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Opinion: Legislature Must Address Unsafe Staffing Levels at State Psychiatric Facilities

Andy O’Brien
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PHOTO: Sally Nichols (second from right) with Riverview Psychiatric Center workers at a hearing at the State House in Augusta this week.

Sally Nichols of New Sharon, a mental health worker at Riverview Psychiatric Center and President of American Federation of State, County and Municipal Employees (AFSCME) Local 1825, wrote the following op-ed for the Press Herald to urge the Legislature and Governor Janet Mills to support LD 1761, which would address staffing shortages at Riverview Psychiatric Center in August and Dorothea Dix  Psychiatric Center in Bangor by adding mental health workers to the 1998 special retirement plan. LD 1761 is awaiting funding on the Appropriations table and then will head to the Legislature for final enactment votes.

When the Maine Legislature returns to work this week, Mainers who work with patients with severe mental illness are counting on lawmakers to address a dire staffing crisis in our field. For 23 years, I have worked directly with some of the most dangerous and severely mentally ill people in the state at Riverview Psychiatric Center in Augusta. If the Legislature does not do something to retain and recruit mental health workers at our facility, I fear we can neither physically nor mentally continue with business as usual.

Patients who come to Riverview have committed murders, rapes and other heinous crimes. Courts have deemed them at imminent risk of harm to themselves or others, incompetent to stand trial and not criminally responsible by reason of mental illness. As mental health workers, we don’t judge our patients for their crimes and recognize that their sickness caused them to commit such violent acts. We approach our work with empathy and compassion. Riverview is medical facility, so the first thing we do when a patient comes into our hospital from prison or jail is remove their wrist restraints and shackles and welcome them with a cup of coffee.

We may not have advanced degrees, but we have been through what we call “Riverview College” and we have the training to effectively de-escalate patients when they have a psychotic break. We don’t use restraints, pepper spray or tasers on patients when they act out violently. We use our words to talk them down, though sometimes we have to use our bodies. 

Unfortunately, we are currently far below safe staffing levels with 53 vacancies this past weekend. At times, we have had just one mental health worker for eleven or twelve patients when we’re supposed to have a one to six staffing ratio, according to the 1990 AMHI consent decree.  When we don’t have enough staff to redirect patients, it can be very dangerous. I carry my two front teeth in a container in my purse as a reminder of what can go wrong. I have been knocked out twice and carried out in an ambulance both times. My last assault gave me permanent facial damage, a limited feeling in my right cheek and upper lip and a droopy eye. My co-worker didn’t recognize me when she found me lying in a pool of blood.

In testimonies before the Maine Legislature, my coworkers and I have told harrowing stories about violent attacks we have suffered and witnessed. We have been punched, choked, kicked, stabbed and sexually assaulted. A pregnant worker was stabbed multiple times and fortunately survived after two surgeries. One worker received such a deep wound on his head from a patient that his skull was exposed. A male colleague had every bone in his face broken and never returned to work. My colleagues have had multiple surgeries for dislocated shoulders as well as hip replacements and rods and screws put in their ankles and legs due to injuries on the job.

One day I witnessed a patient stomp on the head and neck of a coworker a dozen times before he was finally redirected. She suffered a traumatic brain injury that caused her to have seizures and mini strokes after the incident. She couldn’t work and had to fight for two years for workers’ compensation. Without income she began to lose hope. On August 30, 2022, her fight finally ended when she took her own life, leaving a twelve-year old daughter.

Unfortunately, these life-threatening challenges we face are not unique to Riverview, they also exist at Dorothea Dix Psychiatric Center in Bangor. The Legislature can prevent future tragedies like this at both facilities by helping us recruit and retain qualified staff. Last year, state lawmakers gave bipartisan support for LD 1761, sponsored by Senate President Troy Jackson (D-Aroostook), which would allow mental health workers like my colleagues to receive state retirement benefits after 25 years of service. Now we just need the Legislature’s Appropriations Committee to fund it, the Legislature to enact and the Governor to sign the bill.

This is the same special retirement plan that our law enforcement, firefighters and corrections officers receive in recognition of the risks they take every day to protect our communities. A number of my colleagues have left to seek work in corrections because they can receive this benefit. If we were also eligible for this special retirement plan, we could better recruit and retain qualified mental health workers. This bill would also allow my colleagues to retire from doing this dangerous and physically demanding work at a reasonable age.

I’m 75 years old, so this probably won’t affect me, but I believe we owe it to my coworkers in recognition of the critical service they provide and the dangers they face every day.