A landmark legal agreement requiring Maine to improve care for adults with severe psychiatric and mental health needs will be dissolved after nearly 35 years.

According to a filing last week by Dan Wathen, the chief justice overseeing the 1990 consent decree involving the former Augusta Mental Health Institute, the state has “obtained substantial compliance” on standards presented in February 2021 when the framework for dissolving the agreement was announced.

Daniel Wathen, the judge overseeing the consent decree. Joe Phelan/Kennebec Journal

“The department welcomes the judge’s recognition that the state of Maine is in substantial compliance with the 1990 Consent Decree, thanks in large part to investments by the Mills administration,” DHHS Commissioner Sara Gagné-Holmes said in a statement. “The department has worked hard to strengthen Maine’s adult community mental health care system to ensure timely access to high-quality services over the past six years, and we are pleased that our systemic improvements are making a difference.

“We look forward to following the judge’s recommendation to file a substantial compliance notice with the court, which reflects our continued commitment to a strong and robust care system in Maine and which we hope will provide a long-awaited resolution to the consent decree after almost 35 years.”

Under the agreement announced in 2021, the state could petition to dissolve the court order only if it demonstrated substantial compliance in 17 individual areas for at least four of six consecutive quarters. The standards were designed to ensure that mental health clients receive services promptly and that service providers are held accountable.

It took 14 quarters for that to happen, but Wathen wrote that he was pleased with the state’s progress.

“In my view, these efforts are intended to build on and maintain the improvements achieved in the state’s community mental health system and psychiatric hospitals,” he wrote.

The consent decree settled a class-action lawsuit brought on behalf of about 300 patients of the Augusta Mental Health Institute after a series of deaths in the summer of 1988 and has governed Maine’s mental health system ever since. The 99-page order outlines a set of principles the state must follow in treating individuals, prioritizing patients’ rights and services in the least restrictive setting available and using hospitalization as a last resort.

Before the consent decree, many people with mental illness were housed at AMHI or other institutions. The facility closed for good in 2004, but at its peak more than 1,800 people lived there, about 12 times as many patients as are housed today at the state’s two psychiatric hospitals, Riverview in Augusta and Dorothea Dix in Bangor.

The consent decree had the force of law, but never mandated funding or even provided individual access to services. In numerous reports over the years, Wathen and his predecessors found that the state often fell short of the standards, which have been updated and changed since the original decree was signed, largely because all but the most needy , now living in the community. rather than large-scale institutions.

In recent years, however, the state has made improvements, including:

• Create a model for certified community behavioral health clinics to be implemented by January 2025. The clinics are designed to provide outpatient crisis and emergency care.

• Establishing a 988 crisis line staffed 24 hours a day and expanding mobile crisis teams.

• Improving medication management for clients, including those being discharged from Riverview and Dorothea Dix.

• Strengthening its relationships with Disability Rights Maine and the Maine Consumer Council System, which act as independent patient advocates.

A spokesman for Disability Rights Maine said the agency would not comment Tuesday on the judge’s latest report or the state’s intention to dissolve the consent decree, referring to the matter as “active litigation.”

Even with improvements to the state’s mental health system, challenges remain.

This very month, two Augusta lawmakers called for a review of staffing and patient safety concerns at Riverview and Dorothea Dix after hearing from staff members at the two hospitals.

And earlier this year, the state has faced criticism for sending patients to out-of-state facilities who use solitary confinement and correctional tactics that have been banned in Maine psychiatric hospitals. In each case, the referred patient was found not criminally responsible for their crimes.

Serious mental illness is defined as any disorder that results in functional impairment that substantially interferes with or limits one or more major life activities, according to the National Institute of Mental Health. This includes schizophrenia, bipolar disorder and major depression. About 4.5% of the adult population has a serious mental illness. That translates to more than 40,000 Maine people, although only about 12,000 qualify for full mental health benefits under MaineCare.

In recent years, some of the biggest challenges have been with people who have been on long waiting lists for residential services, community integration services or daily living skills. Some of these waiting lists have been driven by persistent staff shortages and supplier turnover.

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