December 14, 2012

Families mostly powerless when mentally ill adult resists help

Legal protections make it difficult to force treatment, but one man's personal tragedy has led to changes.

By Kelley Bouchard kbouchard@pressherald.com
Staff Writer

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Joe Bruce, whose wife was killed by their son, helped to enact a state law that allows family members and law enforcement to initiate outpatient treatment for those who are mentally ill.

Jim Evans/Staff photographer

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Members of the Bruce family posed for this photo in their Caratunk home several years before Willy Bruce killed his mother in a psychotic rage in 2006. Amy and Joe Bruce are seated in front, with Willy Bruce and Amy's mother, Gladys, behind.

Courtesy photo

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But six years after his wife's death, Bruce believes little has changed and nothing more has been done to help families of mentally ill adults navigate Maine's mental health care system.

"The system is still a wreck," Bruce said recently. "The pendulum has swung too far in the wrong direction. Families really get no help at all. They're often totally shut out. They can't find out where a loved one is, let alone whether he's getting treatment."

Others familiar with Maine's mental health care system point to some improvements, but they agree with Bruce.

"It's still really difficult for family members," said Carol Carothers, executive director of the National Alliance on Mental Illness in Maine. "I've known parents with full guardianship (of a mentally ill adult) and some care providers still wouldn't talk to them."

In the years since Amy Bruce's death, the Maine Department of Health and Human Services has taken steps to improve treatment and release policies at Riverview to prevent a similar tragedy, according to state officials and mental health advocates.

However, the department also has experienced budget curtailments totaling $12.4 million in the fiscal years 2008 to 2012, according to spokesman John Martins. The department was unable to provide total mental health care spending data for that period, including federal Medicaid claims, which are currently being collected and analyzed.

Despite a 10 percent increase in demand for public mental health services nationally - one in four American adults has some form of mental illness - Maine reduced annual spending in this area from $201 million in fiscal 2008 to $174 million in fiscal 2012.

Yet Maine has done better than most states in taking care of the mentally ill, according to NAMI. It was one of only six states to get a B grade in the advocacy group's 2009 report card on the states. No state got an A. Maine won points for having one of the lowest uninsured rates in the nation and because its Dirigo health plan provides equal coverage for mental illness and substance abuse disorders.

In August, the agency combined its adult mental health and substance abuse divisions, creating the Office of Substance Abuse and Mental Health Services. Director Guy Cousins said the move mirrors a trend in medical care that recognizes the links between the two health issues.

In 2010, the Maine Legislature, pressed by Bruce and other mental health care advocates, adopted a Progressive Treatment Program, commonly known as assisted outpatient treatment.

The program allows a judge to order community-based mental health care, including monitored medication, as an alternative to commitment to a psychiatric hospital or involvement in the criminal justice system.

However, as Maine's program is written, Bruce said, its effectiveness is questionable for the 40 percent to 50 percent of seriously mentally ill people who have anosognosia, a neurological condition that leads them to deny their illness. Family members without legal guardianship have no additional power to compel an unwilling loved one to attend a commitment hearing, where assisted outpatient treatment may be considered as an option.

To help families and others better access mental health care in Maine, NAMI Maine recently convened a task force and issued a written guide for consumers, family members, caregivers and police. It outlines the laws pertaining to the mentally ill, including individual privacy protections.

"It doesn't fix the way people misinterpret the law, but it does attempt to explain it," Carothers said. "When it comes to protecting privacy rights, my sense is (care providers) don't know what they can (say to family members), so they don't (say) anything."

Carothers noted that the state pays NAMI Maine and other nonprofit agencies to provide assistance to families of the mentally ill.

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