Sixteen years after a consent decree required major changes in the state’s mental health system, the Department of Health and Human Services has finally developed a plan that court officials find acceptable. While it is positive that the state’s plan was given initial approval last week, it shouldn’t have taken more than a decade when the judge overseeing the decree found that poor management, not a lack of money, was the problem.
A 1990 agreement, known at the AMHI consent decree, settled a class-action lawsuit by patients at the Augusta Mental Health Institute after several deaths at the state-run facility. The decree called for improving services and reducing the number of patients at the state’s two mental health hospitals while continuing to shift more patient care to community settings.
An immediate problem was that there were not sufficient community services. The state has slowly worked with community and private hospitals and mental health care providers to ensure counseling, housing and crisis services are available throughout the state.
A later problem was that the state had no set standards to ensure patients were receiving appropriate, adequate and timely care.
The most recent problem was a legislative mandate requiring a shift to a managed care plan for mental health services with the goal of improving access to such services. That change is taking longer than expected, although the department is wise to ensure it is done right, not just quickly.
Throughout the decades since the decree, Justice Nancy Mills has repeatedly expressed frustration over the state’s lack of progress in meeting the requirements of the agreement. A contempt of court proceeding is still pending against the state, although it will most likely be dropped with approval of state’s plan. The state must remain in compliance with the new plan for a year before court oversight of the mental health system can end.
Last week, the plan was approved by former Maine Chief Justice Daniel Wathen, who was appointed in 2003 as the court master overseeing the state’s compliance with the consent decree. Justice Wathen’s emphasis on standards and a cooperative tone are reflected in the 101-page plan.
A key component of the plan is continuity of care, which entails clients, advocates providers and hospitals working together to ensure that appropriate care is available when needed throughout the state. Consumer councils will be established to assess whether there are gaps in service and how they should be filled. It will be up to the state to ensure there are resources, both financial and physically, available to ensure continuity.
Most important, the plan sets standards in areas ranging from access to care, length of hospital stays to satisfaction with the services provided, to ensure that the system is working. This is the first time the state has such comprehensive guidelines, which were developed with clients, advocates and providers.
The plan, many parts of which are already in place, marks a large step toward compliance with the consent decree. The final step is ensuring Maine meets all the plan’s standards.