Peet: moving ahead

Despite being prodded by the courts, shaken by its own performance history and constantly impeded by the political system, Maine’s Department of Mental Health appears to be holding a course that ultimately will resolve issues that have troubled the system for more than two decades.

It breaks down something like this:

The department wisely has decided to de-emphasize the public policy debate over closing the two state mental hospitals.

DMH has a sheaf of studies in hand assessing the relative merits of shutting down the institutes in Bangor and Augusta. The most recent was released just two months ago by Gov. Angus King’s Task Force on Mental Health. Its recommendations were specific, and included a timetable.

The task force proposed closing Augusta Mental Health Institute in October 1997, building one or more state-of-the-art mental health facility in the state and closing Bangor Mental Health Institute by the end of the decade. Totally consistent with previous reports, the task force study shares another similarity with its predecessors. It is unlikely to receive aggressive follow through by the Legislature.

For 25 years, the department has been spinning off portions of the AMHI campus to other agencies and boarding up wards while the patient census there shrunk from 1,600 to around 100. The cost of maintaining physical plant and staff remains high. The figure commonly used is $25 million a year. It is a major reason why Maine’s investment in this important health arena is skewed badly: 60 percent of resources are invested in the hospitalized 5 percent of the population needing mental health services.

The remedy, however, has overmatched lawmakers who simply don’t want to make the politically unpleasant decision to completely shut a state hospital’s doors. Under the circumstances, forcing AMHI’s closure in the Legislature is not worth the fight by DMH. The past confirms that. Instead, it will focus on the future.

The prospect of diverting poorly invested institutional dollars to needed community care has been appealing to the beleaguered department, but for this session it sensibly is moving to defuse the polarizing issue of hospital closure by working around it. Commissioner Melodie Peet is astutely using resources and psychology in an effort that should calmly wind down what she calls the “open-close” hospital debate, while establishing a credible level of community clinical services.

There is a chasm in care in this state between doctors’ offices and expensive hospitalization. The latter should be a last resort but today is often the only choice, by default. Peet plans to fill the gap with a variety of innovations including a crisis response system, short-term stabilization and evaluation beds in home settings and a mobile capability to address psychiatric emergencies in rural settings. She also wants to increase the number of practitioners in Maine. It is a constructive, impressive agenda.

Worth repeating for the new Legislature: Gov. King and Commissioner Peet inherited a mental health system that was costly, inefficient and inhumane. Now, for the first time since that system began unraveling during the early 1970s, an administration is trying to make responsible repairs and salvage the lives of mentally ill people who were deliberately discarded by state policy. It is an effort that deserves enthusiastic support.