This op-ed is in response to a Dec. 12 article by Sun Journal reporter Emily Bader, “Advocacy groups rebuke calls to expand Maine’s progressive treatment program.”

Gabriel Damour, killed on Thanksgiving morning in Poland, didn’t have to die. His brother, Justin Butterfield, has been charged with his murder. Justin suffers from schizophrenia and, according to his ex-girlfriend and mother of his children, Yaicha Provencher, he seemed to have no awareness of his illness.

More mental health advocacy groups are speaking out against Maine’s so-called progressive treatment program following Gabe’s murder.

Maine’s Progressive Treatment Program (PTP), enacted in 2010, if utilized, would have likely prevented this tragedy. The PTP is compassionate treatment for those with brain disorders who have no awareness of their illness. It’s essentially a court order that allows people to be ordered into treatment in the community. Under the PTP, if their illness becomes worse, they can be brought to a hospital before they become a danger to themselves or others, before tragedy occurs.

In the four years Justin’s family struggled to get care for him, he was never enrolled in the PTP. This is because the PTP has never been truly embraced by Maine’s Department of Health and Human Services except for a small number of patients coming out of the two state hospitals and a handful of folks who have been savvy enough to orchestrate getting their loved ones enrolled through a psychiatrist, ACT Team, or hospital.

The administration has been taking the advice of Disability Rights Maine and the Peer Council, both of whom have been feeding them misinformation. Tragically, their voices have been heard over the voices of Maine family members, medical professionals, and law enforcement who are all resoundingly in favor of PTP.

Responses calling the PTP “forced treatment,” and the argument that people can instead be convinced to accept treatment by building trust, are both false. The argument that it’s forced treatment has been soundly rejected in the courts, which have found “the compulsion generally felt by law abiding citizens to obey court directives” is not force.

Building trust doesn’t work for someone who has no awareness of his/her illness because they cannot recognize they’re ill. That’s what anosognosia is.

DRME has stated that it opposes the PTP because it knows of no peer review, randomized studies suggesting that a court-ordered commitment for mental health treatment alone improves treatment outcomes. The fact is, SAMHSA added Assisted Outpatient Treatment (AOT) to the National Registry of Evidence-based Programs and Practices (NREPP) back in 2015, after an independent assessment concluded the program met its requirements for demonstrating positive outcomes in multiple, rigorous peer-reviewed studies.

AOT is also recognized by the American Psychiatric Association, the National Sheriffs’ Association and the International Association of Chiefs of Police. SAMHSA’s designation also followed recognition of AOT by the U.S. Department of Justice, whose Office of Justice Programs deemed it to be an effective and evidence-based practice for reducing crime and violence in 2012.

Forty-seven states and the District of Columbia currently authorize the use of some form of court-ordered outpatient treatment for individuals with the most severe psychiatric illnesses. This type of early intervention has been found to be highly successful in states where it is utilized, resulting in 77% fewer psychiatric hospitalizations. In addition, 74% fewer experienced homelessness, 83% fewer arrests, and 87% fewer incarcerations.

The state of Maine had applied for, but did not accept, the IMD waiver for SMI in 2019 based on DRME’s argument, claiming it was  “in violation of the ADA, Olmstead, and the Settlement Agreement.” Those arguments are misguided, as proven elsewhere in our IMD Position Statement.

Maine accepted the IMD waiver for SUD. Given that at least half of those with SUDs also suffer from SMI, this was a very foolish decision. You cannot treat one without treating the other.

There’s also a false statement going around that the IMD waiver for SMI can only be used for hospital beds. From JDSUPRA, states are using their waiver for things like pilot crisis intervention and mobile crisis response services, peer support services, supportive housing and enhanced home and community-based services.

It’s time for all of us to come together, leading with science and facts, to build a system that doesn’t leave anyone behind. It’s time for a system where everyone can receive equitable, compassionate, collaborative treatment and support that enables them to live their best lives.

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