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

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

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

“The department welcomes the court master’s recognition that the state of Maine is in substantial compliance with the 1990 Consent Decree, thanks in large part to the investments of the Mills administration,” DHHS Commissioner Sara Gagné-Holmes said in a statement. “The department has been working hard to strengthen Maine’s adult community mental health system of care 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 court master’s recommendation to file a notice of substantial compliance with the court, which reflects our ongoing commitment to a strong and robust system of care in Maine and which, we hope, will deliver a long-awaited resolution to the consent decree after nearly 35 years.”

Under the agreement announced in 2021, the state could petition to dissolve the court injunction only if it demonstrated substantial compliance in 17 individual areas for at least four out 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’s satisfied with the state’s progress.

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

The consent decree settled a class action lawsuit brought on behalf of about 300 patients of 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 for the state to follow in treating individuals, prioritizing patient rights and services in the least restrictive available setting, and using hospitalization as a last resort.

Prior to 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 height 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 it never mandated any funding or even ensured individual access to services. In numerous reports over the years, Wathen and his predecessors found that the state often fell short of meeting standards, which have been updated and amended since the original decree was signed, largely because all but individuals with the most acute needs are now living in community settings rather than large-scale institutions.

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

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

• Establishing a 988 crisis hotline that is staffed 24 hours a day and expanding mobile crisis teams.

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

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

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

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

Just this month, two Augusta lawmakers requested a review of staffing concerns and patient safety at Riverview and Dorothea Dix after hearing from staff members at the two hospitals.

And earlier this year, the state faced criticism for sending patients to out-of-state facilities that use isolation and corrections tactics that have been banned at Maine’s psychiatric hospitals. In each case, the patient sent away 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 severe depression. About 4.5% of the adult population has a serious mental illness. That translates to more than 40,000 people in Maine, 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 waitlists for residential services, community integration services, or daily life skills. Some of those waitlists have been driven by persistent staff shortages and turnover at providers.