Current Issues

Recovery Guidelines--INPUT NEEDED!

The development of Maine's new practice guidelines for recovery-oriented care is underway and needs focused consumer attention and input. As many may already know, the Office of Adult Mental Health Services (OAMHS) is using guidelines developed by Connecticut as the template for this project. (CT Guidelines)

The guidelines contain 6 "domains" or areas, and OAMHS is gathering any and all input on one domain each month during 2010, as follows:

May. . . . . . . .
Recovery-oriented care is consumer and family-driven
June . . . . . . .
Recovery-oriented care is timely and responsive
July . . . . . . . .
Recovery-oriented care is person-centered
August . . . . . 
Recovery-oriented care is effective, equitable, and efficient
September. .
Recovery-oriented care is safe and trustworthy
October . . . .
Recovery-oriented care maximizes use of natural support and settings

There are several ways to give feedback: 1) Participate in OAMHS monthly webinar-conference call; 2) email your written comments to This e-mail address is being protected from spambots. You need JavaScript enabled to view it ; 3) snail mail to OAMHS, Recovery Guidelines, 11 SHS, AMHI Campus/Marquardt Bldg, Augusta, ME 04333-0011;  or 4) comment below, and we will submit to OAMHS. The CCSM will also gather feedback from the local councils. For information on how to join the webinar-conference call on May 18th, click HERE.

Each domain is available separately by clicking above or by going to the Recovery for ME page on the OAMHS website. You may also request paper copies by calling Jane Malinowski at OAMHS: 287-4243. Meaningful feedback does require thoughtful study--we encourage everyone to dive in and give it their best. The process will move pretty quickly, so let's "strike while the iron is hot!"

 

Sharing Information and Confidentiality

CSN 5's Continuity of Care Work Group just sent out a survey asking consumers about how they would like their information shared among the providers from whom they seek services. How to share information in order to receive good coordination of care and still maintain appropriate confidentiality is an important ongoing issue for consumers and providers alike statewide.

If you live in Androscoggin, Franklin, or Oxford Counties and you wish to complete the CSN 5 Survey, click here to download it. If not, please read it to get your thoughts flowing, and share your views and ideas in the comments section below.  Thank you!!

(Completed surveys can be returned to the CCSM, and we will pass on to our CSN 5 representative, Grace McDonald, who serves as co-chair of the Continuity of Care Work Group. See Contact Us for address.)

   

Involuntary Outpatient Commitment

March 26 Update:

ACTION: Call or write your state legislators and urge them NOT to pass the Majority Report on LD 1360.

March 22 Update:

More developments, and unfortunately not for the better. On Thursday afternoon, March 18, the HHS Committee voted to reconsider LD 1360. Senators Mills and Nutting offered yet another amendment to the minority report for the Committee's consideration. A motion for a vote was quickly made and seconded to approve this amended version, and after relatively brief discussion of the amendment, they voted 8-4 to pass. This vote shifted the former minority report to become the majority report, adding to the likelihood of the bill passing when it reaches the full house and senate, though that is not a forgone conclusion by any means. The house and senate will consider both the majority and minority reports and may pass either or neither version. For details, see Majority Report and Minority Report, after voting on March 18.

Since last year to now, LD 1360 has undergone many changes, thanks in great part to the hard work of stakeholders opposed to the bill. The amendments considered in recent work sessions looks very little like the original bill, thankfully. However, this last amendment that is now the majority report does differ from the most previous amendment. Helen Bailey of the Disability Rights Center offers the following synopsis:

"In the new amendment, the provisions that would have allowed the court to appoint a guardian or conservator, have been removed.The new amendment also removes the provision that would have permitted the court to issue an order that would have permitted the agency supervising the PTP to forcibly administer medications.  These were two provisions that we objected to.  The amendment also fixes a few technical problems we pointed out and some ordering problems.  But otherwise there were no further amendments adopted that we suggested.

The new amendment also adds some troubling provisions.  The court now is only required to appoint one independent examiner in both inpatient and PTP commitment hearings.  Both the inpatient and PTP commitment hearing can also be continued for a period of 21 days, up from 10, extending the period of time a person could be hospitalized prior to hearing to 38 to 40 days.  That examiner could be the individual who initiated the blue paper and/or signed the certificate upon the person's being in the hospital for 24 hours because the provision requiring this independence has been removed.  The commitment period to the PTP has been increased from an initial 6 month period to 12 months.  The extension period in both amendments is 12 months.

The increase in the continuance period and the reduction in the number of examiners were apparently made after considering the financial implications."

For more details from Helen's analysis, please see her line-by-line comparison of the lastest amendment with the previous amendment HERE.

February 18 Update:

The Health & Human Services Committee held another work session on LD 1360 on February 17th. The majority of the committee voted only to approve Question 1 (see below), and repeal the "sunset" on the progressive treatment program [PTP] and continue it with a new sunset date of July 1, 2014. ("Sunset" is the date the legislation will "die" if not renewed again). They also emphasized that DHHS needs to provide adequate reporting and data on the progressive treatment program as it moves forward, including before and after (longitudinal) information and outcomes for those ordered to participate.

The majority agreed that changing Maine's involuntary commitment laws should be a thoughtful, comprehensive process that involves all stakeholders. It appeared from the discussion after the vote that Senator Mills intends to present another draft of the bill that either takes out certain highly problematic elements of the current version or addresses committee members' concerns raised during the discussion.

Another important part of the work session was around the costs associated ("fiscal note") with the proposed legislation. DHHS maintains there would be costs involved in services and the Administrative Office of the Courts also raised substantial concerns about increased court costs for the required independent examinations, as well as strains on District Court dockets. The proponents (people in favor) of LD 1360 raised questions about increased costs, emphasizing their intention that the proposed bill would not require any additional funding.

The committee discussed the major decision points of the bill outlined in the form of 5 questions:

Question 1: Whether to extend the progressive treatment program [PTP] past July 1, 2010?
Question 2: Whether to extend the progressive treatment program [PTP] to persons being discharged from Acadia Hospital and Spring Harbor Hospital?
Question 3: Whether to extend the progressive treatment program [PTP] to persons who are involuntarily committed (white paper) as an option for the Court instead of involuntary hospitalization?
Question 4: Whether to extend the length of time of an order of involuntary treatment [in hospital] from 120 days to 6 months, with an extension period of up to 1 year?
Question 5: Whether to revise the involuntary commitment laws: decreasing the number of examinations from 4 to 3, simplifying the definitions of "likelihood of serious harm" and providing a definition of "medical practitioner" and, with reagrd to the progressive treatment program [PTP], allowing applications to be filed by the ACT team or Commissioner, providing the Court authority to enter orders to ensure compliance with the treatment plan, and simplifying and shortening eligibility, notice and hearings provisions?

 


The latest amendments to LD 1360 in part reflect the "4th option" for involuntary commitment (described below), but does so by changing existing laws for involuntary commitment to psychiatric hospitals and the Progressive Treatment Program (PTP) law. In addition to allowing for limited involuntary outpatient commitment (which the vast majority of Maine consumers stand firmly against), changes in wording and other things included in the amendments give rise for concerns and objections.

   

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