Judge Evert Fowle presiding over a Co-Occurring Disorders and Veterans Court in Augusta.
‘Lack of will’, potential conflicts of interest plague comprehensive mental health solution
Third in a three-part series. Click here to read part one.
Critics of how Maine deals with potentially violent mentally ill adults point out that these people can be dealt with at either the “front end” — in the community — or the “back end” — in the mental hospitals, jails and prisons after they have become violent or unruly.
While “front end” efforts stand the most likelihood of keeping mentally ill people from turning violent, “back end” efforts have garnered the most attention from legislators and governors.
In 2014, the mental health unit at the Maine State Prison in Warren was beefed up into what is called the IMHU, the Intensive Mental Health Unit, doubling the number of beds to 32 and adding counseling staff.
Corrections Commissioner Joseph Fitzpatrick, who is proud of the prison’s mental health unit, also is pleased that the Legislature in 2016 funded a $150-million expansion of the Windham prison, a goal he said he had pursued for years and that Gov. Paul LePage supported.
That expansion will contain an infirmary providing, in addition to mental health care, geriatric beds for the growing population of older prisoners. It will also include facilities for substance abuse, domestic violence, and sex offender treatment, as well as medical care. It will have 200 to 300 beds, but it’s still three to five years from opening.
The Promise of Drug Courts
Those on the front lines of dealing with Maine’s severely mentally ill see the need for more solutions outside of the correctional system. Some judges and prosecutors see great hope that “drug courts” are a way to stem the tide of mentally ill people flowing into the jails and prisons.
There are seven drug courts in Maine. The most innovative and perhaps most promising is the Co-Occurring Disorders and Veterans Court in Augusta.
“Co-occurring” refers to people who suffer from both mental illness and drug addiction. Because these conditions often go together, the other drug courts tend to be co-occurring in an unofficial way. Begun in Florida two decades ago, drug courts now number several thousand across the country.
“It’s got to be the future” because “business as usual won’t work,” said Superior Court Justice Nancy Mills, who oversees these courts in Maine. She established the Augusta co-occurring court in 2005. The military veterans component was added in 2011.
Successful participants avoid years behind bars by undertaking a rigorous, tightly monitored, individualized program for up to two years of mental health and substance abuse counseling, volunteer work, perhaps college classes, curfews, random drug testing and weekly meetings with a judge.
To qualify, participants must be evaluated by a committee on their chances of success — and be guilty of a serious crime. The veterans also get treatment at Augusta’s federal veterans hospital. They’re watched over by devoted volunteers, the Veteran Mentors of Maine, themselves ex-military. Backsliding is tolerated, resulting in sentences such as soup-kitchen work or a day or two in jail.
According to a February report to the Legislature by the judicial branch, there are about 250 drug court participants in the six counties that have them. About 50 people graduated last year.
One participant, interviewed in the Capital Judicial Center in Augusta, is Dennis Moore, 36, a thin man with a green baseball cap he wore backwards. He said that, although the program is strict, “this is a great alternative to prison.”
He should know. He spent 10 years in prison and two in jail for “multiple felonies,” including, he said, assault and stealing from his grandmother. He is now pursuing a mental health degree at the University of Maine at Augusta.
“In prison, you get angry,” he said.
The courts’ supporters tout a low rate of the return to crime, known as recidivism.
At a Lewiston forum in June on the mentally ill in the jails and prisons, Maeghan Maloney, the Kennebec and Somerset County district attorney, claimed “not a single graduate has ever committed another crime” in the veterans section of the Augusta drug court and the co-occurring disorders section hasn’t had a graduate commit a crime since 2014. She compared these results to the “75 percent recidivism rate of those who go to prison.”
But recidivism rates are a challenging subject. There’s no central source of information about them in the United States. Corrections officials say it’s difficult to track recidivism in Maine because there’s no electronic data interface between the prisons and jails.
The rough consensus among national experts is that recidivism is around two-thirds within three years for all people exiting from prison. In contrast, the consulting firm Hornby Zeller Associates found the re-offender rate after 18 months of graduation from Maine drug courts was 16 percent.
Then there’s the advantage of saving taxpayers money. Each drug court costs about $140,000 a year for counseling and monitoring, according to Mary Ann Lynch, a spokeswoman for the judicial branch.
Adding in the judges’ and clerks’ time, each graduate costs taxpayers approximately $23,000 per year for just a year or two. By comparison, the Maine State Prison last year cost $46,000 per inmate per year — often a cost that continues for many years.
“It’s cost-effective, humane, and it works,” Justice Mills said of the drug courts.
Although there has been an effort in every legislative session to expand the veterans court, Maloney said, “It has thus far failed because of money.”
Drug courts are a form of community mental health and substance abuse care. But even if their recidivism numbers and costs are promising, like most other “diversion” programs they still take place at the back end, when people are already in trouble with the law and, at least so far, they involve small numbers.
A push for reform?
Disability Rights Maine, a nonpartisan, nonprofit group with a $3 million annual budget and nearly 40 employees, would seem to be a prime candidate to push for front-end reform. It represented patients in the 1989 AMHI lawsuit that resulted in the 1990 consent decree that obligated the state to reform the mental health care system. It officially remains a watchdog to see that the decree is followed.
In interviews, however, the group’s leaders have conflicting views of the state’s mental health services. “There’s progress, but it’s halting at times,” said Kevin Voyvodich, the group’s managing attorney. On the other hand, Kim Moody, executive director, admitted that “the community mental health system is not doing okay.”
To reduce the flood of mentally ill people into the jails and prisons, Moody said, there’s a need to create a diversion program — “mobile crisis units” — so that “the intervention will be on the front end, to support people before they end up in the kind of crisis that can lead to arrest.”
When asked if Disability Rights Maine has concerns with 13,000 people being dropped from mental health services during the LePage administration, Voyvodich was non-committal. “Our position is what are the most appropriate services and are they getting them?” he said.
“We don’t have a conclusion yet.”
Moody, however, said the “blanket cut” of services was “detrimental to many individuals.” This year the group testified in favor of LD 808, Democratic state Sen. Shenna Bellows’ unsuccessful bill to restore many services. (Strictly speaking, the group doesn’t lobby the Legislature because of its tax-exempt status and other federal laws controlling its activities, Moody said.)
As for the Riverview Psychiatric Center, the state’s chief mental hospital, in Augusta, Voyvodich said, “We always want to see improvement.” Disability Rights Maine, he said, is more focused on supporting the rights of mentally ill individuals vis-à-vis their caretakers than working on big changes in the mental institutions themselves.
Moody pointed out that Disability Rights Maine provides patient “advocates” for Riverview and Dorothea Dix Psychiatric Center in Bangor.
These employees at the two hospitals are financed with a $162,415 state grant. Disability Rights Maine is 85 percent funded by state and federal grants totaling $2.57 million last year: $1.36 million from the state and $1.21 million from the federal government.
Despite the high level of government funding, Moody maintained that the group has “utter independence from the state.” Besides issues involving mental health, Disability Rights Maine also deals with the rights of other disabled people, such as those with intellectual and physical disabilities.
The organization has come under criticism in recent years. In 2014, Rep. Richard Farnsworth, D-Portland, questioned why the group did not report immediately to the state’s Adult Protective Services, as the law required, that a guard had pepper-sprayed a naked, defenseless female patient at Riverview. A former nurse there reported the incident months later.
In an interview, Farnsworth said Disability Rights Maine’s “tempered” response was insufficient. “I thought they probably should be taking [Riverview] to court,” he said.
Speaking broadly of groups serving disabled people, Kathy McInnis-Misenor, a veteran disabled-persons’ organizer in Saco, commented: “It’s easier to cooperate than to sue.” She also declared that, “It’s a total conflict of interest” for disability groups to be reliant on government money. She is not alone in having concerns about potential conflicts of interest due to government funding for advocacy groups.
“Many in the provider community have asked that question,” Farnsworth said.
In the same government-funding boat is NAMI Maine, another major advocacy group for the mentally ill.
Among its activities, NAMI Maine — an affiliate of the National Alliance on Mental Illness, the country’s largest group promoting improved conditions for the mentally ill — receives grants to help train police forces to interact more sensitively with mentally ill people in crisis. Its annual revenues in 2014 were $2.5 million, of which $1.8 million came from government grants.
NAMI Maine’s executive director, Jenna Mehnert, declined to give an interview or answer emailed questions for this story. (With the exception of providing a spending chart, DHHS was similarly unresponsive to requests for interviews and information.)
A quite different group representing mentally ill people is the Consumer Council System of Maine. Set up by the consent decree and composed of nine regional councils and one statewide council of mentally ill people, it provides input to state agencies making decisions that affect this population.
Despite the $320,000 a year the council system gets from the state, the organization’s director, Simonne Maline, is outspoken on the need for change. Because the state “never fully funded a comprehensive mental health program,” she said, the consent decree “almost means nothing.”
Discussing mental health advocacy groups generally, Maline said, “There’s a lot of fear out there about speaking your mind because of losing contracts.”
James Lysen, a Lewiston city councilor who used to run a health center providing mental health services, observed at the June forum on “The Criminalization of the Mentally Ill” that there’s wide agreement on the problem and even on the solution — more resources — for the care of the mentally ill. Despite such agreement, “It just seems that the will is not there” to provide the resources, he said.
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