AUGUSTA, Maine - It's been a tumultuous few years for the Riverview Psychiatric Center in Augusta.
The hospital lost federal certification - and $20 million in annual funding - after federal regulators discovered a number of safety violations, including corrections officers' use of stun guns and handcuffs and handguns to subdue patients back in 2013.
It's now fallen on Superintendent Jay Harper to get Riverview back on track. A former patient advocate, Harper took over leadership of the facility last spring. Patty Wight reports on what he's accomplished so far.
A year ago, Donald Beauchene was blunt about his opinion of Riverview. "I have a lot of complaints about this place," Beauchene says. "But they're legitimate complaints."
A patient at Riverview for more than a decade, Beauchene said treatment groups lacked substance, and patient freedoms had shrunk to the point where it was difficult to demonstrate when someone was ready for discharge back into the community.
But now, a year later, Beauchene's view on Riverview has changed. "It's improved tremendously," he says. "Jay Harper is trying to do this recovery model. It's come a long way, but it still has a long way to go."
Before taking over as Riverview's superintendent, Harper was a frustrated patient advocate at the 92-bed hospital.
"It became more and more clear to me every month I was here that the hospital really didn't have a vision for itself, or a direction," Harper says. "It was just kind of happy to get by on a day-by-day basis. If the institution or organization doesn't know where it's going, it's hard to sit with patients and ask them where they're going."
Riverview serves both civil and forensic patients, most of whom are admitted involuntarily through the court system. When Harper took the reins, he implemented the recovery model of treatment where patients are active partners, versus passive participants. Some even help lead treatment groups. Richard, a patient who doesn't want to use his last name, co-facilitates a Narcotics and Alcoholics Anonymous group.
"It gives me a sense of well-being," Richard says. "It gives me a chance to acknowledge my own shortcomings, and by tabling that, I can have other people look at it as well and give me some encouragement as well."
It's hoped that the recovery model will also help address another issue at Riverview: safety, for both patients and staff.
"It's not just physical safety - it's emotional safety and security," Harper says. "And that helps to drive some of the decisions we make about more involvement of a patient's voice, so they feel safe and secure. They're being heard."
Riverview now employs eight acuity specialists who are trained to diffuse or prevent potentially violent situations. "To put the fire out at a spark, before it gets to a huge bonfire, so to speak," says acuity specialist Jared Thibodeau.
Thibodeau has worked at Riverview for 10 years in different roles. He says the current administration - which includes a new medical and nursing director - is more open and collaborative. That's a sentiment shared by patient advocate Kristina LaChance.
"Before, under the previous administration, the issues - everything felt like it was a battle or argument," LaChance says. "I didn't feel as though issues we were bringing forward were heard or necessarily addressed."
LaChance is employed by the Disability Rights Center but her office is embedded in Riverview. She says under the previous administration, it was hard to walk out the door at the end of the day. Though she still has concerns about the use of restraints and seclusion, she says when an incident happens, the administration is transparent and quick to respond.
Dan Wathen agrees. He's the court-appointed master of a consent decree that requires certain rights for Riverview patients. "Well, the reporting has improved drastically," Wathen says. "First of all, they have a very clear understanding that all incidents have to be reported."
Despite these improvements, other issues persist. As Harper provided a tour of the hospital, one patient called out to him. "I have not seen the fruits of your labor one iota!"
This patient, who prefers to be called by his Muslim name, Abdul Ar-Rahman, says the staff culture at Riverview hasn't changed since Harper took over.
"They're still apathetic. They're still apathetic to our needs," he says. "There's no active treatment plan. I have not received active treatment for over a year here. I've been stuck on this unit, and that unit, which is most acute unit."
That unit is Lower Saco, where the most acute forensic patients stay. Harper acknowledges some patients, like Ar-Rahman, don't have access to all treatment options.
"The challenge there is, although he's thoughtful and articulate, when his behavior becomes more manageable, he will have access to much greater and richer diversity of treatment options than he's had in the past," Harper says.
But patient advocate Kristina LaChance says patients shouldn't have to meet a standard of behavior to access treatment. It's an issue that crops up more and more as the balance of patients walking through Riverview's doors have tipped toward the forensic side - those who come through the criminal justice system.
Many current patients also have complex issues - traumatic brain injury, developmental disabilities, dementia - on top of mental illness. At the same time, Harper says the hospital barely has enough staff, all of whom need more training. Court Master Dan Wathen says many positions are filled by temporary workers.
"As an institution, it would be far better to have psychiatrists who are there - that's their full time position," Wathen says. "They're not just there for a period of three or four months, and then somebody else comes in, and then somebody else comes in."
"Riverview is a perfect example of what happens when you slowly erode the funding," says Jenna Mehnert, the executive director of the National Alliance on Mental Illness in Maine, "when you don't have quite the same number of staff, when you can't provide staff with evidence-based models of training because it costs more, when you can't hire an extra clinician or psychologist because those staff lines are frozen. And you do that every year - a little less, a little less, then you end up with how we found ourselves in the situation of Riverview."
Jay Harper is working to improve these issues. He's expanded an internship program to boost the number of psychologists at Riverview and to cultivate future employees. He's also converted a storage room into a staff classroom, and set up interactive TVs for live case conferences with Geisel School of Medicine at Dartmouth.
Riverview remains uncertified by the Centers for Medicare and Medicaid Services, but federal regulators could show up any day. Harper says he's looking beyond just recertification, and envisions Riverview as a center of excellence.
Jenna Mehnert of NAMI applauds those efforts. But she says Harper will need additional state funding to make it all happen.
