More than Money

As Superior Court Chief Justice Nancy Mills made clear in two tersely worded orders, the second issued last week, the state is not meeting the requirements of the consent decree aimed at improving the state’s mental health system and its flagship institution, the Augusta Mental Health Institute, not because of a lack of money but because of poor management.

While the harsh assessment and the accompanying requirement that AMHI be placed in receivership may be a setback for the Baldacci administration, it is also an endorsement that the governor is on the right track in trying to repair the state’s badly broken mental health and human services system. Justice Mills’ Sept. 10 decision points out that the governor is right to first get the Department of Human Services’ financial house in order – a difficult task given that millions of dollars in funds turn up unaccounted for on a monthly basis.

Her ruling also indicates that hiring new management to oversee the department, which is to be merged with the Department of Behavioral and Developmental Services, is a move in the right direction. The goal for the administration is to now do these two things quickly enough to satisfy Justice Mills’ orders while also not devoting so much attention to management issues that the people served by the state’s mental health service agencies are shortchanged.

Many times in her September and May rulings, Justice Mills wonders how, 13 years after the consent decree was signed, the state can be so far from fulfilling its requirements. Of the 259 items required in the decree, 174 have not been met, according to the judge’s May ruling.

“This is not a failure of funding. The evidence made clear that until the recent budgetary problems, money for consent decree purposes was consistently provided by the Legislature. This is a failure of management to get the job done,” Justice Mills wrote in May.

To be fair, the lack of will and disregard for standards demonstrated by state government would reflect more on the prior administration since the state last certified it was in compliance with the decree in January 2002, well before John Baldacci was elected governor. However, given the years of failing to meet this mandate, the current administration must move quickly to fix the myriad problems.

Gov. Baldacci has already moved the state closer to compliance. The governor immediately adopted the recommendations of PricewaterhouseCoopers, the auditing company hired to review DHS accounting practices. Last month, he signed an executive order to hire five new people to help resolve bookkeeping problems and plans to move ahead with improvements in accounting practices. These and other changes will improve the management side of the ledger.

Harder to improve will be the human side of the equation. Clearly, the state’s mental health system must be made more efficient, but it must also have a heart. It is clear that moving people out of mental hospitals without adequate community-based treatment facilities does not work. It is also clear that housing the mentally ill in correctional facilities does not work. Despite its good intentions, the AMHI decree has in many ways harmed those patients who are not covered by the 1990 document. Because they are second in line for services, these people often are treated as second-class citizens.

It is easy to see, as has Justice Mills, what has not worked. It will be much harder to find, implement, and, most importantly, fund a system that does work. If a court-appointed receiver, coupled with Gov. Baldacci’s planned improvements, moves the state closer to the goal of providing high-quality services to all of its mentally ill, it will be a huge step forward, and none too soon.