Panel studying violence in health care settings focuses on lack of resources

AUGUSTA – The urgent need for additional behavioral health care resources was again at the center of the second meeting of a legislative working group on Tuesday studying the process of bringing criminal charges against perpetrators of violence in institutions. health care.

Task Force members and guest speakers painted a picture of Maine’s behavioral health care system in which hospitals, residential and outpatient facilities, and prisons are understaffed and lack appropriate resources to manage people who become violent and who may have a mental illness.

The question then becomes finding the right place for these people – if there is one available – and whether they should be held accountable through the criminal justice system.

The task force must “be very careful not to criminalize mental health,” said Malory Shaughnessy, executive director of the Alliance for Addiction and Mental Health Services.

Healthcare facilities cannot use a mental or behavioral health diagnosis to screen for acts of violence nor does it indicate that a person will act violently, said Dr. Michael Melia, chief of emergency medicine. at Eastern Maine Medical Center in Bangor.

At the same time, “we cannot expect staff in these facilities to suffer these assaults simply because they have a diagnosis.”

But as Shaughnessy and others have pointed out, many organizations lack the staff and capacity to make certain capital investments that would make facilities safer for patients and staff.

“I feel like this is set up as a problem between hospitals and behavioral health facilities and then we call the police when we can’t deal with it. And it’s really a resource issue,” said Betsy Sweet, an attorney with the Behavioral Health Community Collaborative, which represents mental health agencies.

“If we can manage people and their behaviors with additional resources (and) without criminalizing them, that’s really critical for this committee,” Shaughnessy said.

As it stands, law enforcement is “the default after-hours and weekend social service provider,” Cumberland County Sheriff Kevin Joyce said.

“The reality is that we’re using prisons to make up for” what’s missing in Maine’s mental health system.

“We’re trying to mitigate mental health crises,” Joyce said. “And really until February, at least in Cumberland County, there were no options other than emergency service.”

Joyce said the Spurwink Lounge Crisis Center in Portland relieves some of the pressure on law enforcement in the area, “but my colleagues in other parts of the state don’t have that luxury. “.

Dr. Michael Kelley, chief of behavioral health at St. Mary’s Health, said that when it comes to people with some sort of mental disability who become violent with staff, he said it’s appropriate that ” we don’t want to criminalize mental health.”

However, “if we don’t draw the line somewhere, unfortunately that sends the message that people can do whatever they want,” and as a mental health provider, he said that sends the message to those people. that they are not of the same type. of no one like anyone else.

It also sends a message to staff that they do not deserve protection, he said.

As a physician, he thinks about a patient’s mental capacity to understand the choices they make, the consequences of those choices, and whether they know right from wrong.

When it comes to deciding what that patient’s capacity was and whether to involve law enforcement, “it’s not an easy decision,” Kelley said. “As providers, we are very committed to protecting our patients…but we have to protect people.”

But when it comes to the justice system, the onus is on the state to prove beyond a reasonable doubt that a person acted with full capacity, Maine District Court Judge Andrew Robinson said.

“All of these protections and standards reflect the significance of the consequences of being convicted of a crime,” he said.

The high burden of proof and other factors, such as an individual’s mental state, make bringing charges in these cases difficult – or at least incredibly complicated.

Robinson said he wanted to describe this process because it’s “important for people to know what challenges exist for a prosecutor making these decisions.”

Frayla Tarpinian, assistant district attorney for Kennebec and Somerset counties and a member of the task force, said she understands why health care providers or employers, who are “thoughtful and attentive to the cases they have presented”, feel frustrated.

“When they’re not being prosecuted, it seems to them and they feel like we don’t care about them,” she said.

Prosecution decisions are unique and vary from case to case, office to office.

“When we talk about prosecutions, you’re in very interesting territory because it’s really up to a prosecutor to decide whether to charge,” Tarpinian said.

As she did at the task force’s first meeting in August, the assistant prosecutor questioned the ‘effectiveness’ of using the criminal justice system to deter violence in care settings health.

“I would really like to fight with the idea that if we go after these people more, we’re going to stop the violence,” she said.

The working group is due to meet at 9 a.m. on September 27. the hybrid meeting will be held in person at the State House in Augusta and will be streamed online. This is the first time the task force will hear public testimony.

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