Case: DOJ Investigation of Maine's Behavioral Health System for Children

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Case Summary

This is a case about the inadequacy of Maine’s behavioral health system for children under the Americans with Disabilities Act (ADA). On June 20, 2022, the Civil Rights Division of the U.S. Department of Justice (DOJ) sent a letter of findings to the State of Maine, notifying the state that it violated Title II of the ADA by unnecessarily segregating children with mental health and developmental disabilities. The DOJ claimed that Maine’s behavioral health system was inadequately integrated, rel…

This is a case about the inadequacy of Maine’s behavioral health system for children under the Americans with Disabilities Act (ADA). On June 20, 2022, the Civil Rights Division of the U.S. Department of Justice (DOJ) sent a letter of findings to the State of Maine, notifying the state that it violated Title II of the ADA by unnecessarily segregating children with mental health and developmental disabilities. The DOJ claimed that Maine’s behavioral health system was inadequately integrated, relying too heavily on institutionalization rather than providing necessary services in more integrated, community-based settings.

The DOJ investigation revealed a troubling situation where Maine’s community-based behavioral health system failed to adequately serve children, leading to unnecessary institutionalization. Despite existing community-based programs, children were often segregated in psychiatric hospitals and residential treatment facilities due to the state’s failure to provide sufficient services. This failure was evidenced by lengthy waitlists, a lack of crisis services, and inadequate support for Treatment Foster Care parents, resulting in children being separated from their families and communities.

Maine was aware of these deficiencies for years, with reports highlighting the lack of immediate availability of children’s behavioral health services. The state’s system suffered from a significant shortage of community-based providers, especially for children in rural areas and those with significant needs. Furthermore, Maine’s crisis services were under-resourced, leading families to rely on law enforcement and hospitals during mental health crises.

The DOJ’s investigation included interviews with affected families and service providers and analysis of state data, showing that an average of nearly 290 children lived in in-state residential treatment facilities monthly, with many more sent to out-of-state facilities. Despite theoretically available community-based supports, actual access to these services was severely limited, perpetuating the cycle of institutionalization.

Maine’s juvenile justice system also played a role in the ongoing problem, with many children with mental health needs being detained at Long Creek Youth Development Center due to the lack of community-based services. This situation had been exacerbated by Maine’s failure to maintain a network of providers and support for Treatment Foster Care—a specialized service in which foster parents are trained, supervised, and supported by qualified staff to meet the needs of children in their care who have behavioral health needs—further illustrating the systemic shortcomings of the state’s approach to behavioral health care for children.

The DOJ’s findings highlighted a clear violation of the ADA’s integration mandate, which requires public entities to administer services in the most integrated setting appropriate to individuals’ needs. The report concluded with recommendations for Maine to undertake significant systemic changes to comply with the ADA and better serve children with behavioral health needs. These included enhancing access to community-based services, addressing waitlists, providing adequate crisis services, and supporting Treatment Foster Care parents to prevent unnecessary and prolonged institutionalization. The DOJ expressed a willingness to work cooperatively with Maine to implement these recommendations and resolve the identified violations.

Summary Authors

(2/10/2024)

Documents in the Clearinghouse

Docket

Last updated Aug. 30, 2023, 1:26 p.m.

Docket sheet not available via the Clearinghouse.

Case Details

State / Territory: Maine

Case Type(s):

Disability Rights

Key Dates

Closing Date: June 20, 2022

Case Ongoing: No

Plaintiffs

Plaintiff Description:

U.S. Department of Justice's Civil Rights Division

Attorney Organizations:

U.S. Dept. of Justice Civil Rights Division

Public Interest Lawyer: Yes

Filed Pro Se: No

Class Action Sought: No

Class Action Outcome: Not sought

Defendants

Maine's Behavior System for Children, State

Facility Type(s):

Government-run

Case Details

Causes of Action:

Americans with Disabilities Act (ADA), 42 U.S.C. §§ 12111 et seq.

Available Documents:

Findings Letter/Report

Outcome

Prevailing Party: None Yet / None

Nature of Relief:

None

Source of Relief:

None

Issues

General/Misc.:

Deinstitutionalization/decarceration

Government services

Housing

Juveniles

Disability and Disability Rights:

Developmental disability without intellectual disability

Intellectual/developmental disability, unspecified

Mental Illness, Unspecified

Mental impairment

Reasonable Modifications

Discrimination Basis:

Disability (inc. reasonable accommodations)

Discrimination Area:

Disparate Treatment

Medical/Mental Health Care:

Intellectual/Developmental Disability

Intellectual disability/mental illness dual diagnosis

Mental health care, general

Mental health care, unspecified