I would like to congratulate Dorothy Hill of Acadia Hospital on her recent naming as the Nurse of the Year by the American Psychiatric Nurses Association. This honor clearly reflects her excellence as a nurse and an administrator. At the same time, I am compelled to respond to her inflammatory remarks about the “state’s public mental hospitals,” as that includes Bangor Mental Health Institute.

Hill said in the article, “Acadia Hospital CEO named Nurse of the Year” (BDN, Nov. 1-2), that “It’s time for the state to get out of the business,” noting that “private hospitals can provide effective care and treatment for less money.”

First of all, to liken psychiatric care to a business is both an oversimplification of issues and an insult to those we serve. More than anything else, psychiatric treatment is a society’s obligation to care for individuals who struggle with brain disorders and the consequences of unfortunate life circumstances. Those of us on the front lines realize that our patients would rather not be in the hospital or receiving the care we provide; they are not customers or clients for whom we are providing a product. Like all medical patients, they are temporarily here until such time that they are well enough to return to their community; that takes days, months or years.

Because psychiatric conditions often afflict the state’s most vulnerable citizens or lead to a downward social progression, should not the state play a leading role in the provision of this care? To suggest that BMHI has “only a few patients” is to miss the point. Many of us recall the days when we had 40 to 50 admissions a month, at least 11 inpatient wards and almost 500 people working here. Many of us are frustrated at our current inability to accept every admission from the emergency room, or transfers from hospitals like Acadia when the determination has been made that the patient will need a longer time to stabilize.

Yet because we are at the mercy of the vicissitudes of the state budget – self-perpetuating delusions that all state hospitals are “snake pits” and such ill-conceived notions that all who suffer from psychiatric illness can be successfully treated with short-term stays and then discharged to some utopian community-service network – our wards and staffing numbers have been cut to the bone over the years.

Budgetary constraints lead to maneuvers such as early retirement incentives, regular “freezing” of positions (even when there is no one else in the hospital filling that role), forced overtime due to lack of full-time staff and canceled treatment-related programs. For some time it has been a major undertaking for our on-site administration to obtain funds for adequate staffing, and then to retain these staff in light of crushing work schedules.

Despite these overwhelming obstacles, BMHI has consistently provided excellent patient care. As a testament to that, the hospital recently earned a 94 percent score by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), the major accrediting body for hospitals in the United States, with 99 percent given to our Outpatient Psychopharmacology Clinic. Not only are these the highest JCAHO scores in BMHI’s history, but staff members were also invited to listen as surveyors spoke warmly of the care we provide. While another agency has been dissatisfied with our paperwork, JCAHO recognized that our primary mission – patient care – was being fulfilled.

All in all, it would be better for BMHI and Acadia to view their roles as complementary rather than adversarial. A person with no previous history of hospitalization can often be best served by going to a private hospital, due to issues of stigma and the fear engendered by being admitted to the “state hospital.” At the same time, it’s nice that BMHI is still here to offer both choice to individuals with mental illness and a safe haven for when no other options are available.

Deborah Ryan, M.D. is a staff psychiatrist at Bangor Mental Health Institute.