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

The state has “substantially complied” with those regulations, according to a filing filed last week by Dan Wathen, the presiding judge overseeing the 1990 consent decree involving the former Augusta Mental Health Institute. Standards summarized in February 2021 when the framework for terminating the agreement is announced.

Daniel Wathen, the presiding judge who oversaw the consent decree. Joe Phelan/Kennebec Magazine

“The Department welcomes the chief justice’s recognition that the state of Maine has achieved significant compliance with the 1990 Consent Decree, thanks in large part to the Mills administration’s investments,” DHHS Commissioner Sara Gagné-Holmes said in a statement. “The Department has been working hard for the past six years to strengthen Maine’s adult community mental health care system to provide timely access to high-quality services, and we are pleased that our systemic improvements are making a difference.

“We look forward to following the chief justice’s recommendation to file a substantive notice of compliance with the court, which we hope will deliver a long-awaited decision that reflects our ongoing commitment to a strong and robust system of care in Maine, a consent decree after nearly 35 years.”

According to the agreement announced in 2021, the state could only apply for the termination of the court decision if it demonstrated substantial compliance in at least four out of six consecutive quarters in 17 separate areas. The standards are designed to ensure that mental health patients receive services promptly and that providers are held accountable.

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

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

The consent decree settled a class-action lawsuit filed on behalf of nearly 300 patients at the Augusta Mental Health Institute after a series of deaths in the summer of 1988 and has governed Maine’s system for treating the mentally ill ever since. The 99-page order outlines a set of principles the state must follow in treating individuals, prioritizing patient rights and services in the least restrictive environment possible and using hospitalization as a last resort.

Before the consent decree, many people with mental illness were placed in AMHI or other institutions. The facility was completely closed in 2004, but at its peak more than 1,800 people lived there; That number was nearly 12 times the number of patients 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 it never mandated any funding or even guaranteed individual access to services. In numerous reports published over the years, Wathen and his predecessors found that the state often fell short of meeting standards that have been updated and modified since the original executive order was signed, largely because all but the individuals with the most urgent needs now live in the community. environments rather than large-scale institutions.

But in recent years the state has made improvements, including:

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

• Establishing a 24-hour 988 crisis line and expanding mobile crisis teams.

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

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

A spokesperson for Maine Disability Rights said the agency would not comment Tuesday on the presiding judge’s final report or the state’s intention to terminate the consent decree, calling the matter “active litigation.”

Despite improvements in the state’s mental health system, challenges remain.

Just this month Two Augusta lawmakers request review After hearing from staff at two hospitals about staffing concerns and patient safety at Riverview and Dorothea Dix.

And earlier this year, State faces criticism for sending patients to out-of-state facilities Those who used isolation and correctional tactics banned in psychiatric hospitals in Maine. In each case, the referred patient was found not to be criminally responsible for the crimes he committed.

According to the National Institute of Mental Health, serious mental illness is defined as any disorder that results in functional impairment that significantly interferes with or limits one or more major life activities. This includes schizophrenia, bipolar disorder and severe depression. Approximately 4.5% of the adult population has a serious mental illness. That means there are more than 40,000 people in Maine, but only about 12,000 are eligible for full mental health benefits under MaineCare.

Some of the biggest challenges in recent years have been with people on long waiting lists for residential services, social integration services or daily living skills. Some of these waiting lists have occurred due to persistent staff shortages and staff turnover at providers.

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