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Proposed reform
delayed in Maine
(October
2005 Issue)
By Sean Smith
Maine will have to wait a little longer to roll out its proposed
reform of the state's mental health care system.
Earlier this summer, the Maine Department of Health and Human Services
unveiled a plan to move the mental health system to a managed care
model, as had been mandated by lawmakers.
But in August, Maine Court Master Daniel E. Wathen rejected the
state plan, saying it did not sufficiently gauge the cost of implementation
or identify the means of meeting some of the expenses involved.
Wathen did accept the overall plan's "no wrong door" goals and
principles in providing assistance to anyone contacting HHS offices
or agencies, and the blueprint for managing the transition to managed
care. All of these acceptances were cause for optimism even in the
face of the rejection, according to Health and Human Services Deputy
Commissioner Brenda Harvey. "The disapproval of the plan was based
on lack of information, not in regard to the idea of managed care
itself," says Harvey, interviewed last month. "Also, we're already
dealing with some of the other concerns expressed, such as paying
more attention to employment resources."
As Harvey sees it, Wathen's decision does not seriously detract
from the move forward in the state's efforts to end the 15-year
consent decree - the outcome of a class-action suit involving the
Augusta Mental Health Institute (AMHI) - that has governed much
of Maine's mental health care.
"For me, one critical thing is that [Wathen] approved the standards
of performance that the state had devised for gauging our progress,"
Harvey says. "With the consent decree, it's hard to know where the
goalposts are."
The decree was signed in 1990 by state officials to settle a lawsuit
filed by Augusta Mental Health Institute patients who cited poor
conditions at the facility. Among its goals, the decree - as explained
in a summary of the document by the Maine Disability Rights Center
- affirmed that patients be "the driving forces" in their own treatment
planning and programs and mandated improvements in the quality,
comprehensiveness and availability of mental health services.
Perhaps the decree's most dramatic impact, however, was requiring
a reduction in the use of AMHI while directing increased support
for "non-mental health system" services in the community. These
included areas such as community hospitalization, housing, residential
support services, crisis intervention and resolution services, vocational
opportunities and training and transportation.
The decree originally estimated a completion date of Sept. 1, 1995,
but the deadline was extended.
In 2003, Superior Court Chief Justice Nancy Mills ordered that
a receiver be appointed to operate AMHI, reporting to Wathen, who
was appointed as court master. Mills also authorized the appointment
of a second receiver to operate the community-based mental health
system but stayed the appointment for six months. In March of the
following year, Wathen recommended that the system not be placed
under a receiver.
This year saw the Maine Supreme Court reject Mills's plan for taking
over some of the mental health system, while Maine legislators mandated
a one-year transition to a managed care system and a cut in costs.
"We are in an ongoing process," says Harvey. "Only the court can
say when we are in compliance, and we'll continue to work with them
toward that end."
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