The U.S. Health Care and Financing Administration’s (HCFA) second report on the Augusta Mental Health Institute was released recently. While not scathing, it paints a rather depressing picture of daily life at the hospital. More importantly, the report demonstrates that little progress has been made in improving the quality of treatment available there.

The last few decades have not been kind to AMHI. Long a warehouse for the chronically mentally ill, a series of patient deaths resulted in decertification of the hospital by HCFA and loss of accreditation. A class action lawsuit was filed in 1989 alleging an inhumane environment, inappropriate commitment of patients, and a lack of treatment and treatment planning for many patients. The settlement one year later required the state to develop a plan for a comprehensive mental health treatment and support system that emphasized services in the community and reduced the utilization of the state hospitals.

HCFA reviewed the conditions at AMHI three years ago after a patient, Wrendy Hayne, was murdered by another patient, Harold Pulsifer. The first review by HCFA contained a series of citations concerning health and safety issues. There was no attempt to evaluate treatment of the patients in that first report. This time, HCFA focused almost exclusively on serious gaps in treatment at AMHI, particularly the lack of personalized treatment planning for each patient, forced overtime by staff and a lack of adequately trained staff.

One of the deficiencies, extraordinarily high turnover in medical staff, cited in the first HCFA review remains unaddressed, even aggravated. AMHI is now on its seventh clinical director since the Wrendy Hayne slaying.

The descriptions provided by the HCFA surveyors this time are particularly indicting: “a 44 year-old woman was admitted for severe psychosis approximately three weeks prior to the survey date. The patient has continued to refuse medication. On several instances, … observed the patient pacing the halls or sitting off by herself. Other than occasional brief exchanges, no efforts to engage the patient were observed.”

The surveyors also noted that on one weekday morning, of 22 patients in a particular unit, only two were observed to be in a structured treatment, while 12 of the others were in their beds with the door closed.

Wake-up call

The Department of Mental Health has been crisis-driven in the last few years, careening from one public relations wreck to another. A spokesperson for the department described the HCFA report as “a wake-up call,” an opportunity to develop a higher, better level of care for a changing group of patients.

Helen Bailey, the attorney for the class action suit, has a slightly different viewpoint. “If this is a wake-up call, then the department has a sleep disorder. They’ve missed a lot of alarm clocks before this one.” However, Ms. Bailey is quick to point out that the department has done an “amazing” job of building outpatient treatment opportunities for patients who formerly would have had little choice but AMHI or BMHI. More needs to be done, but patients have a wealth of community based treatment opportunities and support services that were unavailable a decade ago.

People with serious mental illness once spent a significant portion of their lives in places like AMHI. Now they live and receive treatment in the community, just like people with other, chronic non-mental illnesses. Occasionally, due to internal or external factors, they suffer relapses and need temporary, intensive treatment. While community hospitals like Acadia Hospital are often sufficient, some patients don’t respond quickly and are still acutely ill. The “safety net” for these patients is and should remain the state hospitals.

The HCFA report reiterates the class action suit of 10 years ago: AMHI must provide personalized, productive treatment for its patients. It is time to complete the transformation of AMHI from asylum to community-care hospital, from warehouse of sad stories to treatment center of hopeful ones. The state has worked hard to develop a vastly improved system of treatment and support in the community. It is now time to do the same within AMHI.