AUGUSTA – Dangerous living conditions and patient deaths prompted mental health advocates to sue the state to ensure that those with mental illness could get the help they needed.

Twenty years later, the state continues to pursue compliance with a consent decree that will be in place indefinitely. Improvements have been made, advocates say, but they worry budget cuts could hamper progress.

“It is not at all uncommon for (consent decrees) to go on for 25, 30 years,” said Daniel Wathen, a retired Maine Supreme Judicial Court chief justice who is court master for the case.

Patients represented by Helen Bailey and other lawyers sued the state Feb. 27, 1990, alleging dangerous living conditions and infringement of personal rights.

An advocate for patients who often visited the Augusta Mental Health Institute recalls a particularly hot summer before 1990 that exacerbated the difficulties patients experienced.

Department of Health and Human Services employee Richard Estabrook, who is chief advocate for patients, said the lack of air conditioning and the prescription of psychotropic drugs that limit the ability to sweat were lethal for some patients.

He remembers one man who had suffered burns over a significant portion of his body, which made it even more difficult to cool off. He died while in restraints at the facility.

“What a horrible death for this man who was in a place that was supposed to be treating him,” Estabrook said.

State officials agreed to comply with the terms of the consent decree by 1995, but they have been found in contempt of court several times since then for missing court deadlines

One of the major components of the consent decree was to reduce the number of patients housed at AMHI from 280 to 70. The facility was closed in 2004 when the Riverview Psychiatric Center opened. Today, the center can serve about 90 patients.

Another goal was to move many services out of institutional settings and into the community.

While much of that has been done, budget cuts and a shift to more federal funding continue to keep the state from achieving compliance with the decree.

Carol Carothers, executive director of the Maine branch of the National Alliance on Mental Illness, said she was a guardian for a woman at AMHI at the time of the decree. “It was pretty abysmal in there,” she said.

The improvements over the past 20 years are visible, but Carothers and others fear that continued budget cuts will mean steps backward for patients.

The consent decree covers about 4,500 people — everyone treated at AMHI or Riverview since 1988. The state must provide similar services to others with mental illness, 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 the state’s increasing reliance on federal Medicaid money.

While that works for people who qualify for Medicaid, it has hurt those who don’t, he wrote.

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.

He also 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 care are often held too long because there’s no suitable place for them to live in the community.

He would not put a timetable on when the state might reach final compliance. But he said he’d like to be the final person assigned to monitor the decree.