State still working to comply with settlement
Judge says progress has been made to better services for mental health, despite cutbacks
By Susan M. Cover scover@mainetoday.com
MaineToday Media State House Writer
AUGUSTA -- Dangerous living conditions and patient deaths prompted mental health advocates to sue the state 20 years ago to ensure that those with mental illness could get the help they need.
Twenty years later, the state continues to be bound by a consent decree that will remain in place indefinitely.
"It is not at all uncommon for them to go on for 25, 30 years," said Daniel Wathen, a retired Maine Supreme Judicial Court chief justice who serves as court master for the case. "It would often be the case that, before compliance is achieved, it would take that amount of time."
Patients represented by Helen Bailey and other lawyers had sued the state Feb. 27, 1990, on behalf of 12 patients alleging dangerous living conditions and infringement of personal rights, according to a Kennebec Journal story.
On Aug. 2, 1990, what was described at the time as "a historic settlement" was reached in Kennebec County Superior Court.
The first named plaintiff was Paul Bates, who hanged himself at what was then the Augusta Mental Health Institute. He took his life by hanging from an exposed pipe that was supposed to have been covered to prevent those types of deaths.
Even before 1990, an advocate for patients who often visited the facility recalls a particularly hot summer in granite buildings that seemed to just get hotter by the day.
Richard Estabrook, a Department of Health and Human Services employee who serves as chief advocate for patients, said the combination of no air conditioning and psychotropic drugs that limited the ability to sweat proved lethal for some patients.
He remembers one man who had suffered burns to a significant portion of this body, which made it even more difficult to cool off. He died while in restraints at the facility.
"To this day, I think what a horrible death for this man who was in a place that was supposed to be treating him," he said.
One of the major components of the consent decree was to reduce the number of people at AMHI, from 280 patients to 70. The massive facility was closed in 2004 when the Riverview Psychiatric Center opened. Today, the hospital can serve about 90 people.
Another goal of the decree was to move many of the services out of institutional settings and into the community.
And while much of that has been done, budget cuts and a shift to more federal funding continues to prevent the state from reaching compliance with the decree.
Carol Carothers, executive director of the Maine branch of the National Alliance on Mental Illness, said she worked as a guardian for a woman who was at AMHI at the time of the decree.
"It was pretty abysmal in there," she said. "The hospital is nothing like what it was in those days."
State mental health officials agreed to comply with the terms of the consent decree by 1995, but have been found in contempt of court several times since then for missing court deadlines.
The improvements over the last 20 years are visible, but Carothers and others worry that continued budget cuts will mean steps backward for patients.
"There's been a disproportional cut to community mental health services over the last six years," she said.
The consent decree covers about 4,500 people -- everyone treated at AMHI or Riverview since January 1988. The state has an obligation to serve others with mental illness by providing similar services, bringing the total number of people served to about 12,000.
In his most recent report on the status of the consent decree, Wathen was critical of a trend in recent years in which the state has become more reliant on federal Medicaid money while decreasing state subsidies.
While that works for people who qualify for Medicaid, it has hurt those who don't, he wrote.
"Although maximizing federal participation is a useful strategy and endorsed by the consent decree, Maine has gone too far in 'Medicaiding' its mental health care costs at the expense of grant funding," he wrote. "By shifting costs too aggressively, it has destroyed, or at least diminished, the safety net of services that were previously available for the low income population that is ineligible for MaineCare."
Wathen goes on to recommend that DHHS ask for $4.6 million in additional funding in 2012 to restore services to those who don't qualify for MaineCare.
Also, he recommends that the department ask for $995,000 to help with rental assistance.
Wathen said in an interview that those who are ready to be released from state psychiatric care are often held too long because there's no suitable place for them to live in the community.
Yet despite the shortcomings, Wathen said the state has made progress even as it has cut the budget.
"If you see where they did cut, it shows sensitivity to the need to maintain a level of support, even in difficult times," he said.
Wathen said he would not put a timetable on when the state might reach final compliance. But he said he'd like to be the final court master assigned to monitor the agreement.
For Carothers, while ending the decree is important, there's also concern that, without constant pressure, treatment could deteriorate.
She and other advocates still fight the stigma associated with mental illness.
"It's always seen as less than physical health," she said.
Susan Cover -- 620-7015
scover@mainetoday.com
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14 COMMENTS
Divinity said...
"The consent decree covers about 4,500 people -- everyone treated at AMHI or Riverview since January 1988. The state has an obligation to serve others with mental illness by providing similar services, bringing the total number of people served to about 12,000." ______________________________________________________________________________ This estimate, i.e. 1.2% of Maine's adult population having mental illnesses, is as little as one-twentieth the actual statistic. As has happened in the past, resources for non-institutional care continue to be allocated to the "walking anxious." Many agencies build their business model on intake for only those whose needs and diagnoses are least severe. Mainecare mental health services are used in large part to provide supports for individuals at risk of homelessness and in poverty. Our welfare system uses MH resources while our corrections system is carrying the burden of severe and persistent mental illness.
July 24, 2010 at 7:01 AM Report abuse
hawk50 said...
Not to take away from patient needs, but it seems odd to still have so many problems after building a multi-million dollar facility and shoving state employees into "abyssmal" digs in the old buildings. Speaking of safety, take a look at the fact that on the third floor of the Department of Correction suite in Elkins-Harlow near the elevator by the Kennebec room. The door to the exit stairs is locked all the time and were a fire to break out, either take the elevator if it is running or jump. The issue has been brought up several times and the response has been a smile and a shrug.
July 24, 2010 at 7:14 AM Report abuse
UofA said...
This decree will never be completed. If a citizen was ordered to do something the State would be on them like silly glue. They refuse all of the completion dates and will continue doing so.
July 24, 2010 at 7:14 AM Report abuse
xenon said...
Unfortunately with most community-based service programs, it starts out with a wide array of services being provided, with it looking great, and later gets cut so far back that the consumer is living in great risk. I saw this with home based care for the elderly and dependent adults and for those in need of community mental health services. People want to live in the community, but they need a level of services that does not get provided.
July 24, 2010 at 7:30 AM Report abuse
PersonalRigh said...
NAMIMaine, Carothers, have used a lot of state monies. Too damn bad they don't really understand recovery. Also Carothers, has gotten fairly wealthy while "advocating" and expects to be treated like royalty. Not my kind of queen bee, she stings but her honey is bitter. People with mental illness, join The Advocacy Initiative Network, for Your rights, Your mind, Your Recovery. 1-888-375-5969.
July 24, 2010 at 7:52 AM Report abuse
Reality said...
I worked with this person who had burns over 90% of his body, they don't mention that the area hospitals wouldn't take him. The legislature din't provide the money to install air condition, the staff at the time did all they could at with what was offered. cold compress, ice etc. We all cared for the people that died while under the care of the state of Maine, who needed to be sued to make a change. Times have changed for the mentally ill and things are so much better. Now we have so many people that aren't mentally but meet the criteria as there is a funding source for all these LCSW and agency to bill MaineCare. If you don't have a payer source it is amazing how little services you get. If you listen to Baily and Corothers this will never be settled and more people will come to be identified as having a mental illness. All people in jail will have a mental illness. We went from a system that had little money being throw at it to one that is out of control.
July 24, 2010 at 8:07 AM Report abuse
Theresa42 said...
Hawk50 said: "Not to take away from patient needs, but it seems odd to still have so many problems after building a multi-million dollar facility and shoving state employees into "abyssmal" digs in the old buildings....."....... What on earth does a new building which houses only 90 of our state's most severely mentally ill have to do with the buildings where state employees work?....... Your thinking shows me three things...........1) You have never suffered the pain of severe debilitating chemical imbalance in your brain.........2) You have no compassion and are seriously ignorant of this horrible suffering. 3) You have never had to cope with a family member suffer with mental illness....... YOU ARE A VERY VERY FORTUNATE PERSON. But try to educate yourself if that's possible. YOU HAVE NO CLUE!
July 24, 2010 at 9:28 AM Report abuse
funnycnslr said...
I am a therapist and work with many people struggling with mental illness. As of July 1st, 2010,MeCare made severe cuts and clients can now only get 18 sessions a year, versus once a week if needed. While 18 sessions a year is ok for some clients, it will be devastating for those with chronic mental illness. We'll see them go to the hospital and utilize more expensive services. So, State of Maine....we'll see how that works out for ya!
July 24, 2010 at 11:04 AM Report abuse
PeacefulSoul said...
First off..NAMI Maine and Carol Carothers do incredible work on a budget so low it is amazing they can function. Queen Bee? Hardly!!! She certainly isnt driving around in a BMW!! Promote your own program if you must, but do not tell lies about a program that works every day to help families and people with mental illness. MORE FUNDING FOR HOUSING! MORE FUNDING FOR HOUSING! My son has been homeless on the street with such a low level of care they cant even find him half the time. Its a disgusting situation. cut funding for those who can not help themselves while the state legislators get raises and perks.
July 24, 2010 at 12:15 PM Report abuse
Reality said...
PeacefulSoul sorry to hear about your son, unfortuately all the money on this earth isn't going to change your son's illness or desire to get treatment and willing to participate in such. Unless you want someone to harass him, which is against his right. If you want this you need to work with the legislature to change our civil rights. People wanted a conscent degree and they got, we can't treat the people like your son that needs treatment but doesn't realize he needs it. I guess we have gone too far the other way and will continue to.
July 24, 2010 at 7:24 PM Report abuse
Hipupchuck said...
Why are crazy people the responsibility of the state? How about the parents?
July 24, 2010 at 10:02 PM Report abuse
Izzy said...
Hawk50-It isn't odd that it still is going on. I worked there and you wouldn't believe the way things are done...wrong. I redid the entire filing system and things were so misfiled. Clients put into deceased files and still here. Alcoholics trying to stay sober and succeeding and on form as if they never took a sober breath. Goals achieved but never acknowledged. I was actually told "not to read them" as I enter them! One client a crisis worker wanted officials to "lock her up and throw away the key" Nice huh.
July 25, 2010 at 7:56 AM Report abuse
Izzy said...
Hipupchuck-Why parents indeed. Consent Decree doesn't allow for parental involvement. Parents would love to have the ability to help their kids before their kids kill them. Examples of this all the time. Read the articles.
July 25, 2010 at 8:10 AM Report abuse
Hipupchuck said...
Izzy, # Proverbs 22:15 Folly is bound up in the heart of a child, but the rod of discipline will drive it far from him. # Proverbs 23:13 Do not withhold discipline from a child; if you punish him with the rod, he will not die. # Proverbs 23:14 Punish him with the rod and save his soul from death. # Proverbs 26:3 A whip for the horse, a halter for the donkey, and a rod for the backs of fools! # Proverbs 29:15 The rod of correction imparts wisdom, but a child left to himself disgraces his mother. Maybe the state should not have banned the rod. Look at the result!
July 25, 2010 at 12:11 PM Report abuse