April 06, 2020

Mental health care: The future hits home > BMHI’s role is focus of Bangor forum

BANGOR — Will it close or won’t it?

In the midst of complicated debate about the best place to care for people with mental illness — in the community or in the hospital — that’s what people want to know about Bangor Mental Health Institute.

The answer, according to the state Department of Mental Health, is that BMHI will stay open with fewer patients.

Yeah, sure, say some cynical folks who put little stock in that promise. Their confidence was shaken last month by an announcement that in coming months 62 of the hospital’s 400 jobs will be cut.

“There’s an idea that this is a covert attempt to weaken the institution and ensure it will close. That is not the case,” said Melodie Peet, the latest state mental health commissioner to try pushing Maine’s mental health care out of institutions.

She will be at BMHI today for a 4 p.m. public forum in the hospital auditorium, called by the City Council, where legislators, employees and others will discuss the future of mental health care in Bangor.

Local officials say dialogue to date has been lacking. Legislators, who have authority over the hospital’s budget, felt they should have been consulted on the plan to cut positions. They asked Peet to explain her vision this week at a meeting in Augusta.

“We think the appropriate role of hospitals is short-term backup for people who are out living better lives in the community,” she said.

Ten years from now, “we’re not going to see people living their lives in state hospitals, and I think that’s a good thing,” Peet continued. “But we’re always going to have some baseline inpatient capacity.”

An assessment last summer of the 140 patients at BMHI found 80 who do not need hospital care, including some who have lived there for years, Peet told the Bangor representatives. Discharge plans have been developed for them, and the department hopes to move many to community placements in group homes or supervised apartments by June.

Corresponding staff members will be phased out along the same time line, with hopes that most positions will be vacated naturally when people retire or resign before the summer deadline. Total capacity will drop by 50 beds.

The big question Peet heard from legislators Monday was if enough group homes and supervised apartments will be ready by summer to absorb the mass migration.

“I would ask if there are adequate resources now to handle the number of mentally ill people who are already out there, with the number who are in homeless shelters,” said Rep. Elaine Fuller, D-Manchester.

The commissioner acknowledged the need to develop more capacity in the community and said the state will solicit proposals in February and award contracts in April to add to existing housing for about 40 of the discharged patients.

In establishing homes for this group of 40 with mental illness, Peet said she will discourage new construction and encourage proposals adapting existing state-owned properties in Bangor.

The other 40 patients include about 10 mentally ill people who will move to existing state-operated residential programs that meet their needs, and about 30 people who are wards of the state Department of Human Services. They are appropriate candidates for care in nursing homes, to be paid for by DHS, said Peet. Talks with nursing homes are under way.

“Basically they’re taking the approach that if they take this step, the bold move of closing beds, it will force a response in the community,” said Sen. Robert Murray, D-Bangor. “I think that’s a dangerous approach.”

Long history

The move away from mental institutions has been in progress for more than 30 years, since the “warehousing” of mentally ill people was widely rejected in the 1960s. At the same time, major pharmacological advances made independent living an option for increasing numbers of patients.

Between 1970 and 1975, Maine’s two state mental hospitals, BMHI and Augusta Mental Health Institute, discharged nearly 2,000 patients.

In 1975, then-Gov. James Longley proposed closing BMHI. Protest erupted, with accusations of regional bias. The plan was soundly rejected by the Legislature, but fears lingered.

Public confidence in AMHI eroded during the 1980s, when nursing shortages and patient deaths brought federal investigations. In 1995, soon after her appointment by Gov. Angus King, Peet proposed closing AMHI. Legislation was swiftly enacted to prevent that closure.

The hospital stayed, and so did residual resistance to the commissioner. Two years ago, Peet barely survived a no-confidence vote by the Legislature’s Health and Human Services Committee, whose Republican members criticized her communication style.

But Peet, a former mental health administrator in Connecticut, has not backed down. Backed by task force studies recommending the hospitals’ closure, she has continued to tout the benefits of hospital downsizing, both in cost and life quality.

Maintaining a mentally ill person in a hospital costs $150,000 per year, more than three times as much as a placement in an apartment or group home, Peet told Bangor legislators. More than half of Maine’s mental health budget is spent on two big institutions serving an estimated 5 percent of the state’s mentally ill population.

She also expressed concern about how long patients stay at BMHI. Nine months was the average stay for the 80 patients whose release is in the works. The average stay at mental hospitals nationwide is two weeks, she said.

Maine also has more hospital beds for its patients than some states with larger populations.

“My guess is that ultimately we’re looking at 50 beds in Bangor, and maybe 50 beds statewide 10 years from now,” she said.

In an interview earlier this winter, Peet said she was unsure if the BMHI campus, the century-old brick hospital on the hill, was the best place for future care to be carried out.

“It’s a huge old building, with lots of corners, from a time when people were warehoused,” she said. “There comes a point at which you’ve gone as far as you can go.”

Hospital as home

On the inside, BMHI fails to make good on the stereotype of a “dark, awful place full of scary people,” in the words of Jill Long, director of rehabilitation services. Like most employees, she is friendly and open with a visitor, eager to share the good things going on in the complex.

Passing under the words “Bangor State Hospital” carved in stone above the front door, the hall opens onto a big brick fireplace with black andirons. In the nearby family resource room, a poster lists famous people from Van Gogh to Winston Churchill over the motto “People with mental illness enrich our lives.”

On the vocational wing, patients are paid to refinish antique furniture while learning vital job skills like how to get along with a boss. Each morning in the Learning Center, next to the library, residents from all over the building gather to drink coffee and talk about current events.

Jack, a big, aloof tiger cat, has the run of one ward for elderly patients. Washers and dryers allow day-program participants to bring in their laundry. Just like on the outside, the daily routine is spiked with special events: a dance, a shopping spree, an ice-fishing trip.

Along one hall, impending change hangs on a bulletin board, where bright color photos of local group homes show the future for many patients. Staff say the prospect of moving out is most disturbing to those who have called BMHI home for 30, 40 or 50 years.

“Here, they know where the services are, they can walk to them, and they know the people there,” Long said.

Among staff, “there’s genuine concern about what’s going to happen to patients,” she said. “There’s not a lot of faith in what’s going to be built.”

If appropriate housing is built, there is cause for optimism. Of patients moved to the newest group homes, few have returned to the hospital, and those who have needed a “tuneup,” not a long stay, Long said.

About 300 patients are admitted annually at BMHI, and about the same number are discharged. Roughly half of new admissions are turned around in two or three weeks, while the other half need care for several months, according to Long. “It’s not two or three years any more,” she said.

Almost from the first day, patients are prepared for transition out of the hospital, learning how to cook, apply for jobs or get a library card. Staff agree that with the right programs, many could succeed in a less restrictive setting.

First, though, they want specific information, sure to be a hot commodity at today’s forum. “Will it close?” may be the first question, but hope is running high for deeper discussion of a multidimensional issue, involving individual lives.

“I’m discouraged by the simple images, `community good, hospital bad.’ For some it is, for some it isn’t,” BMHI psychologist Jeff Aston said. “There’s no simple answer.”

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