December 13, 2019

State submits AMHI plan > Consent decree deadline met

AUGUSTA — State officials delivered a $39 million plan to Kennebec County Superior Court Monday, meeting a court-imposed deadline to comply with the Augusta Mental Health Institute consent decree.

Although Gov. Angus King acknowledged he didn’t know where the state would find the extra money to implement the plan, he and other state officials hoped the AMHI compliance plan would satisfy the court and avert a crisis if the court decided to take over the state mental health system.

The document calls for a comprehensive, statewide mental health system run through seven regional service networks, 150 new caseworkers, 24-hour crisis hot lines, mobile outreach services, and more housing options for clients.

“This signals a new beginning for the mental health system in Maine,” Gov. King told a late-afternoon press conference. “We’re viewing this as an opportunity for Maine. … My goal is to have the best mental health system in the United States, and we can do it.”

On March 8, Justice Nancy Mills ruled the state was in contempt of court for failing to make meaningful progress on meeting the terms of the AMHI consent decree which was reached in 1990.

“The days of second chances and never-ending patience are over,” Mills wrote in her order.

Mills threatened to have the courts put the state mental health system in receivership, and in effect to have the courts run the system, unless the state shaped up.

Mills’ order gave bureaucrats at the Department of Mental Health and Mental Retardation only one week to put together what was supposed to be the final plan for implementing the AMHI consent decree. The decree governs conditions inside the mental hospital and in the community for more than 3,000 present and former AMHI patients.

The decree spells out standards of patient care in the hospital, while requiring the hospital to be reduced in size as better, more comprehensive services are created in communities.

Mental Health Commissioner Melodie Peet said the state will try to improve mental health care for all people in the state, not just the AMHI class members, so as not to create a two-tiered system of care.

King said the new plan of about 150 pages is both a compilation of previous plans and a document with a new message. Among highlights of the plan:

Patients would have a single point of entry to the mental health system. A single telephone call would refer the patient to available services. No one would be denied services.

A 24-hour crisis hot line would be established in each of seven regions.

Mobile outreach teams that could respond to crises at people’s homes would be established throughout the state.

More short-term crisis beds would be established in communities, while housing for the mentally ill was increased statewide.

About 150 new caseworkers would be hired, of whom 73 would be state employees and the rest employees of private service providers.

Spending on the AMHI consent decree during the current two-year budget period would be increased from about $23 million to $39 million. Productivity savings already have produced $7.5 million for the consent decree so an additional $8.2 million needs to be funded.

“We do not have a particular source for that money at this point,” said King. “We’re going to have to find it.”

At an earlier news conference Monday, King said, “We’re going to have to scour the budget.

“Whether it will satisfy the court and the special master [Gerald Rodman], I don’t know,” King said. “I certainly hope it will because it really does represent a good-faith effort to meet these requirements and even go beyond them.

“I think they’re going to be pleased. I hope they’ll take it for what it is, which is a very good-faith effort to come to grips with this thing. It’s time to get away from confrontation. It’s time to be more cooperative.”

King repeated his refrain that too much money in Maine is spent on institutions such as AMHI and Bangor Mental Health Institute and not enough on community services.

But he said for the first time that community services may have to be created first before more patients are discharged from AMHI and BMHI. The state has been criticized for downsizing the institutions too quickly without adequate community services in place.

“The problem is we’ve got AMHI and the total budget is $27 million a year and the total patient population is on the order of 140 people,” said King. “That’s a lot of resources to a very few people. Then there are people on the streets in Portland, Bangor and Presque isle who are getting virtually no resources and they need them.”

Of the mad scramble to write the plan, Commissioner Peet said, “There was a lot that was very hard about pulling this plan together in the last week. But in a way, it was a luxury, a liberating experience to work on this. This is a fundamentally different document than anything that went before it.”

King said the state may appeal the judge’s authority to take over a branch of state government, even if the case doesn’t reach that point. But King stressed such a procedural appeal would have nothing to do with the state’s ability to comply with Mills’ order.

Rep. Michael Fitzpatrick, D-Durham, House chairman of the Human Resources Committee, said of the administration plan, “It’s very hard to follow the funding. That’s where the discussion will take place. But this is a positive step forward. This is a coherent statement.”

Fitzpatrick is executive director of the Alliance for the Mentally Ill of Maine.

William Stubbs, president of the Alliance for the Mentally Ill of Maine, said his group was most interested in comments from mentally ill people and their families on the performance of private service providers.

Stubbs said Peet was planning to give consumers of mental health services more of a say in the contracts that are awarded to providers, but she recently backed away from this and said contract administration would remain centralized with the state.

“The key thing is the money and the contracts and who awards them,” said Stubbs.

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