It has been a year since Mark Bechard — off his medication and in a psychotic rage — walked from his apartment to a Waterville convent in a cold, driving rain and began randomly bludgeoning nuns.
A former patient at the Augusta Mental Health Institute, Bechard was receiving community-based care when he savagely beat and killed two of the nuns and left two more seriously injured on Jan. 27, 1996.
The images of him — wild-eyed, shackled and soaked in blood, being led by police from the convent — brought the problems of the mental health system into everyone’s living room. Public outrage over the senseless attack put the state’s $104 million mental health system under a microscope and resulted in countless review committees and task forces charged with finding the gaps within the fragmented system and recommending ways to repair it.
“Every year we have a scattering of [police] standoffs or murders in the state in which the perpetrator had some form of mental illness. That’s the reality,” said Mike Fitzpatrick, executive director of the Alliance for the Mentally Ill of Maine. “This time it was truly different. The Bechard killings were horrific and the incident galvanized every person in Maine. … It put fear into each community. Whether people with mental illness are accepted into the community is at the heart of the Bechard case.”
Monday will be the first anniversary of the brutal slayings of Sisters Edna Marie Cardoza, 68, and Marie Julien Fortin, 67, at the Servants of the Blessed Sacrament Convent. Two other nuns, Sister Mary Anna DiGiacomo, 62, and Sister Patrica Anne Keene, 60, were seriously injured during Bechard’s onslaught.
But this anniversary won’t be one of recriminations or bitterness for the small group of Servants of the Blessed Sacrament.
“I know that my sisters are gone, but they’re in heaven with the Lord,” said Sister Keene. “How could you wish anything else than heaven for somebody, right?”
She said the nuns will dedicate their regular Mass Monday to the nuns who were killed. The order has announced it plans “to let this anniversary pass in a quiet, prayerful way.”
“We want to have this year finished so that we can start and go on with our lives,” Sister Keene said.
A nonjury trial last fall ended with the judge’s finding that Bechard was insane and thus not criminally responsible for what he had done. As a result, he was admitted to AMHI — for the 10th time. He remains there today assigned to a forensic ward.
To many, Bechard represented the darkest and most frightening side of mental illness. And his wasn’t the only case in the past year to focus attention on Maine’s mental health system.
In March, Stephen Lee of Waterville, who had been on a waiting list for four months to get court-ordered counseling at the same agency that was treating Bechard, allegedly killed a 76-year-old Winslow woman.
On April 6, Wrendy Hayne, a patient at AMHI, was stabbed to death by another patient.
In November, 46-year-old Virginia Green allegedly killed her 75-year-old mother, by beating her on the head with a rock. Green was considered an example of someone living successfully with mental illness. She had a history of manic-depressive disorder and of substance abuse. At the time of the alleged murder, she was not using any public mental health services, but was receiving private care.
As the state continued its trend of deinstitutionalization and community-oriented care, the residents of those communities looked at Bechard and other mentally ill people with great apprehension.
Despite the tragedies, Alliance for the Mentally Ill director Fitzpatrick is convinced that the state’s mental health system is improving. He credits that change to Gov. Angus King and the Legislature, which finally decided that the Department of Mental Health, Mental Retardation and Substance Abuse Services needed more money in order to fund properly a community-based mental health system.
Before the Bechard killings, Fitzpatrick said, the governor and lawmakers believed that the department could simply downsize the state’s two mental health institutions and transfer any money saved to community programs.
“The Bechard murders changed all that,” he said, “absolutely changed the dialogue. It put the fact that we needed additional money front and center, and by the end of the [legislative] session an additional [$15.9 million] was allocated to the mental health budget. That’s a humongous amount of money.”
Community-based mental health agencies across the state now are submitting proposals and bids for the money. It is expected that the money will be used primarily for emergency services, such as fully staffed crisis intervention teams and additional intensive case managers.
Also during the past year, the DMHMRSAS received legislative approval to create quality improvement councils in seven regions across the state.
“Through the review process, one of the biggest problems that was identified was a lack of accountability,” said Katie Fullam Harris, associate commissioner for the DMHMRSAS.
By developing a regional structure, mental health officials hope to create a regional point of accountability. The quality improvement councils comprise mental health consumers, family members, mental health service providers and members of the general public.
Those councils will be charged with advising the DMHMRSAS on the delivery of services in their particular regions, and to report systematic flaws occurring at the local level.
Also this year, the department has come to realize that there are not enough psychiatric services in Maine, especially for low-income people. The department has hired two regional medical directors and is in the process of hiring a third to consult with psychiatrists, to ensure that people have access to psychiatric care.
“I would say that one year after the Bechard case, and two years after commissioner [Meodie Peet] has come on board, the services for people with mental illness in Maine have improved and will continue to improve. We’ve taken enormous steps this past year,” said Fullam Harris.
The DMHMRSAS and the Department of Human Services also have joined forces to start a pilot program to monitor patients who have been prescribed Clozaril, a stabilizing medication for patients who are seriously mentally ill. It’s also the drug that Bechard was supposed to be taking while he was living in community-based housing in Waterville.
Bechard was off his medication during the days preceding the killings at the convent.
The program allows DMHMRSAS officials to monitor prescriptions of the drug and alerts them when a patient has not picked up the drug from the pharmacy when expected. If the drug is not picked up, the patient’s physician is notified.
Notification, however, is as far as it goes, and the DMHMRSAS relies on the patient’s physician to do follow-up.
The extra $15.9 million for the mental health budget also will allow the department to hire 60 intensive case managers to target at-risk populations. Each manager will have a small caseload that is supposed to allow working closely with clients who otherwise might slip through the cracks.
But former Sen. Joan Pendexter, R-Scarborough, who was co-chairman of the Health and Human Services Committee that reviewed the DMHMRSAS last summer, believes the problems with the state’s mental health system extend beyond money.
Pendexter feels the department was not doing a good job of overseeing the community agencies with which it has contractual relationships, such as the Kennebec Valley Mental Health Center in Waterville, which was supposed to be providing services to Bechard.
After the attack on the nuns, the DMHMRSAS reviewed the KVMHC and found several flaws in the organization.
“My concern is that we are providing this agency with millions of dollars. We go in there and identify all of these problems, yet we continue to work with them. Why would we want to do business with an agency that is not providing the services we pay them to provide?” she asked.
The Health and Human Services Committee’s investigation resulted in partisan stalemate and was stymied by confidentiality laws that prohibited mental health officials from discussing specific details about the Bechard case or the April 6 stabbing death of AMHI patient Wrendy Hayne by another patient. “Tragedies are always going to occur, but as policy-makers we have a responsibility to find out if it occurred because we weren’t providing Mark [Bechard] with the right care. That was never answered,” she said.
Just before the release of the committee’s reports, William Stubbs, president of the Alliance for the Mentally Ill of Maine, said in September, “It makes me angry as hell to see 13 legislators spend the whole summer and not come to grips with the system. I’m frustrated with the preoccupation with personalities.”
Finally, the Democrats and the Republicans on the committee each filed a report with very broad recommendations. The Democrats noted that the current mental health delivery system was in trouble, and that the response to the tragedies throughout the year had been slow and inadequate.
It was noted that years of neglect, funding cuts and the lack of comprehensive vision were responsible for the “chaotic system” that exists.
Both parties called for better quality control, accountability and communication within the department. They also called for the creation of a team to take immediate action when serious incidents involving mental patients occur.
Pendexter didn’t get much satisfaction from the process.
“We couldn’t even find out if Mark Bechard had a caseworker assigned to him. That was confidential. How can the Legislature effectively review any state department when we can’t find out what’s going on? Instead we just continue to throw money at a bad system of care. They have [$104 million] to care for the mentally ill in this state. Somebody’s going to have to prove to me that that isn’t enough money,” she said.
As for the stabbing death of Wrendy Haynes, Pendexter said, “AMHI is getting away with murder. No one has ever taken resonsibility for that.”
Judy Regina of the Maine Sheriff’s Association Mental Health Initiative understands the need for review and firmly believes that much can be done to improve the system if agencies and departments learn to communicate with one another.
It is often the mentally ill person who is dealing both with the Department of Corrections and the mental health department who slips between the cracks, she said.
Another task force was formed and a forum was held last October better to determine how the criminal justice and mental health systems can work together to fill the voids and produce a well-managed system of care.
Regina said the problem that remains is identifying mentally ill people who exhibit patterns of violence.
That is not an easy task.
“Being able to predict which person with serious mental illness is going to commit a violent act is not something we’re very good at,” she said. “There may in some cases be red flags, but we can’t always predict. I know it’s not very reassuring to know that we don’t always know what we are doing.”
Regina and Fitzpatrick, however, are concerned that legislators are going to try to find all of the answers in the form of more legislation.
It appears their concerns are valid.
Proposed mental health legislation for this session includes:
Amending the laws governing admission to mental health institutes.
An act requiring mental health hospitals to admit former patients who refuse to take their medications.
An act to amend the confidentiality provisions of the Department of Mental Health, Mental Retardation and Substance Abuse Services.
An act to ensure quality care for people with mental illness.
An act requiring the DMHMRSAS to report the facts of a patient’s death to the Legislature.
Two acts to amend the involuntary commitment laws.
An act to require mental health patients living in the community to take necessary medications.
Fitzpatrick believes that if the proper mental health services are in place, there is little need for legislation such as forced medication for the mentally ill.
“If someone is released from BMHI and they have an intensive case manager making perhaps daily checks on them, that manager is going to know if that patient is deteriorating and they can take action, even if that involves starting the process of involuntary commitment,” he said.
Mandating medications is a hot topic this legislative session, primarily because of the Bechard case.
Regina’s concern is how to enforce a compulsory medication law, other than hold the patients down and force the medication down their throats.
“If they refuse to take their medication, which many of them do because much of this medication has unpleasant side effects, then what? Take this medication or else what?” she said.
Such a law, if it were strictly enforced, could quickly fill up the remaining beds at AMHI or BMHI if the punishment were reinstitutionalization.
Fitzpatrick is more hopeful.
“The incident at the convent was like throwing cold water over the Legislature and the governor’s office. They finally realized that there is the potential for tragedy out there. … I would suggest taking another look at this system in six months. I think you’ll see dramatic changes,” he said.