The numbers are going in the wrong direction for certain clients of the mental health care system in Maine. Although nearly a quarter of a century has passed since Maine settled a lawsuit agreeing to standards of care for patients of the state’s mental health system, the most recent report on its implementation shows a marked increase in the number of those waiting to be assigned caseworkers.
According to the report, filed by former Maine Supreme Judicial Court Chief Justice Daniel Wathen, Esq., who was appointed by the courts to monitor the state’s compliance, there are 543 patients waiting to be assigned caseworkers by the Department of Health and Human Services. This number is up from 387 in the previous six month report and about 100 in 2010.
“The waiting list has been a source of concern from the beginning, or certainly since I have been involved,” says Wathen. “Since the caseworker can often be the gateway to all community mental health services, that is where I am trying to focus and put a little pressure.”
Under the agreement filed in 1989, the decree requires the Maine Department of Health and Human Services to assign caseworkers for clients with severe and persistent mental illness to assist them in accessing services in the community. The department has seven days from the time of the request to meet this requirement. Instead, people are waiting an average of two months for a caseworker while some have been on the list for far longer; several were still waiting nearly a year after their request.
The original lawsuit was brought by Maine Advocacy Services on behalf of residents of the Augusta Mental Health Institute, the state-run hospital, after serious problems with the facility allegedly contributed to the deaths of 10 residents. The 1989 class-action suit resulted in an agreement, known as the AMHI Consent Decree, to make corrections to the way the mental health system in the state was run. Wathen, although not involved in the original case, was brought on board to oversee its compliance in 2003.
For those who are not eligible for coverage under the state’s Medicaid program (called MaineCare), state funding has been an issue.
“The general fund needs to be legislatively appropriated,” Wathen explains. “If you look back over the past 10 years, the funding has not changed significantly but the population of people has not shrunk so each year it is becoming more and more difficult to find funds [for all of mental health care].”
Budgetary concerns aside, there still remains a problem when the list of those who are eligible for Medicare funding are also waiting far more than the mandated seven days.
“There are significant numbers on both lists. You would think that those who are Medicare eligible would have no waiting list because the funding is provided for their care but it doesn’t work out that way,” says Wathen.
The state has been addressing both concerns, says Guy Cousins, director of the Maine Office of Substance Abuse and Mental Health Services. A pilot program to streamline the process has begun to reduce the numbers of those on the Medicare eligible list and funding for the remainder has been sought.
“SAMHS has been working with six agencies to pilot the Network for Improving Addiction Treatment (NIATx) projects…a process improvement model that works across behavioral health organizations to improve their business processes,” he says. “SAMHS hopes to expand the number of provider sites undertaking the NIATx process to help them identify pathways to easier access.”
The budget concerns have also been addressed and should help to ameliorate the problem.
“SAMHS has received funding during the biennium which should address capacity issues for agencies in hiring staff,” he says. “SAMHS anticipates there may always be a ‘wait list’ for services in some agencies. We are working to minimize the time that clients spend on the wait list.”
The report also noted concerns with other aspects of care for clients at Riverview Psychiatric Center, which has replaced AMHI, including security problems. According to Wathen, these issues must be resolved to avoid the hospital being found in contempt of court and necessitating a recommendation of placing the hospital under the care of a receiver.
By Catherine Robertson Souter