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Establishment of the Department of Health & Human Services

In an attempt to consolidate and eliminate bureaucracy, in 2003 a bill was proposed at the Legislature to merge the Department of Human Services and the Department of Behavioral and Developmental Services (formerly the Department of Mental Retardation) into one department: the Department of Health and Human Services.

Some legislators were concerned by the merger – Representative Lerman of Augusta said this during one of the final floor votes: “I really think that it will be a distraction from the mission that we need to pursue very vigorously. That is to really do systems design, reduce cost, improve efficiency and improve the services that people receive…I fear there are certain populations served by these departments, which will be overshadowed and will not get the attention that it deserves. There are certain services currently being offered by the Department of Behavioral and Developmental Services that will at best be second citizens within the bigger Department of Human Services.”

Representative Kane of Saco had a more optimistic view of the changes: “We should not underestimate the magnitude of the challenges before the committee in dealing with this proposal. We shouldn’t underestimate as well its potential for enhancing the lives of Maine’s most vulnerable citizens through a more coordinated, accountable and cost-effective system of health and human services. We have a unique opportunity of proposing and passing landmark legislation that is going to serve this state well for a long time.”

In the end, the law passed, and the current Department of Health and Human Services was born.

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Institutional Bias

Institutional Bias

It is easy to assume that institutions are the right place for people with significant needs – in an institution, the assumption is that we can keep them “safe”, provide all the care they need in one place, and people with disabilities can live with “people like them”. These assumptions were worked into the policies and laws until the systems and the biases were intertwined and interchangeable.

Despite the evidence that institutions do not provide better care, a more stimulating environment, or less expensive treatment options than the community, our systems still reflect the historical assumptions that built them. When asked if people would like to live in the community they sign a waiver from their right to an institution.  The “institutional bias” is imbedded within the current waiver system – how most people with developmental disabilities access services – makes getting good and services in the community harder.  For that matter, the “institutional bias” includes an unwritten value statement that people with developmental disability do not have a natural place within the community.  But is that true?  Doesn’t everyone have a place?

More troubling still, many organizations are beginning to look towards building new institutions, using very similar language to that of the early 1900’s. They point towards the failures of the community system as proof that we need large congregate settings for people with developmental disabilities.

What are the assumptions here?