AUBURN — One day recently, the Androscoggin County Jail housed:

An 80-year-old man with dementia so severe that he wasn’t able to recognize his own lawyer.

A man charged with theft who became catatonic behind bars.

A woman who, according to an evaluation by St. Mary’s Regional Medical Center, was schizophrenic and possibly suicidal. The hospital warned the jail it should be prepared to deal with that.

Except it wasn’t prepared to deal with her or the other two inmates or any of the other people with severe mental illnesses it had in its custody. None of the jails in the state are. Because they aren’t psychiatric hospitals.

Officials say it’s a scene playing out in every jail in every county of the state, and at least one attorney is calling it a “crisis.”

“I believe mental health issues now are being criminalized,” said Androscoggin County Sheriff Eric Samson, who oversees his county jail. “They’re being placed here, where we don’t have resources or the expertise to deal with these people appropriately. I try to look at things like it was my family member. I’m sorry, but if my children develop schizophrenia, this is not where they need to be.”

Advocates, families, jail officials, lawyers and lawmakers throughout the state say the problem is widespread and pervasive: people with mental illnesses languishing in county jails — without skilled care, therapy or even, sometimes, medication — because, while they’ve been arrested for a crime, jails aren’t meant to handle them.

The result, they say? More crime by people whose mental illnesses have been left untreated. More drug addiction. More cases clogging the court system. More problems for beleaguered and cash-strapped jails. More anguish for people with mental illnesses and their families and more frustration for law enforcement officers who believe the man or woman they just arrested desperately needs help but they can’t provide it.

“There is that temporary relief for the outside when that individual is taken into custody and ends up here, but it’s not the right thing to do,” Samson said.

At the same time, many say, the places that were created to handle Mainers with mental illnesses, the state’s psychiatric hospitals — Riverview in Augusta and Dorothea Dix in Bangor — aren’t taking forensic patients, those connected to the criminal justice system. Or, at least, aren’t taking enough to make a difference.

Getting a bed for a jail inmate in an actual state psychiatric hospital, either to be evaluated or stabilized, can take months, if it happens at all.

“I don’t think in my five years I’ve gotten anybody to Riverview,” Oxford County Jail Administrator Ed Quinn said.

And the problem doesn’t simply end when those inmates get out of jail. Many say the state’s Intensive Case Management Program, which is supposed to help inmates with severe mental illnesses prepare for their release and identify health care, counseling, medication and other necessities, has shriveled in recent years.

That means more people end up right back in jail because their untreated mental illness quickly flares again. It’s a cycle jail officials and lawyers see repeated over and over.

“It doesn’t feel like the criminal justice system is the appropriate tool to be dealing with mental health issues, but we appear to have become the safety net,” said District Attorney Andrew Robinson, who is responsible for Androscoggin, Oxford and Franklin counties. “It’s frustrating for those of us who want to do justice and feel like we’re not properly equipped to handle the mental health component. It’s not a fair fit.”

Many people say the issue is complex, involving money, resources and priorities. No one has an easy answer, but many believe the state — which oversees both public mental health hospitals and the Intensive Case Management Program — bears a large part of the responsibility.

“It really is, I think, becoming a crisis situation,” said Lewiston defense lawyer James Howaniec, whose clients have sat in jail for months despite court orders sending them to a state psychiatric hospital for evaluation.

The state, for its part, is silent on the issue.

Maine Department of Health and Human Services officials repeatedly refused to answer questions for this story. (See related story.)

‘A freaking train wreck’

Those involved with the issue are quick to draw a line between criminals who may happen to have mental health issues and people who run afoul of the law because they have severe mental illnesses.

The first should be behind bars, they say. The second should get treatment.

“I rob a bank and I’ve got depression: tough,” said Jenna Mehnert, executive director of the Maine chapter of the advocacy group National Alliance on Mental Illness, or NAMI. “I have schizoaffective disorder, which is a combination of bi-polar and schizophrenia, and I’m in a manic state and I’m speeding because I’m trying to get to Canada because I have the delusion that everything is going to be better once I get to Canada. That’s criminalizing mental illness.”

That, she said, is what happened to a 30-year-old man who ended up in the Franklin County jail in Farmington recently, charged with driving to endanger and failing to stop for police. By the time his family reached out to NAMI for help, the man had been in jail for two weeks. Neither he nor his family could afford bail. 

Caught in the grip of a manic phase, the man hadn’t slept since being arrested, hadn’t received any psychiatric care and was being kept in solitary confinement, Mehnert said. When he saw her, he cried.

“It was a freaking train wreck,” she said.

The man — who is from New Jersey and has a master’s degree in architecture — wants to be hospitalized for treatment, Mehnert said.

“My staff and I are trying to figure that out. There’s no easy answers in a case like this,” Mehnert said. “Ideally, in these two weeks he’s been in jail he would have seen a psychiatrist, he would have gotten some medication. He would be stabilized right now.”

According to the National Institute of Mental Health, surveys from 2002 and 2004 show about 64 percent of jail inmates across the country have mental health problems. Only 17.5 percent receive treatment while behind bars.

In Maine, many say the state’s struggle to deal with people with mental illnesses goes back decades. A 1989 a class-action lawsuit against state leaders and the Augusta Mental Health Institute (now the Riverview Psychiatric Center) led to a legally binding consent decree that sought to overhaul and improve Maine’s mental health system.

Maine — like much of the rest of the country at that time — began shifting away from institutions in favor of outpatient care, which kept people in their communities.

“The institutionalization process, there was a reason why they dismantled that. That was horrible. That was a nightmare,” said Robinson, the district attorney. “Ironically, I think this is better, but it is not the system people envisioned. It does not meet the needs of people with mental health (problems).”

Twenty-five years later, Maine has made progress, but it still hasn’t fulfilled the consent decree’s requirements. And many say the robust community supports that were supposed to be there for mentally ill Mainers either never materialized or have been eaten away by budget cuts.

Sheriffs say that’s led more people with mental illnesses to jail. Many also have substance-abuse issues.

“If we don’t provide basic services, they end up in the ERs or they end up in the jails, where it’s costing all of us far more money and it’s not the care and support many of them need or deserve,” said Penobscot County Sheriff Troy Morton. “It’s frustrating.”

On one recent day, 59 percent of inmates at the Penobscot County Jail in Bangor were taking psychiatric medication; 20 percent were taking two or more medications. 

“When I started as a corrections officer (25 years ago), training was all about security and making sure that people didn’t escape and fights didn’t occur,” Morton said. “Today, your primary things are teaching signs and symptoms of suicide and detoxification.”

Although jails supervise all inmates and will pull some into protective custody cells or cell blocks if there’s a concern, many staff worry about their ability to keep people with mental illnesses safe behind bars. 

“There’s this belief that jails are safe places, and they’re not,” Samson said. “These people are extremely vulnerable. Even if they’re not in crisis, they’re being exploited. Whether it’s phone calls or canteen or who else knows what’s going on. And are they reporting it appropriately?”

“(Other inmates) take their meal trays. There can be sexual assaults,” added Lane Feldman, who deals with Androscoggin County jail security and assessing new inmates. “As soon as they come through our walls, we know they don’t belong here; they know they don’t belong here. But there’s just a big, huge target on their back.”

Court-ordered to the hospital, still in jail

Jails typically maintain relationships with local mental health agencies, which can help jails deal with mentally ill inmates, especially if the inmate was a client of the agency. They also can bring obviously mentally ill people to the local emergency room for assessment after an arrest — though that often results in a diagnosis that the jail can’t treat or do anything to remedy. 

Courts can order inmates into mental health treatment, but that doesn’t always work, either. At least not quickly.

“I’ve got two people that are court-ordered,” Cumberland County Sheriff Kevin Joyce said. “They’re court-ordered by a judge and I still can’t get a bed for them.”

Jails keep health care workers on site, some with mental health expertise, but how many workers — and how many hours a week they’re available — depends on the size of the jail and its budget. 

Jail leaders and mental health advocates say too little state money and a state-imposed cap on property-tax funding for jails has left the jails with little money to pay for the specialists they need.

“Just like they start watering down the coffee, they start cutting out the services. Not because they want to but because they simply don’t have the funds,” Mehnert said.

Androscoggin County Jail, which handles about 5,000 intakes a year, has a nurse on site 16 hours a day and a doctor who handles sick calls about three hours a week. For mental health, it has one licensed clinical social worker 40 hours a week and a psychiatrist who provides tele-psychiatry services one hour each week.

One day last week, 30 percent of the jail’s 129 inmates were taking at least one psychiatric medication. Another handful of people had been prescribed medication but refused it. 

That count didn’t include one recent inmate: a man who was charged with theft in June. Police said he repeatedly stole food even though he had the means to pay for it, and his mental state worsened during his months in jail awaiting trial. Eventually, he became catatonic.

“Sometimes they’re kind of stable and they deteriorate over time. Or the ones that are borderline, all of a sudden deteriorate and then they become assaultive, violent. Or their health deteriorates, like this individual recently,” Samson said.

The jail started seeking a bed in a psychiatric hospital for the man in September. He didn’t get one until the first week of November.

And even then it wasn’t through traditional channels.

Ultimately, Samson said, the District Attorney’s Office worked to have him bailed on the condition he went to St. Mary’s Regional Medical Center. From there, because he was no longer a jail inmate, he was able to be involuntarily committed.

“You’d like to think you get on a list and your name is called in a couple of days,” Samson said. “We know that doesn’t happen.”

Limited options

Those involved in the issue say jails have three outside options for inmates who are severely mentally ill: Dorothea Dix, Riverview or the new intensive mental health treatment unit at the Maine State Prison in Warren. 

Although the Dorothea Dix facility can take jail inmates, it doesn’t often. It has a good reputation, but has been downsized in recent years, according to Mehnert at NAMI Maine.

“Constantly, people are cutting beds out of Dorothea Dix,” Mehnert said.

Riverview is a newer facility with a 44-bed forensic section, divided to serve acute patients at a unit called Lower Saco and more stable patients at a unit called Upper Saco. The hospital has struggled in recent years, including losing its federal certification and facing court scrutiny for failing to admit mentally ill jail inmates.

As court master, Daniel Wathen is appointed by the court to oversee the implementation of the consent decree. He files progress reports with the court every six months and shares those with the Legislature. As part of his authority he can make recommendations that become binding unless DHHS challenges them in court.

Wathen said he may make new recommendations on Riverview soon.

A September site visit for the consent decree noted staffing problems at Riverview. In an October letter to DHHS, Wathen advised that “in many respects the management of Riverview has failed to make satisfactory progress” in promised changes.

In a Nov. 5  written response, DHHS acknowledged that “there’s always room for improvement” but said that it “does not fully concur with the findings.”

Although Riverview is supposed to be one of the options for jails, Wathen said the hospital hadn’t taken any jail transfers in the past year or two.

“They were either full or they were operating at capacity considering the behavioral issues they were dealing with on the forensic side,” Wathen said. “Only recently did they start taking jail transfers again, which is a good thing.”  

He said in the past couple of months Riverview has, in particular, reduced its waiting list for in-depth evaluations — assessments that are typically court-ordered to determine a person’s mental state. It now has one or two jail inmates waiting for evaluation.

But while there’s been some headway, Wathen said, Riverview’s primary charge still isn’t to take jail inmates; it does it to help out.

“They genuinely are trying to do what they can in their capacity, but it’s a very limited capacity,” Wathen said. 

The Maine State Prison’s new mental health unit has 32 beds, only about two dozen of which can be used because of a staffing shortage. Two of those beds are set aside for emergencies.

The unit serves prison inmates, jail inmates who are beyond the capacity of their local jails — especially if they’re violent — and Riverview patients who have major mental illnesses and are too aggressive for the hospital to handle. The prison unit can provide full treatment and counts among its staff a psychiatrist, a psychologist, a team of master’s degree-level clinicians and specially trained corrections officers.

Since the unit opened in February 2014, Maine Department of Corrections Commissioner Joseph Fitzpatrick said, jails have made 30 requests to place people there. The prison said yes to 29.

Sheriffs and jail administrators say the new unit is good to have and treatment there has been successful, but wait times have been long and the unit is not big enough to handle such a large, statewide problem.

“Twenty beds isn’t even a Band-Aid,” said Feldman at the Androscoggin County Jail. “They could have done 200 and that maybe wouldn’t have even been enough.”

Fitzpatrick agreed that his help is limited.

“It’s a finite number of beds, so it does not really take the place of more extensive services in the county jails,” he said. “I think that need is very real.”

‘Crossing our fingers’

Even when inmates get help behind bars — even when they leave stable — sheriffs and advocates say too many people cycle right back in. Just like there’s not much help on the inside, they say, there’s not enough help on the outside.

“When they’re released, we’re opening the door, we’re crossing our fingers hoping they’re not going to come back,” said Joyce, the sheriff in Cumberland County.

Many say the state’s Intensive Case Management Program is a big reason. The program is supposed to help severely mentally ill inmates get ready for their release, but sheriffs and others say they’ve watched the program shrink in recent years.

“We’re already down from three (intensive case managers) to one,” Samson said. “And we’re sharing (that one) with Oxford County.”

Through Samson, that intensive case manager declined to comment for this story. Samson was told DHHS would not allow it. 

DHHS spokesman David Sorensen initially said the department would answer questions posed in writing. Several days after receiving those questions, he said DHHS would not answer them.

Emails and a certified letter sent to DHHS Commissioner Mary Mayhew went unanswered.

Because DHHS would not answer questions for this story — including questions seeking basic information about the state’s Intensive Case Management Program — it’s unclear how many intensive case managers there are in Maine or whether all mentally ill inmates have quick, easy access to them. It’s also unclear what the state is spending on the problem. (See related story.)

Wathen said DHHS recently proposed a rule change to get people connected to an intensive case manager within seven days.

“If there’s a delay in the connection of services and these people are on the streets, you either have to provide service promptly or they’re gone,” Wathen said.

Sheriffs and advocates say it doesn’t help that some inmates don’t have access to MaineCare when they get out because they don’t qualify as childless adults. Others, they say, lose their MaineCare, food stamps and other support while behind bars. Without help from a case manager or someone else, people who are mentally ill often struggle to go through the process to get those supports.

“They get out with less resources than when they came in,” Samson said.

Laurie Churchill Coutts of Brewer knows that situation both professionally and personally. She worked for years as a juvenile probation officer throughout Maine and as a drug and alcohol counselor. Her 30-year-old son battles mental illness — including depression, anxiety and bipolar disorder, she said — and has been in and out of jail most of his adult life.

Recently, he was arrested again, this time on drug charges. Coutts believes her son turns to illegal drugs as a way to self-medicate.

“It’s too much for one person to bear,” she said. “It’s a life-and-death thing every day. Every day I would never know. Is my son going to be alive or, God forbid, am I going to get that call or have an officer at my door telling me he’s deceased?”

Solutions?

Those involved say there’s no easy answer.

Some believe the state should kick in more money or drop the property-tax funding cap imposed on jails so they can raise the money they need on their own. With more money, they say, jails can hire more specialists to help with inmates who have mental health problems.

But that won’t do much for people who need in-depth evaluations or are so severely mentally ill that they need the intensive support of a hospital. And it doesn’t fix what some see as a greater problem in dealing with people who are mentally ill in Maine.

“There is no silver bullet” said Wathen, the court master. “(There are) a lot of management issues that the state has not dealt with satisfactorily. I’m sure that there are needs for money in various areas, but just to put the money in without correcting management is not going to do it.”

While he believes the state has made progress in its efforts to help people who are mentally ill, he said Maine “still has a long way to go.”

“I know it’s frustrating at times. I get frustrated,” he said. “There are people within the mental health system who are really well-intentioned, who do good work. It’s really the inability to spread that over the entire state, over the entire system.”

Some involved in the issue believe at least some jails should get specialized units for inmates with mental illnesses. But some jail officials are concerned that would muddy their situation even more. Jails were created to be correctional facilities, they say, not hospitals.   

Some believe the state needs to dramatically improve and increase community resources so people with mental illnesses have a better chance of getting stable and staying stable — and staying out of jail in the first place. But that costs money and it’s unclear whether the state could afford it.

And even when money is available, it can be hard to draw specialists to Maine, especially to rural areas of the state. All of Franklin County, for example, has one psychiatrist, according to the mental health agency there. “There isn’t anybody to hire,” said Dalene Sinskie, executive director of Evergreen Behavioral Services in Farmington. 

Some believe the state should establish a secure forensic unit somewhere, but there have been concerns over the details. And mental health advocates have worried that the state will try to place people there who have been found incompetent to stand trial or not criminally responsible for their actions — people who legally belong in a hospital, not a jail unit. 

“We just want to make sure the individuals are receiving treatment, not punishment. Prison is punishment, a hospital-like environment should be treatment,” said Kevin Voyvodich, a lawyer for Disability Rights Maine, an advocacy group in Augusta. 

DHHS and Gov. Paul LePage have made proposals of their own. One came earlier this legislative session when the governor submitted a bill to establish a “forensic treatment fund” to pay for a free-standing behavioral assessment and safety evaluation unit. That bill earned a split vote from the Health and Human Services Committee and died between houses.

A number of lawmakers said the one-page bill, LD 1428, was brought forward at the last minute and provided virtually no details about the proposed facility, including whether it would privatize care.

It is unclear whether LePage will make another push. The governor’s spokeswoman, Adrienne Bennett, did not respond to requests for information about it.

Other bills this year have sought to create a new forensic unit or to otherwise help mentally ill jail inmates, including LD 440, which sought to establish a forensic unit at either the Cumberland or Sagadahoc county jails, and LD 657, which proposed increased funding for mental health care services in jails. The first was tabled. The second received a split vote in the Criminal Justice and Public Safety Committee and died between houses.

State Rep. Mark Dion, D-Portland, co-sponsored the bill that would have established a forensic unit in the Cumberland or Sagadahoc county jails. He served as Cumberland County sheriff for 12 years until he joined the Legislature in 2010.

On average back then, he said, three-quarters of his inmates were taking a psychiatric medicine. Some days he hit 100 percent.

Although there’s no immediate solution to the problem, he said, “I believe we can get there as soon as we realize it’s going to be the administration and the Legislature to move that forward.”

“In the meantime, we’re sacrificing the best interest of families that are in crisis. For them, it’s an immediate problem. They deserve our best work,” he said.

State Rep. Drew Gattine, D-Westbrook, co-sponsored both bills. During this second half of the legislative session, which is reserved for emergency bills, he’s submitted a new proposal that would require a study on the state of mental health care for both forensic and civil patients, as well as an assessment of the state’s needs and options.

“Let’s look at this and solve our problem the way a problem should be solved,” Gattine said. “Let’s start by trying to figure out what do we need? What’s our current capacity? What’s our current need? What do we think it might cost? How are we going to protect people’s rights?”

State Rep. Peggy Rotundo, D-Lewiston, agreed. 

“Many of us feel that we really do need a greater comprehensive assessment to figure out the best solution for addressing a very, very significant need in the state,” she said.

Gattine’s proposed bill was rejected by the Legislative Council in a party-line vote last month, which prevented it from being drafted into a bill this session. Gattine appealed the decision; on Thursday, the Legislative Council put off making a decision on his appeal with no discussion. The council next meets on Dec. 17.

Although Gattine would like his proposal to move forward, he said it’s the discussion he wants most.

“I think we have to be very open in how we discuss this,” he said. “The conversation about how Maine cares for people with mental illness has a long and very painful history. A large portion of Maine’s mental health system still operates under a court order because of the fact we, the collective ‘we’, have failed these people who are ill for so many times. It’s an awful part of our history, but it’s a part of our history. It needs to challenge us to continue to do better.” 

In Androscoggin County, Samson put it another way.

“What we’re doing now is not right,” he said.

[email protected]

DHHS declined to talk

The Maine Department of Health and Human Services oversees the state’s public mental health hospitals and its Intensive Case Management Program, which helps severely mentally ill jail inmates plan for their release.

Over the past two weeks,? DHHS officials either declined to comment or repeatedly ignored requests for information related to the statewide problem of people with mental illnesses in Maine county jails. The silence ran from a local caseworker up to DHHS Commissioner Mary Mayhew.?

Androscoggin County Sheriff Eric Samson said a local intensive case manager for the Androscoggin and Oxford county jails declined to comment. Samson said he was told DHHS would not allow it.

DHHS spokesman David Sorensen refused to allow an in-person interview with anyone from the department to talk about the Intensive Case Management Program. He initially agreed to answer questions posed in writing. But nearly a week later, with those questions in hand and a separate request to talk about the state’s psychiatric hospitals, he changed his mind.

“We’re going to decline to participate in your story. Thanks for reaching out,” he wrote in an email.

Emails and a certified letter sent to Mayhew went unanswered, as did emails sent to the spokeswoman for Gov. Paul LePage.

The silence meant many key questions went unanswered, including:

* How many intensive case managers there are in Maine and whether mentally ill jail inmates have quick, easy access to them;

* How much the state spent and is now spending on the Intensive Case Management Program;

* Whether DHHS leaders agree there’s a problem with long wait times for jail inmates to get beds in a state hospital;

* Whether the governor plans to again push an earlier, failed proposal to establish a “forensic treatment fund” to pay for a free-standing behavioral assessment and safety evaluation unit;

* Whether the governor has any other plans for handling the problem of people with mental illnesses in jails.

— State Rep. Drew Gattine, D-Westbrook

— State Rep. Mark Dion, D-Portland 

 — Lewiston defense lawyer James Howaniec, whose clients have sat in jail for months despite court orders sending them to a state psychiatric hospital for evaluation.

— Jenna Mehnert, executive director for NAMI Maine

 — Laurie Churchill Coutts of Brewer, whose son is mentally ill and has been in and out of jail most of his adult life

— District Attorney Andrew Robinson

— Eric Samson, Androscoggin County Sheriff

— State Rep. Peggy Rotundo, D-Lewiston


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