July 22, 2013

Maine's mentally ill waiting too long for care

Also in violation of a consent decree are deficiencies reported at Riverview Psychiatric Center in Augusta.

By KEITH EDWARDS Kennebec Journal

AUGUSTA - More than 500 Mainers are on a waiting list for the most basic of mental health services, with an average wait of two months and some waiting nearly a year.

The long wait is in apparent violation of a longstanding consent decree that settled a lawsuit brought two decades ago by mental health advocates and that holds the state mental health system to agreed-upon standards of care.

One part of the consent decree -- according to former Maine Supreme Judicial Court Chief Justice Daniel Wathen, who oversees the decree and files regular reports on its implementation -- requires the state Department of Health and Human Services to assign a caseworker to people with severe and persistent mental illness to assist them in accessing services in the community within seven days of a request for a caseworker.

Wathen, in his court master's report for the period of January to June 30, wrote, "The most persistent and glaring example of non-compliance with the consent decree is the department's failure to promptly provide timely community integration services for those with severe and persistent mental illness."

Wathen said six months ago that there were 387 people on a waiting list for assignment of a caseworker with an average wait of more than 40 days and some waiting up to 300 days.

"Today, the situation is worse," Wathen's report released Thursday notes, "543 people, both class members (the term for former Augusta Mental Health Institute patients covered by the terms of the consent decree) and non-class members including those who are MaineCare eligible and those who are not, are now on the wait list, and they are waiting an average of 58 days, with some waiting more than 350 days. Clearly the trend is in the wrong direction, although it may be influenced to some extent by the funding uncertainty that accompanies the budget process and the end of the fiscal year."

Guy Cousins, director of the state Office of Substance Abuse and Mental Health Services, said a lack of funding is part of the problem and seconded Wathen's suggestion that it is exacerbated by some service providers who are hesitant to take new clients into programs with uncertain funding.

Also part of the problem, Cousins said, are processes that don't get people seeking treatment into the mental health system quickly enough.

He said a pilot program the state is trying with six service providers shows promising signs of being able to provide people with access to mental health services sooner.

He said the change involves streamlining providers' intake systems.

He said in just one week, from July 8 to 15, the pilot program reduced the waiting lists of the six providers by 19 percent.

"It's incredibly encouraging, the work this pilot program is doing," Cousins said Friday.

Wathen noted that in the last year, the state has improved its capacity to track waiting lists, and he agreed the pilot project could improve things.

The consent decree has not been in "active supervision" since Wathen's 2011 recommendation that other adequate mechanisms exist to monitor operations at Riverview Psychiatric Center, the current state hospital in Augusta. However, he noted in his report that deficiencies reported at the center since March "could constitute a violation of the consent decree and serve as the basis for requesting reinstatement of active supervision. ... I do not at this time make such a request."

Wathen said the state has a plan to address the deficiencies and has taken steps to address safety concerns at Riverview.

The deficiencies cited in Wathen's report include two "serious security situations." One was an incident in which a client assaulted a staff member, and the other "involved jeopardy to the health and safety of patients arising from the actions of correctional officers providing unit security."

(Continued on page 2)

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