Maine’s Department of Health and Human Services and a group of plaintiffs with severe mental health and psychiatric needs have reached an agreement that could end 30 years of court oversight of state mental health services.

A new report from Daniel Wathen, the court master overseeing a 1990 consent decree involving the former Augusta Mental Health Institute, outlines standards designed to ensure that mental health clients receive services promptly and that service providers are held accountable.

If the state meets the standards in at least four out of six consecutive quarters, it can petition to dissolve the court injunction that has guided Maine’s treatment of its mentally ill population.

Gov. Janet Mills announced the agreement Friday afternoon.

“The creation of the AMHI consent decree three decades ago marked the beginning of a long and necessary process to improve Maine’s mental health system. It has touched the lives of countless Maine people, from the original plaintiffs and their loved ones to those in need of compassionate and effective care over the subsequent decades,” Mills said in a statement. “With this landmark agreement, the resolution of the consent decree is within sight.”

The consent decree settled a class action lawsuit brought on behalf of about 300 patients of AMHI after a series of deaths in the summer of 1988 and have governed Maine’s system for treating the mentally ill ever since.

The 99-page decree lays out in detail a set of principles for the state to follow in treating the mentally ill, prioritizing patient rights and services in the least restrictive available setting and using hospitalization as a last resort.

The consent decree had the force of law, but it never mandated any funding or even ensured individual access to services. In numerous reports over the years, Wathen and his predecessors found that the state often fell short of meeting standards, which have been updated and amended since the original decree was signed, largely because all but individuals with the most acute needs are now living in community settings rather than large-scale institutions.

As part of the new agreement, DHHS must:

Continue to fund the Consumer Council System of Maine, which represents the class of individuals covered under the consent decree and includes those housed at Riverview Psychiatric Center in Augusta, Dorothea Dix Psychiatric Center in Bangor and those who live in community-based settings.

Designate one or more staff members in the Office of Behavioral Health to serve as point person for individuals or their guardians or advocates who might be having trouble getting timely access to mental health services.

Continue contracting with Disability Rights Maine as the protection and advocacy organization for the protected class of individuals.

The state also must demonstrate substantial compliance in 17 individual areas, nearly all of which set benchmarks for timeliness of specific services. That’s down from the 120 standards that had been in place as recently as 2015.

In his progress report, Wathen, a former Maine Supreme Judicial Court chief justice, commended DHHS for its efforts over the last two years.

“Throughout the years of 2019 and 2020, the department … demonstrated a willingness and a commitment to hold providers accountable for their performance obligations and an improved capacity to provide reliable data to mark its progress,” he wrote.

Maine DHHS Commissioner Jeanne Lambrew said the recent agreement “represents a clear and achievable path toward ending the Consent Decree that has held Maine’s mental health system accountable for more than three decades.”

Simonne Maline, executive director of the Consumer Council System of Maine, said she’s hopeful the state can meet the standards, but that it hasn’t had the best track record.

“And in a lot of ways, the protections that the consent decree did provide have eroded over the years,” she said.

Maline said she thinks the most important piece in the new agreement is the inclusion of additional staff members within the department to help consumers navigate problems accessing services.

“I am hopeful,” she said. “I think Maine is trying to do better.”

Mark Joyce and Kevin Voyvodich, attorneys with Disability Rights Maine who represent the class of individuals covered under the consent decree, said they helped negotiate the standards to ensure timely action and better enforcement of the state’s various contracts with mental health service providers.

“We’re very exited about this, but it’s important to remember that the consent decree is not gone,” Joyce said. “It’s still in full force and effect.”

Voyvodich said one of the myths of the consent decree over the years is that it protects individual rights. It doesn’t – it only addresses systemic problems. But the new language, he said, will be more effective in ensuring individuals get timely service.

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, according to the National Institute of Mental Health. This includes schizophrenia, bipolar disorder and severe depression. About 4.5 percent of the adult population has a serious mental illness. That translates to more than 40,000 people in Maine, although only about 12,000 qualify for full mental health benefits under MaineCare.

In recent years, some of the biggest challenges have been with people who have been on long waitlists for residential services, community integration services, or daily life skills.

Most of those individuals are living in the community and receiving varying levels of service from providers across the state. In some cases, though, if individuals are deemed a danger to themselves or others, they end up at either Riverview or Dorothea Dix.

Riverview had been plagued with problems for several years, culminating in a 2013 federal audit – initiated after an attack on a staff member by a patient – that found numerous deficiencies. The hospital failed to ensure safety, failed to protect patients’ civil rights, failed to hold staff responsible for inadequate care and more.

It lost federal certification and the $20 million annual subsidy that came with it. Things have improved dramatically since, Wathen has concluded in recent progress reports.

Tracking patients in the community has always been a little more challenging and continued cuts to mental health services over the years haven’t helped. Service providers have long called on the state to increase reimbursement rates through MaineCare.

In many cases, individuals with severe mental illness have ended up in jail or in a hospital for extended stays because they haven’t found services within their community.

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