Wednesday, April 16, 2014
Some 25 years ago, a rash of patient deaths at the Augusta Mental Health Institute was attributed to overcrowding, a shortage of community-based treatment options and a deteriorating facility.
Under a consent decree that settled a 1989 lawsuit, Maine people with severe mental illness are supposed to get help accessing community-based treatment within seven days of making a request. Instead, they’re waiting an average of two months – in some cases, nearly a year.
The deaths prompted a public outcry, followed by a class-action suit in 1989 that resulted in a court-approved agreement on parameters for state care of adults with mental illness.
A report released last week makes clear the state is slipping in its efforts to meet these standards. People with severe mental illness are supposed to get help accessing community services within seven days of making a request. Instead, they're waiting an average of two months, with some waiting nearly a year.
The report -- which also cites deficiencies at AMHI's successor, Riverview Psychiatric Center -- presents a troubling scenario, one to which the state must react promptly if it wants to maintain the progress it's made in treating these vulnerable Mainers.
In 2010, Daniel Wathen, the court-ordered monitor for the state's compliance with the 1990 consent decree, noted that more than 100 people who don't qualify for MaineCare were on the waiting list to be assigned a community-based services caseworker.
Last week, he reported that the waiting list continues to grow -- from 387 six months ago to 543 now -- and it includes people eligible for MaineCare as well as those who aren't. "Clearly, the trend is in the wrong direction," he wrote.
Granted, the situation was aggravated by the budget uncertainty at the end of the last legislative session. As well, there are promising signs, such as a Department of Health and Human Services pilot project that has helped cut waiting lists for community-based services by streamlining the intake process.
We hope the project sees long-term success and a commitment of state funds. Access to care is crucial for people with severe mental illness. Without it, their disorder can make it harder for them to find work or housing; they are more likely to wind up on the streets or in jail. (Half the people in jail or prison in Maine have a mental illness.)
The state's mental health system faces other challenges, including:
• Two "serious security situations" at the state hospital since March, according to Wathen, the court master.
• The return of veterans from Iraq and Afghanistan, whose "signature needs ... are substance abuse, trauma-related mental health conditions, and traumatic brain injury," says the patient advocacy group NAMI Maine.
• Lack of services for children and teenagers with mental health issues, especially in rural areas.
Legislators passed a bill this session that would provide mental health services at the Maine State Prison, which could free up some of the 92 beds at Riverview and improve conditions there. But the Appropriations Committee didn't fund the legislation, so the proposal is dormant unless further action is taken when the Legislature returns to Augusta in January.
In 1990, the state made a commitment to improve its treatment of people with mental illnesses. The most recent report from the court master raises some serious questions about how well the state is fulfilling that pledge. If it continues to fall short, those who feel the greatest impact will be people least equipped to absorb it.