Fix mental health system

Like a clunker on its last legs dumped on a succession of unsuspecting owners, Maine’s broken mental-health system has been passed along to four governors. Angus King was left holding the keys this week when the wheels came off, the transmission dropped and the inspection expired.

He has less than a week to get a new sticker.

It can be done, but this governor needs the Legislature to demonstrate unusual courage to accomplish in a matter of weeks what his predecessors failed to do in 20 years.

The parts to rebuild the system already exist. They need only be put in place. The money is there if lawmakers can summon the will to make difficult decisions and set spending priorities.

The governor, state representatives and senators can succeed this time for an important reason: They don’t have any choice. They have a legitimate crisis, with hundreds, perhaps thousands of deinstitutionalized mentally ill walking the streets without adequate care, treatment or supervision. The state now has a March 18 deadline to deliver a plan to the superior court.

Justice Nancy Mills warned the state last Friday that, “The days of second chances and never-ending patience are over.” The state has not responded to a 1990 consent decree to provide community services for approximately 3,000 people released from Augusta Mental Health Institute. The court unilaterally is ending its unrewarded five-year vigil. If Augusta doesn’t act promptly, the court will, possibly taking control of the system and its resources in the interest of patients.

Resistance is not an option.

Given the painful daily predicament of the underserved mentally ill in Maine, the documentation of their suffering, their lives in homeless shelters, and their untimely deaths, and official acknowledgment that the system is broken, state government doesn’t have a moral leg to stand on. Legally, its situation is tenuous, even precarious. This is a showdown state government must avoid. It will lose.

Instead, it’s time to cooperate and help the system heal itself.

Ways to do it

Maine’s mental health system has been hemorrhaging for two decades. The first step is to stop the bleeding.

In addition to the toll in lives of mentally ill citizens, financial resources — hundreds of millions of dollars — have been squandered on ancient facilities that serve only a minor role in the delivery of modern mental health services.

Buildings at Augusta Mental Health Institute remain open at a cost of $27 million a year despite a census that will dwindle to 102 patients at the end of June. Maine will be spending more than $250,000 per patient per year at AMHI, not because the mentally ill are best served that way, but because it is politically expedient. AMHI, and to a lesser extent Bangor Mental Health Institute, stand as monuments to effective advocacy by regional legislators.

Close AMHI. BMHI is accredited, AMHI is not. AMHI also is the institution under scrutiny by the courts. Closing it will allow the Department of Mental Health to divert resources into community-based programs that will serve thousands of deinstitutionalized mentally ill citizens and satisfy the terms of the consent decree.

Shutting the doors at AMHI also closes a wound: By allowing this hospital to remain open, the Legislature potentially compounds the state’s problem. Until its doors are shut for good, patients can transit through AMHI and out onto the streets, where they add to the court’s concern. Coming up with a plan to find and identify people already released is just one of the challenges for Commissioner Peet during the next three days. Closing AMHI ensures that patient class will not get larger.

Temporarily consolidate resources at BMHI, including the forensic unit. Allow as many patients as possible to remain where they are, but move AMHI patients to Bangor, into private institutions or into more closely supervised community programs.

Maine has not been completely idle the past five years. The department is reviewing its accumulation of compliance plans crafted since 1990. As the state assesses these programs and connects them (many patients move erratically between state and independent agencies), it should focus on improving case management, an unglamorous but very efficient remedy to a range of internal problems rooted in lack of good procedure and poor communication.

Employ this generation of state mental health workers to provide services to the deinstitutionalized mentally ill. Dedicated, experienced workers at AHMI and BMHI would be an asset in meeting the terms of the consent decree. They represent a pool of skilled manpower that knows the technique and value of developing close relationships with patients. They could deliver outreach programs to the homeless. Today, many mentally ill clients must come to urban areas to receive care. State hospital workers could be deployed to provide mental health services effectively and more cheaply in rural settings.

Maine spends 62 cents of every mental health dollar to serve the fewer than 5 percent of DMH clients who are at AMHI and BMHI. The big reason is jobs. Although some patients should be in an institutional setting for their own well-being or society’s good, the state hospitals remain open because each week hundreds of paychecks go out to the staffs at these institutions.

It will be easier for lawmakers to close or responsibly scale back state facilities if they offer independent institutions incentive to hire AMHI or BMHI workers or assure this group of state employees a meaningful role in helping Maine through the transition from institutional to community care.

Gov. King and Commissioner Peet did not create this problem, but it can be resolved on their watch with the help of lawmakers who find the courage to seize opportunity in the crisis.