Maine news, sports, weather | Kennebec Journal, Augusta, Maine

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