Court oversight of Maine mental health services ends after 3 decades

A landmark legal agreement requiring Maine to improve care for adults with severe mental health and psychiatric needs will end after nearly 35 years.

The state has “achieved substantial compliance,” according to a filing last week by Dan Wathen, the chief judge who oversaw the 1990 consent order against the former Augusta Mental Health Institute. standards set out in February 2021 when the terms of termination of the agreement were announced.

“The Department welcomes the Chief Justice’s recognition that Maine is largely in compliance with the 1990 Consent Decree, thanks in large part to the Mills Administration’s investments,” DHHS Commissioner Sarah Gagne-Holmes said in a statement. “Over the past six years, the department has worked diligently to strengthen Maine’s adult mental health care system to ensure timely access to high-quality services, and we are pleased that our system improvements are making an impact.

“We look forward to following the Chief Justice’s recommendation to file a Notice of Substantial Compliance, which reflects our ongoing commitment to Maine’s strong and reliable system of care and which we hope will lead to the long-awaited consent decree after nearly 35 years. “

Under the agreement announced in 2021, a state can petition to lift the injunction only if it demonstrates substantial compliance in 17 separate areas for at least four of six consecutive quarters. The standards were developed to ensure that mental health clients receive services promptly and that service providers are held accountable.

It took 14 quarters, but Wathen wrote that he was pleased with the state’s progress.

“In my opinion, these efforts are intended to build on and maintain the improvements made in the state’s public mental health system and mental hospitals,” he wrote.

The consent decree settled a class-action lawsuit brought on behalf of about 300 patients at the Augusta Mental Health Institute after a series of deaths in the summer of 1988, and has governed Maine’s mental health treatment system ever since. The 99-page order lays out a set of principles the state must follow when treating people, prioritizing patients’ rights and services in the least restrictive setting available and using hospitalization as a last resort.

Before the consent decree, many people with mental illness were housed in AMHI or other institutions. The facility closed for good in 2004, but at its peak it housed more than 1,800 people, about 12 times the number of patients housed today at the state’s two mental hospitals: Riverview in Augusta and Dorothea Dix in Bangor.

The consent decree had the force of law, but it never required any funding or even guaranteed individual access to services. In numerous reports over the years, Wathen and his predecessors have found that the state often falls short of standards that have been updated and changed since the original order was signed, largely because all but the people with the most pressing needs now live in communities. institutions rather than large institutions.

However, the state has made improvements in recent years, including:

• Establishment of a certified community behavioral health clinic model to be implemented by January 2025. The clinics are designed to provide outpatient and emergency crisis care.

• Creation of a 24-hour crisis hotline 988 and expansion of mobile crisis teams.

•Improving medication management for clients, including those discharged from Riverview and Dorothea Dix.

• Strengthen its relationship with Disability Rights Maine and the Maine Consumer Council System, which act as independent patient advocates.

A spokesperson for Disability Rights Maine said the agency would not comment Tuesday on the latest chief justice’s report or the state’s intent to terminate the consent order, calling the matter “active litigation.”

Even with improvements in the state’s mental health system, challenges remain.

Just this month two Augusta legislators demanded a revision about staffing issues and patient safety at Riverview and Dorothea Dix after hearing from employees at the two hospitals.

And at the beginning of this year The state has come under fire for sending patients to out-of-state facilities. who use isolation and correction tactics that are prohibited in Maine mental hospitals. In each case, the expelled patient was found not to be criminally responsible for his crimes.

According to the National Institute of Mental Health, a serious mental illness is defined as any disorder that results in functional impairment that substantially interferes with or limits one or more major life activities. These include schizophrenia, bipolar disorder and severe depression. About 4.5% of the adult population suffers from serious mental illness. That means more than 40,000 people live in Maine, although only about 12,000 are eligible for full mental health benefits under MaineCare.

In recent years, some of the biggest problems have arisen with people on long waiting lists for housing services, community integration services or daily living skills. Some of these waitlists were caused by persistent staffing shortages and turnover among service providers.

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