Recently, DRM made a presentation to the Legislature’s Health and Human Services Committee about the history of the AMHI Consent Decree and where it stands today. Signed in 1990, the Consent Decree is an agreement between residents of the Augusta Mental Health Institute and the State of Maine. The Decree resulted from a lawsuit that was filed in response to problems at the state hospital, including the deaths of a number of patients in the summer of 1989, and problems with the lack of resources in community mental health system. The agreement required the creation of a new comprehensive state mental health system and outlined the rights of recipients of mental health services. Although 27 years old, the principles and goals of the decree related to the treatment of individuals with psychiatric labels both in hospitals and in the community have stood the test of time. In order for a system to adequately meet the needs of individuals without taking away their rights and dignity, all of the principles and goals of the Consent Decree, outlined below, must be realized.
Principles:
- A quality system requires less reliance on AMHI (now Riverview Psychiatric Center) and more resources devoted to community services.
- You cannot tell what a person’s personality, abilities, needs, and aspirations are on the basis of a psychiatric label.
- Consumers of mental health services are entitled to respect.
- Personal needs change over time according to the individual’s needs and circumstances. Community mental health services must be flexible in order to meet changing needs so that, to the extent possible, consumers of mental health services will not have to change their living arrangements when needs change.
- Hospitalization separates people from their friends and family. Hospitalization uproots people from their home communities. The mental health system must be oriented toward helping people to avoid hospitalization. If hospitalization is needed, it should occur as close to home as possible, for as short a time as possible. Individualized community supports should be provided upon discharge.
- Services must be provided in the least restrictive setting appropriate and by the least restrictive means appropriate to each individual’s needs.
- The system must be designed and delivered on the basis of identified individual needs. The consumer of mental health services should not be forced to fit the service, rather the service should be made to fit the consumer.
- A consumer of mental health services has the same rights as do all other citizens, including the right to live in the community of their choice.
- Consumers of mental health services have the right to refuse all or some of the services available to them under the Consent Decree. Consumers of mental health services cannot be denied the services they want solely because they refuse services they don’t want.
Goals:
- To ensure that consumers of mental health services are the driving forces in their own treatment planning and programs.
- To improve the quality, comprehensiveness, and availability of mental health services.
- To maximize the use of “non-mental health system” services whenever possible.
These principles and goals clearly focus on providing supports for individuals to achieve their wants, goals, needs, while moving through a system that focuses on individual support. Fewer institutions, person-driven treatment, and least restrictive treatment environment are the common themes. People are often told what it is they need, but it is important to remember to ask the individual about the hopes and goals they have for their own lives.
There is a shift in the provider-client relationship when a client is asked about their needs. Often the provider simply asking that question creates a treatment process that focuses on the individual. Too many times I have seen a person sent to a setting based on what is available rather than what the individual or, in some cases, the provider believes would be the best treatment setting. The goals and principles of the Consent Decree remind us a system that provides treatment must focus on the individual. They are entitled to flexible, quality, dignified treatment that works for their specific mental health needs. Too often, the need to comply with Medicaid’s complex billing requirements dictates the services an individual receives. We must remember, however, that the Consent Decree does not depend on a specific source of funding, but rather it outlines what services are necessary in order to provide a comprehensive mental system that serves the individual needs of consumers.