Maine’s ranking in mental health programs drops > Report cites failure to coordinate care

WASHINGTON — Programs for Maine’s mentally ill have deteriorated, a consumer advocacy group reported Tuesday, but the state was given high marks for its mental health housing and children’s services.

Maine’s ranking in the yearly report by Public Citizen Health Research Group dropped this year from fourth to 11th, where it tied with 16 other states. Those 16 states are trying to improve mental health programs, according to the report, but have “major problems which impede progress.”

Vermont ranked first in the Public Citizen report, with programs that are “improving significantly.”

New Hampshire and Rhode Island tied for second, Connecticut tied for fourth, and Massachusetts tied for 16th. Hawaii ranked last.

The heart of Maine’s problem, according to the report, is the state government’s failure to coordinate mental health care between the eight community health centers and the two state hospitals in Bangor and Augusta.

In 1989, only one-fourth of all admissions to the Bangor Mental Health Institute were screened by a community health center — a situation Public Citizen calls “untenable.”

“For at least 10 years (community centers) have operated as a system independent from the hospitals and essentially unregulated by the Department of Mental Health and Mental Retardation,” the report states. “They have their own supporters in the Legislature and so have been able to resist all efforts to integrate them into a broader public psychiatric care system.”

The community health center system was created in 1963 to bring seriously mentally ill individuals out of hospital care and into less restrictive community care.

This year’s lower ranking was no surprise to Maine officials. The Public Citizen report comes in the midst of planning and alternating treatment services by the state’s Department of Mental Health and Mental Retardation, according to a statement by Commissioner Dr. Robert W. Glover.

Four weeks ago, according to department spokeswoman Jane Bubar, a consent decree was signed resolving a lawsuit filed by present and former patients at the Augusta Mental Health Institute, a facility beset by problems ranging from nursing shortages to overcrowding and patient deaths due to poor medical care.

The recommendations in the report, Bubar said, are considered “a vital document” for planning the terms of that consent decree.

Bubar said the mental health department also will use the Public Citizen report’s six proposals to improve services as guidelines to see if Maine is moving ahead with mental health services.

Public Citizen proposals include requiring psychiatrists and other mental health professionals to donate one hour per week to public programs, making treatment of patients with serious mental illness a priority measure in state programs, and testing a program where specially trained nurse practitioners and psychologists are allowed to prescribe psychiatric drugs.

The Public Citizen report noted that the community health centers will become the “sole gatekeepers” to the state hospitals in fiscal year 1991. Public Citizen recommends that their funds be tied to performance; if they fail, the group says, the funds should be diverted to other programs.

Some good health centers for the mentally ill do exist in Maine, the report said, including programs in Machias and Bangor. Improved crisis services were noted in Portland, York and Kennebec.

Maine’s housing system for the mentally ill could climb from “mediocrity into excellence,” Public Citizen reported, noting that some agencies are providing “pleasant, humane housing for mentally ill people.” On the down side, the quantity of such housing is not equal with the quality, the report said.

Children’s services, particularly those for emotionally disturbed children, were cited as leading the state’s community-based mental health services. The program’s strengths, Public Citizen said, are day treatment and home-based services.