Options when other programs are not sufficient
For people who are declining services, the evidence is clear that what looks like refusal is usually something more complicated: distrust of systems that have previously failed them, treatment options that don't fit their actual needs, or symptoms that make sustained engagement difficult. ACT teams (described earlier) are specifically designed for this population, and most people who initially decline eventually engage when outreach is sustained and the relationship is trusted. Likewise, individuals may overcome reluctance through sustained contact through syringe service providers, the Bunyan Brigade, low-barrier housing communities, or other peer support. That timeline is often months, not days. The city's obligation during that time is to keep showing up, keep the door open, and keep making engagement easier — not to compel, but not to abandon either.
For the very small subset of people who pose a documented risk of harm to others, and for whom sustained voluntary outreach, ACT engagement, harm reduction, peer support, and housing offers have all genuinely been tried, Maine's civil commitment statute provides a legally grounded last resort. This is not a tool for treatment refusal alone — the standard is a judicial finding of likelihood of serious harm to others, with mandatory public defender representation and regular judicial review. It is intentionally difficult to reach, and it should be. The goal of any commitment is discharge back to the community with voluntary ACT support in place, not indefinite institutionalization. Placement at Dorothea Dix Psychiatric Center (Maine's only state psychiatric hospital, with 100 beds serving the entire state) may be the ultimate outcome in these situations. This represents the far end of a spectrum, not a routine one, due to the fact that there is an extensive process for admission, a high legal standard for committal, chronic staffing and working condition issues, building condemnation, and chronic underfunding of the facility as it stands. In addition, as referenced in MaineHousing's 2019 report, those discharged from inpatient mental health care frequently return to homelessness because of a fragile and underfunded post-discharge support system.
State psychiatric facilities, like jails, are extremely costly for taxpayers. A 2024 report in Texas noted that the average cost per operational bed year at a facility was approximately $270,000. Figures from the '26-27 Maine budget seem to indicate a similar cost for DDPC: about $345,500 per operational bed per year.
Any work done in this space should be reviewed by the city's legal team, as it has historically been the most challenged on civil liberties grounds and could present a large financial burden for the city to defend if done improperly.
For those who don't meet that threshold (those who are suffering visibly but pose no risk to others) the honest answer is that the city cannot compel recovery, and some people will remain on the street for a long time despite every door being held open. This is precisely the motivation to invest seriously in a variety of voluntary pathways that can reach people without coercion: better-funded ACT teams, more peer outreach workers with lived experience, lower-barrier housing, and harm reduction services that meet people where they are. The more robust those alternatives, the shorter the distance between where someone is and where they could be.