocacy group established by state lawmakers, said every ACT team is supposed to include at least seven specialists, including case managers, clinical supervisors, vocational specialists, substance abuse specialists, a psychiatrist, a psychiatric nurse and a peer specialist. The whole team works together for the clients’ care and is available any hour of the day or night and in any location that the clients needs, whether at home or in public.
“They’re set up as the highest level of community support services that are outside the hospital,” Maline said. “They share a caseload and they work as a team.”
Mehnert said the team is directed by a team leader and a psychiatrist and includes a sufficient number of staff members for the core mental-health disciplines, at least one peer specialist, and support staffers who work in shifts to cover 24 hours per day, seven days a week to provide intensive services.
“Multiple contacts may be as frequent as two or three times per day, seven days per week,” Mehnert said.
Eight agencies in Maine offer ACT team services, with a total of 12 teams serving across the state. The outpatient services team for Riverview, the state’s only forensic hospital for mentally ill patients who have committed crimes, works with clients who have more acute illnesses than other teams’ clients do.
“They work pretty intensively with folks,” she said.
How long an ACT team works with a client really depends on the client, Mehnert said. Some people will receive treatment only for a short time; others work with a team for years.
“It’s how the individuals are progressing,” she said. “Some people, with serious mental illness, may be connected to an ACT team for a long time. It’s having the right level of care.”
HIGH STANDARDS
Court documents indicate Begin was assigned to an ACT team since at least October 2013. Patients such as Begin, who are committed involuntarily to Riverview or Dorothea Dix and meet certain criteria, can be included in a progressive treatment program that includes an assignment to the care of an ACT team. If that person has participated in the services as ordered by the courts and becomes more stable in his or her community, the program ends.
Drouin was called to help take Begin back to Riverview, which could have ended his treatment program and his ability to return to the community without first petitioning the court.
Sorensen said Riverview’s outpatient services team is in the process of leaving the Ballard Center; but Kevin Mattson, who owns the building, said the team has not been evicted.
Mattson said the process of renovating the hospital into office space is ongoing. Part of the improvements will be the addition of security, Mattson said, but he said Monday’s shooting does not suggest the building is unsafe.
“I think it is inadvisable, and the wrong focus, to link unfortunate incidents to any business or location,” Mattson said. “Bad things can happen to people anywhere, anytime. There is a distinct random nature to these events.”
Mattson expressed support for Drouin and Augusta police.
“I feel so badly about her, her family and her co-workers, all of whom put their lives on the line every day to protect the rest of us,” Mattson said.
ACT teams have proved successful nationally, but Maine’s ACT teams are struggling because of a lack of funding, Maline said. For example, the state cut $331,000 in funding over two years for the teams in 2010, according to a Disability Rights Center newsletter.
“There are very strict standards about who the members are,” she said. “Maine does not always follow that.”
Maline said Maine ACT teams are not being held to national standards, which include admission and discharge criteria, a minimum 1-to-10 staff-to-client ratio and other requirements, according to NAMI. Providers have told Maline they can’t maintain the standards because MaineCare, the state’s version of Medicaid, the federal health care program for the poor, fails to provide adequate reimbursement to include all the members required to serve on an ACT team.
Riverview dropped the ACT designation and switched to an outpatient services model because it was unable to meet those standards, though it is still known colloquially as an ACT team by other mental health organizations.
“The quality of the team depends on the leadership and the direction to be recovery-focused and person-centered,” Maline said.
A CONFRONTATION
Deputy Chief Jared Mills, of the Augusta Police Department, said last week that the shooting occurred when Drouin responded to mental health professionals’ request to help take Begin to Riverview, which is about a mile down the road, to the south. Begin had been living outside the hospital grounds in Augusta for more than a year as part of a group residential program and was being treated in the outpatient clinic.
Mills said Begin was armed with a knife that he displayed after Drouin arrived.
“There was an armed confrontation, at which point Officer Drouin was forced to use deadly force,” Mills said.
Begin made headlines in September 2003 when he hot-wired a plane at an airfield in Turner and flew to Canada before crashing near Montreal when the airplane ran out of gas. Begin, then 25 and without a pilot’s license, suffered minor injuries and spent several months in jail in Canada before being returned to the U.S., according to published reports.
Investigators theorized that Begin, who lived in Lewiston, fled to escape gross sexual assault and unlawful sexual contact charges in Androscoggin County, while a Riverview report in 2005 quoted Begin as calling the plane incident an elaborate suicide attempt. Under an agreement between prosecutors and defense attorneys, the sexual assault charges were dropped later and Begin was found not criminally responsible because of mental illness in connection with the theft of the plane and violating conditions of release. Begin reportedly had been off his psychotropic medication in September 2003 and “suffered auditory and visual hallucinations that were later controlled by medication,” according to the Riverview report.
State experts testified in 2004 that Begin was diagnosed with schizophrenia, depression and a developmental disorder similar to autism. On Aug. 2, 2004, he was placed at Riverview.
Begin has lived in supervised group residential housing, and his medication is administered by the staff there. He reports regularly to the Riverview outpatient services team, and he meets with a psychiatric provider every 14 days with a minimum of one visit each month with the team’s psychiatrist.
Craig Crosby — 621-5642
Twitter: @CraigCrosby4
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