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Maine proposes
local solution for statewide continuity issues
(November
2006 Issue)
By Catherine Robertson Souter
The ongoing issue of how the mental health care system in the state
of Maine should be run may soon be coming to an end. On Oct. 2,
the state's Department of Health and Human Services (DHHS) delivered
a revised proposal for compliance with a 16-year-old consent decree
to the court master appointed to the case.
The original suit, filed in 1989, alleged that the state violated
clients' rights at the Augusta Mental Health Institute (AMHI) because
of inappropriate treatment and inadequate community support services.
In 1990, the court issued a consent decree that required the state
to establish and maintain a comprehensive mental health system.
Since that time, the state has been brought back to court several
times to determine if requirements outlined in 259 paragraphs of
the decree had been met.
In 2003, stating that the majority of the requirements had not
been met and that the state did not appear willing or capable of
meeting them, the court appointed a receiver to operate AMHI. Further
confusing the issues at hand, the Department of Behavioral and Developmental
Services and the Department of Human Services were combined, now
known as the DHHS.
The state's highest court overturned the receivership ruling in
2004, placing the hospital (now known as Riverview Psychiatric Center)
back in the hands of the DHHS. At that time, the court also established
new compliance guidelines for the state.
In February of this year, to address these issues and questions
raised by a separate government oversight committee about Riverview's
bed capacity, the state hired consultant Elizabeth Jones, the appointed
receiver for AMHI/Riverview. Jones was brought on board to examine
continuity of care issues within the mental health system and recommend
a response to the court demands.
"We hired her to do some continuity analysis," said Ronald Welch,
the recently appointed director of the Office of Adult Mental Health
services for the DHHS. "We used those recommendations to provide
a plan that is in compliance with the decree."
Because Jones had worked with the state hospital, she had in-depth
understanding of both the hospital system and patient community
services and could make recommendations as required. Based in part
on her proposals, the new plan centers on "the premise that local
planning, local problem solving, and a mutual understanding of the
roles and expectations of each service provider are effective ways
to support continuity of care."
The plan includes a number of proposals: new performance requirements;
the creation of seven regional Community Service Networks comprising
all local mental health providers, and total restructuring of residential
housing options, allowing more people to remain in their own homes
while receiving mental health care.
The new plan also outlines support for an independent and localized
consumer council system, which would include consumers, families
and advocacy groups. The state would not be involved in operating
this system, but would require the inclusion of peer input as part
of the community service networks.
While waiting for word from the court on whether the state has
finally met all the requirements in the consent decree, the DHHS
has begun to work towards enacting some of the recommended changes.
"Some of these initiatives are sea changes in the way the system
has always worked," said Welch. "We are starting to work with providers
and consumers in setting up task groups with an eye toward implementation."
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