Editor’s note: this is the second installment of a multi-part series.

AUGUSTA — There is general agreement that treatment is important in keeping seriously mentally ill people from committing violent acts.

A 2016 compilation of studies by the Treatment Advocacy Center states: “No evidence suggests that people with serious mental illness receiving effective treatment are more dangerous than individuals in the general population.” Almost all violent acts by the mentally ill are committed by individuals not being treated, “many of them also abusing alcohol or drugs.”

The studies go on to show that if left untreated, seriously mentally ill people commit acts of violence at around three to four times the rate of the general population.

Burns tells of one man frequenting a shelter who, in four years, had 144 “contacts” with the police and had been in Riverview three times. Another, a very young man, was discharged directly from Riverview to Portland’s city-run Oxford Street Shelter without a medication-management or housing plan. He was transferred quickly to Preble Street’s teen shelter, where within days he became threatening and violent. The police had to “tase” him five times in the shelter’s courtyard.

“We’ve got an awful lot in common with the police,” Preble Street’s Swann remarked. “We consider them our peers in doing ‘front-line’ work.”

Jail, prison deficiencies

The nation’s well-known turn to mass incarceration in the last 40 years has paralleled closely the equally famous “de-institutionalization” of the mentally ill from the old, huge mental hospitals.

A 2015 report by the Vera Institute of Justice, “Incarceration’s Front Door,” describes how, nationally, those coming into the jails — frequently, not for the first time — tend to be mentally ill, addicted to illegal drugs, homeless, and poor. According to another Treatment Advocacy Center study, by 2014 there were ten times more mentally ill people in prisons and jails (383,000) than in state psychiatric institutions (38,000).

At the Lewiston forum, Sheriff Morton said his jail has become “the largest mental health detoxification center in northern Maine.” The jail technically has a capacity of 157 inmates, but on that June day there were 193 in custody.

The federal Substance Abuse and Mental Health Services Administration (SAMHSA) reported in 2011 that nationwide around 80 percent of prison and jail inmates had either mental health or substance abuse problems and 41 percent of state prisoners and 48 percent of jail inmates had both.

In Maine, overburdened sheriffs try to send their most violent mentally ill inmates to the state prison’s Intensive Mental Health Unit, or IMHU, even though these people may have only been charged with, rather than convicted of, a crime.

The prison has its own sizeable resident population of mentally ill inmates. Corrections Commissioner Joseph Fitzpatrick, a clinical psychologist, said more than 40 percent of prisoners take psychotropic medicine.

The prison has long been plagued by suicide attempts, grisly self-injury, prisoner-on-prisoner assaults, and the occasional successful suicide or murder. In the prison’s mental health unit in 2013, one inmate, Guy Hunnewell, killed another, Alan Powell, by smashing him repeatedly with an electric guitar.

Other state lockups have similar problems. Last year in the Long Creek youth prison in South Portland a very mentally ill 16-year-old boy, Charles Maisie Knowles, hung himself. A Corrections Department report earlier this year noted that 85 percent of the young people at Long Creek had three or more mental-illness diagnoses and that a similar number had substance-abuse histories.

The IMHU has begun admitting that it can’t deal with some violent people and has started sending them to a national infirmary for mentally ill prisoners 1,000 miles from Maine: the Columbia Regional Care Center in South Carolina.

In the mental hospitals

The consent decree made a special effort to correct the horrors of AMHI, which once held 1,800 people, many committed for years or even decades with little or poor treatment. The state’s secondary mental hospital, the Bangor Mental Health Institute — now called Dorothea Dix Psychiatric Center — once held 1,100 inmates in similar conditions. (The facility was renamed for Hampden native Dorothea Dix, who 150 years ago launched the international movement to take the mentally ill out of the jails and treat them as sick people.)

With only 92 beds at Riverview — roughly half for “forensic patients,” those placed there by a court — state officials admit that it is not large enough to treat all the people who need its intensive care. Dorothea Dix has around 45 patients who need less-intensive care, but in the last couple of years, up to 30 of those have been forensic patients, an overflow from Riverview.

Riverview in recent years has been beset by staff turmoil — high vacancies, high turnover, and leadership changes — as well as violence by patients against other patients and staff. One patient over the last decade committed at least ten assaults on staff and patients.

And largely because the institution treated some patients as if they were prison inmates, with guards using stun guns and pepper spray on them, the federal government in 2013 decertified it as eligible for federal mental-hospital funding.

That resulted in the loss of millions of dollars a year for Maine and, this year, a bill from federal authorities for $51 million that the federal government says the LePage administration improperly spent.

Like the prison, Riverview has begun sending some violent patients it cannot control — after charging them with a crime — to South Carolina.

The “diagnosis game”

Staples’ story of self-harm illustrates how community and institutional deficiencies in mental health care are intertwined.

For some time a “street person” in Bangor, Staples, 66, has a long history of insanity and assaults. In 2015, after attacking staff at Bangor’s Acadia Hospital, a private mental health facility, he was taken to the Penobscot County jail, eventually found mentally incompetent to stand trial and committed to Riverview.

According to Bangor police reports, in justifying his discharge Acadia staff said his “treatment was complete,” his assaults were “behavioral not psychological,” and he had chosen not to control his violent outbursts — though Acadia also told police he had several serious psychological diagnoses.

After Staples attacked a Riverview patient early this year, he was taken to the Kennebec County jail, where he continued to be combative. As recounted in a police report, Riverview’s staff sent him to jail using nearly the same justifying language as Acadia’s had used: His actions were “volitional and not related to his mental illness.”

The language that both Riverview and Acadia expressed is typically “a way for mental hospitals to shift responsibility for violent mental patients to the criminal justice system,” said a prominent national prisoner advocate, Chicago attorney Alan Mills, who calls it the “diagnosis game.”

Kim Moody, who directs Disability Rights Maine, the “protection and advocacy agency” for disabled people, said her group believes individuals “should not be charged with crimes for behaviors for which they were ordered to receive treatment in the very hospital that is now charging them with assault for those very behaviors for which the hospital is responsible for treating.”

Wathen, the former chief justice of the Maine Supreme Judicial Court, said it’s not always so simple: “It’s not inconceivable that some people in Riverview are capable of forming criminal intent” at some stage in their recovery.

‘Shameful’ Care

Staples’ journey is well-documented. From the Kennebec County jail he was sent to the maximum-security prison’s Intensive Mental Health Unit, where he attacked his eyes.

Three months later, the now-blind man was haltingly led before Superior Court Justice Michaela Murphy in Augusta to have his future decided. Justice Murphy accepted his “not criminally responsible by reason of insanity” plea for his Riverview actions and saw him shipped off to South Carolina.

Staples explained his actions to the judge: “God was telling me for my health to perform these acts” or “I’ll lose my soul.”

A Riverview psychiatric nurse practitioner, Miriam Davidson, testified candidly that the facility couldn’t use the special restraints needed for Staples because it was trying to win back federal certification as a mental hospital.

A frustrated Justice Murphy had two words to describe the inability of any Maine institution to take care of Staples: “serious and shameful.”

— Lance Tapley, of Augusta, is a veteran investigative reporter who has written several stories for Pine Tree Watch, a nonpartisan, nonprofit investigative news service based in Augusta. To reach  Lance Tapley, contact@pinetreewatch.org. For more information, visit the website www.pinetreewatch.org.