Maine Department of Corrections
In 2014, the Maine Department of Corrections (MDOC) received legislative approval to develop and open the state’s first and only Intensive Mental Health Unit (IMHU), located within the secure perimeter of Maine State Prison (MSP). The IMHU, a unit separate from the operations and administration of MSP, houses up to 32 clients of the county jail system and MDOC who suffer from an acute, sub-acute, or chronic mental illness and are violent. The IMHU provides modern, comprehensive mental health and medical care to those corrections clients most in need, in a setting separate from the prison population. Since opening the IMHU, the MDOC has decreased the frequency of self-injurious behavior, reduced violence, increased medication compliance, and improved the transition and transfer process of mentally ill clients back to county jails, communities, or state hospitals.
The opening of the MDOC IMHU sought to provide modern, comprehensive mental health services to the mentally ill corrections population in Maine, in a manner that has rarely been replicated. The IMHU stabilizes clients with ongoing illness and returns them to their community or housing unit, diverts clients who are not appropriate for correctional settings to appropriate psychiatric community settings, and provides clients with the initial or definitive treatment that the community mental health system has not been able to provide.
Breaking away from past practices of segregating and locking-down people who are violently mentally ill, the IMHU provided an opportunity to implement Social Learning Programming—combined with evidence-based programming—through a clinical team in a setting that provides safety, security, and treatment. The goal is improvement in services, environment, and treatment outcomes. The IMHU provided a method of housing and treating Maine’s violently mentally ill corrections population from county jails and the state prison system. The IMHU is staffed by corrections staff trained in mental illness topics, issues and practices, along with a clinical and medical team, seven-days-per-week.
In the early 2000s, advocacy groups, including the ACLU, pressured the Maine DOC to limit the use of segregation for people with serious mental illness. As a response, Maine State Prison opened a secure mental health unit in 2005, where people with severe mental illness should have been provided with higher levels of treatment and supervision. In 2009, advocacy groups again expressed concern for the department’s practices, including that the Secure Mental Health Unit functioned similarly to segregation.
In 2013, the 126th legislature passed a bill aimed to establish an Intensive Mental Health Unit inside the MDOC. LD 1515 provided the funding and authorization necessary to remedy the previous claims and concerns of advocates and incarcerated people.
In 2014, after partnering with CorrectCare Solutions, the MDOC renovated an existing housing unit at the Maine State Prison to better house the mentally ill population. With a clinical team, trained security staff, and 32 beds, the IMHU opened in February 2014.
Maintaining a high-functioning, responsive mental health unit has required on-going oversight and review. Beginning in November 2016, the MDOC conducted a full assessment of the IMHU in response to a high frequency of incidents and concerns on the unit, including the use of chemical agents, self-injurious behavior, assaults on staff, prisoner disciplines, and grievances. The resulting corrective action plan and unit improvements have produced very positive outcomes.
With the approval of the executive branch and legislature, the MDOC opened the Intensive Mental Health Unit. The unit is staffed with a treatment director (psychologist), lead psychiatrist, mental health clinicians, behavioral health technicians, nurses, unit manager, and correctional acuity specialists (specially trained security officers). The unit is overseen by the state’s behavioral health director and the department’s deputy commissioner.
The IMHU provides a highly structured, milieu-based inpatient approach to recovery and rehabilitation for clients in the correctional system with the most severe mental illness and skill deficits. This is accomplished through a comprehensive and integrated network of skills training, technique reinforcement, and support. Through effective clinical intervention and programming, clients are able to overcome difficulties due to persistent mental illness and begin recovery.
The recent solution and outcomes have involved several key components including, on-going assessment and evaluation of the unit’s performance, on-going training of staff, and administrative support to continually enhance services, programs, and treatment strategies. The support of the executive branch and legislature has helped propel the unit towards the intended goals.
The IMHU has been in operation since February 2014. Since its opening, the IMHU has received nearly 200 referrals for placement from the MDOC facilities and county jails. For those acute and sub-acute cases in which stabilization is possible, the average length-of-stay in the IMHU is approximately 120 days. This excludes the chronic cases which may remain in the IMHU indefinitely.
As a result of the IMHU, the department has observed reduced incidents of self-injurious behaviors, improved medication compliance and stabilization (including an ability to forcibly medicate over objection, if necessary), and improved transitional services for clients of the jails and prisons.
Most recently, following the 2016-2017 unit evaluation and corrective action plan, the IMHU has seen a shift in Departmental oversight, unit management, staff training and professional development, revised policy and procedure, enhanced communications and reviews, and heightened programming and treatment. The results have been very positive, including increased staff satisfaction, client stabilization and a stronger unit milieu. Additionally, the unit has seen a decrease in fights, assaults, assaults on staff, suicide behavior, self-abuse, use of force, use of restraints, use of weapons, grievances and disciplines.
These positive results have all been obtained while continuing to house the state’s most dangerous individuals diagnosed with mental illness throughout the prison system and the county jails – individuals for which there is no other suitable placement.
One lesson learned in Maine is the importance of implementation planning. The timeline for developing the IMHU was short, and the period of implementation planning did not allow for all aspects to be considered prior to opening the unit. The result of this was an assessment and corrective action planning process in 2016-2017.
If Maine were to redesign the IMHU, we would modify the housing unit layout, allowing for a greater ability to separate the people with acute, sub-acute, and chronic illnesses from each other. The dayroom-style pod currently does not allow for this, and acute clients sometimes cause disruption to the rest of the unit.