Maine health officials are currently revising the procedure for the involuntary on-site visit of mental health patients at risk of harming themselves or others, in light of a recent ruling by the state’s highest court.
Last month, the Maine Supreme Court concluded that MaineHealth, the parent company of LincolnHealth Miles Hospital in Damariscotta, was in breach of state law by detaining a man for almost a month last year without first getting court approval and that it was not applying the law to its reasonable standard if his request for release is denied.
By the time the court ruled, the man – identified only by his initials in court documents – had already been released, but the judges heard the case anyway for two reasons: it raised significant public concerns and because their decision served as a guide to the community Future could serve.
Department of Health and Human Services spokeswoman Jackie Farwell confirmed this week that the Behavioral Health Department is updating its involuntary engagement process, often referred to as the “blue paper,” to provide more clarity and to reflect the new precedent. The details are still being worked out.
Meegan Burbank, an attorney who represented the person in hospital, was pleased with the decision and the state’s willingness to revise its process, but said the case highlights an undeniable fact: there aren’t enough inpatient treatment beds or alternatives Options for people dealing with mental illness health crisis.
“This does not fix a problem, it highlights a problem,” said Burbank. “We’re still forcing people to be in hospitals that they can’t treat.”
Burbank’s client, who was 22 at the time of last year’s hospitalization, declined to be interviewed for this story. According to court records, he called 911 on February 24, 2020 because of anxiety and symptoms of substance withdrawal. The police responded and took him to the LincolnHealth Miles Campus emergency room.
There, hospital officials initiated an involuntary emergency room application to a psychiatric clinic, commonly known as the Blue Paper, because they believed it was a risk to themselves or others. The application showed that he had a diagnosis of post-traumatic stress disorder and bipolar schizoaffective disorder. He threatened to burn down his home and has a history of suicide attempts, they wrote.
The law, which regulates involuntary obligations, provides that a patient be detained for up to 24 hours pending a court order. The law was changed in 2015 to allow a hospital to continue holding a patient for two consecutive 48-hour periods as long as the patient still has the likelihood of serious harm and the hospital cannot find an available inpatient bed in a mental hospital or another suitable alternative.
There are two state-licensed psychiatric hospitals – Riverview in Augusta with 92 beds and Dorothea Dix in Bangor with 51 beds. The state has also signed contracts with seven private hospitals that provide small numbers of psychiatric beds. In 2020, 3,161 people were discharged from inpatient mental health services in Maine.
In the case of Burbank’s clients, it wasn’t just that there was no bed. He was denied admission to a mental hospital because his psychiatrist found that his problems were primarily related to substance abuse rather than psychosis. So LincolnHealth continued to hold him and even hired local police officers to monitor his emergency room 24 hours a day.
After 18 days, the patient submitted what is known as a habeas corpus to request his release. His argument was both that the hospital never received court permission to hold him and that the hospital never provided clear and convincing evidence that he should be held. The hospital meanwhile claimed that it was “not required to submit involuntary emergency engagement requests to a judicial officer until it found a mental hospital ready to accept the patient.”
“Your position was that we don’t need authority,” said Burbank. “They were so lost in their beliefs that they were right.”
A district judge was on the hospital’s side, which resulted in Burbank appealing to the court.
Without this judicial review, there would plausibly be no official record of the involuntary commitment. In the case of Burbank’s client, Damariscotta Hospital initiated the involuntary engagement process 16 times in less than a month, but never filed anything with the court.
“The data is important in understanding how often people are referred and how many might be turned down,” said Mark Joyce, a Disability Rights Maine attorney who has worked with DHHS as an advocate for people with disabilities, including severe mental illness Concludes contract. “How would you know if something is working if you don’t have the data?”
The other precedent set by the court means that hospital clinicians must demonstrate a higher burden of proof – clear and convincing evidence – before rejecting a patient’s request for release. Burbank said this is especially important as it confirms that people have adequate legal rights even if they have mental illness.
“I respect medical providers … they want to heal people,” she said. “But people have the right to choose whether they want to be cured.”
Despite the court’s decision, this does not mean that individuals will no longer be held in hospitals pending placement, sometimes for extended periods of time.
Although the law says a blue paper allows for two consecutive 48-hour waits after the first 24 hours, judges allow hospitals to restart the process as long as they get court approval and demonstrate that the patient is still at risk of injury is exposed .
The Maine Hospital Association, which represents state hospitals, submitted a short page to LincolnHealth. In it, the association warned against a decision requiring hospitals to discharge mentally ill patients who are medically classified as dangerous to themselves or others.
Jeff Austin, vice president of the Maine Hospital Association, said now that the court has ruled hospitals will comply but said the DHHS needs further clarification.
“Hospitals appreciate that a problem that has been a bit confused for some time has been resolved. We look forward to revised guidance from DHHS, ”he said. “Of course, we would like the underlying problem – lack of resources for mental health services – to be fixed just as easily.”
Kevin Voyvodich, also an attorney with Disability Rights Maine, said it was clear the system was still broken.
“But I am not 100 percent clear whether it is a lack of resources or a coordination of resources,” he said. “It’s not always about more beds, it’s about how resources are managed.”
Burbank said she was excited to see how the state addresses the bigger issues, but she is pleased that the court is offering patients like her client stronger protection to file for release.
“This decision did not take away any authority from the hospitals, it asked the hospitals to obey the law,” she said. “But I hope the state uses this as an opportunity to rehabilitate our system.”
Joyce, with DRM, agreed the decision was positive for patient rights, but was concerned about its practical application. He said patients still don’t always know they have the right to petition for release, and even if they do, it is a challenge to find a lawyer to help steer that process.
“If you have a right but you can’t exercise it, it’s not a great right,” he said.
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