AMHI accord imperiled Proposed budget cuts threaten compliance

AUGUSTA – Proposed budget cuts could undermine the state’s efforts to comply with an 11-year-old agreement mandating adequate mental health services for current and former patients of the Augusta Mental Health Institute.

“That is certainly a fear of mine after listening to the hearing and the court master,” Sen. Jill Goldthwait, an independent from Bar Harbor and co-chairman of the Legislature’s Appropriations Committee, said last week. “This is a very difficult area for the committee. We want to provide what’s right.”

The court master appointed by the Superior Court to make sure the agreement was followed testified about the potential impact of the cuts before the committee last week. The panel, which is examining the budget proposal, also heard concerns from several people at a public hearing earlier this month.

Maine’s history of providing needed mental health services is troubled. In the late 1980s, federal officials cut off funds because of staffing shortages and improper record-keeping practices at AMHI.

A decade later, dozens of patients at the hospital suffered from excessive heat in the century-old buildings. Ten patients died, and federal officials again investigated AMHI.

In August 1990, a class-action lawsuit brought on behalf of patients at the hospital was settled when attorneys for the state agreed to the terms of a consent decree covering an estimated 3,000 past and present patients at AMHI. In the agreement, the state agreed it would provide adequate care by September 1995.

That did not happen, and twice a judge has held the state in contempt for not fulfilling the promises of care made in 1990.

After several years of significant growth in funding for mental health programs and services, the state has asked the court again to rule on whether it is meeting the requirements of the consent decree.

Since 1995, while funding for AMHI itself has decreased by about $500,000, funds for community-based mental health services have jumped nearly $15 million.

Facing a $248 million shortfall, however, Gov. Angus King proposed a supplemental budget that included cuts to services for Maine’s mentally ill. For example, his proposal calls for reducing the program Children’s Mental Health Services by nearly 5 percent below the previous year’s spending level.

“Many of us on the committee are concerned about these cuts,” Rep. Randy Berry, D-Livermore Falls, told Gerald Rodman, the court master overseeing the consent decree, last week. “We had hoped we had finally achieved compliance.”

Rodman told the panel last week that the court would have to decide whether the state has reached compliance. But he acknowledged that he shares some of the committee member’s concerns.

When asked how some of the cuts might affect the decree, Rodman reeled off several specific areas of concern.

One item involves the reduction of $150,000 in rental assistance for clients who are not eligible for Medicaid. Rodman said most clients are eligible for the joint federal-state funded Medicaid program, but “hundreds” are not.

The decree requires that services be provided regardless of whether a person is eligible for Medicaid.

Rodman went on to cite several other cuts in funding for social clubs, residential treatment facilities, vocational rehabilitation and other outpatient services. He declined to answer directly the question of whether those cuts would violate the agreement, saying that would have to be decided by a judge.

Another concern is a provision in the decree that stipulates services to patients and former patients of AMHI, called “class members,” cannot be paid for with funds diverted from programs aimed at those individuals with mental health problems who have never been admitted to AMHI.

“The consent decree is very limited with respect to nonclass members,” Rodman said. “The primary provision in the consent decree related to nonclass members is a prohibition against depriving nonclass members of services solely because they are not class members in order to meet the consent decree.”

But several lawmakers on the committee were very concerned that will be the result of the cuts.

“It seems to me as though that is exactly what parts of this budget proposal are doing,” Goldthwait said during the committee meeting.

However, Lynn Duby, commissioner of the Department of Behavioral and Developmental Services, said during an interview last week the proposed cuts are not designed to do that.”We are not talking about taking away from nonclass to serve class,” she said, “which is the distinction in the decree. There are people who need services because their needs are greater, and there are a group of people who may need or want services, but their needs are less acute.”

While saying the cuts were needed to balance the budget, Duby acknowledged they could pose serious problems in future years because help for Mainers with less acute needs would be delayed and could make their conditions more serious.

“We came up with what we thought was the least painful and most defensible strategy with a horrendous problem,” she said.

If state revenues should improve, Duby said King has identified the mental health services cuts as areas he will recommend be restored first.

Superior Court Chief Justice Nancy Mills is expected to decide later this year whether the state finally is meeting its legal commitments to Maine’s mentally ill.