An old postcard shows former Augusta Mental Health Institute – then known as the Maine Insane Hospital – in Augusta.

A Kennebec County superior court judge has granted the state’s petition to dissolve a landmark injunction that became known as the AMHI consent decree, effectively ending 34 years of legal oversight of mental health services in Maine.

The state filed a request in late October asking to dismiss a complaint brought decades ago by former patients at the Augusta Mental Health Institute. It was granted Tuesday.

The state Department of Health and Human Services has been working since early 2021 to come into substantial compliance with 17 individual benchmarks. Under a proposed agreement with Dan Wathen, the court master assigned to oversee the decree, the state could petition to dissolve the injunction only if it demonstrated compliance for at least four out of six consecutive quarters.

Daniel Wathen, former chief justice of the Maine Supreme Judicial Court. Joe Phelan/Kennebec Journal

It took 14 quarters, but Wathen wrote in October that he was satisfied with the state’s efforts to “build upon and maintain the improvements achieved in the community mental health system and the state’s psychiatric hospitals.”

“This milestone underscores DHHS’s dedication to accountability, elevated standards, and expanded access, guided by improved data,” Wathen said in a statement. “The significant progress achieved since 1990, particularly in recent years, reflects the strength of collaboration among advocates, the Consumer Council, and the administration, creating a strong foundation for sustaining progress and driving future advancements.”

The main tenet of the original 99-page court order was to prioritize patients rights and services in the least restrictive available setting. Prior to 1990, many adults with intellectual and developmental disabilities were hospitalized, often indefinitely, in state-run hospitals where risk for abuse and neglect was high. In fact, the lawsuit was filed in response to a series of a deaths at AMHI in the summer of 1988.

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Gov. Janet Mills, in a written statement announcing the consent decree’s dissolution, called it the end of a “long and necessary process to improve Maine’s mental health system.”

“The Consent Decree has touched the lives of countless Maine people, from the original plaintiffs and their loved ones to those in need of quality care over the subsequent decades,” she said “While our work is not done, I welcome the successful resolution of the Consent Decree, and I remember the 10 people who lost their lives those many years ago. I think of their families and loved ones, and I think of the many people across Maine who continue to need mental health services.”

Disability Rights Maine, the statewide advocacy group that represented more than 300 original plaintiffs, released a lengthy statement Tuesday about the dissolution of the consent decree. Although it did not challenge the state’s petition, it said “significant issues persist in Maine’s mental health system as 2025 approaches.”

“The most critical shortcoming is the lack of enforceable individual rights for eligible recipients to receive services. The current system relies heavily on providers and state administrators, whose effectiveness is often influenced by whatever administration is in power at the time,” the statement said. “Although the AMHI Consent Decree is no longer in effect, Maine must build on the progress of the past 34 years and address these systemic gaps to meet the mental health needs of its citizens, including shifting the power from the state of Maine and the service providers, to the people who receive the services. Otherwise, we will never realize equitable and effective mental health service delivery with long-term quality outcomes.”

At its height, more than 1,800 people were housed at AMHI, about 12 times as many patients as are housed today at the state’s two psychiatric hospitals, Riverview in Augusta and Dorothea Dix in Bangor.

The purpose of the consent decree was to establish a framework for the state to provide services in community-based settings, but that hasn’t always been easy, in part because of inadequate funding and in part because the population of patients has complex needs.

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In one extreme case, a former AMHI patient named Mark Bechard was released into the community and ended up killing two nuns in Waterville. The incident drew national attention and was widely viewed as a systemic failure at a time when many states were trying to figure out how to deinstitutionalize mental health care.

The state struggled for many years to meet the demands outlined in the court ruling, according to progress reports required by the court master. Although the decree had legal weight, it didn’t mandate any funding or even ensure individual access to services. Even today, when a disabled individual cannot access services, they end up in an emergency room or even jail. Some are chronically homeless.

In recent years, though, things have improved. Specifically, the state has invested in providing walk-in crisis care, created a crisis hotline and improved medication management for patients who are released from Riverview and Dorothea Dix. In all, the Mills administration has invested $260 million to improve mental health services.

Still, as Disability Rights Maine pointed out, challenges remain.

In October, two Augusta lawmakers requested a review of staffing concerns and patient safety at Riverview and Dorothea Dix after hearing from staff members at the two hospitals.

And earlier this year, the state faced criticism for sending patients to out-of-state facilities that use isolation and corrections tactics that have been banned at Maine’s psychiatric hospitals. In each case, the patient sent away was found not criminally responsible for their crimes.

In Maine, those who are eligible for services must be diagnosed with a serious mental illness, one that results in functional impairment that substantially interferes with or limits one or more major life activities. This includes things like schizophrenia, bipolar disorder and severe depression. Approximately 12,000 people qualify for benefits under MaineCare.

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