Options when other programs are not sufficient
For a small subset of people (those with severe untreated mental illness or addiction who have declined every voluntary service offer after repeated contacts) court-ordered treatment plans offer a final option short of incarceration. Programs modeled on California's CARE Court provide structured treatment plans for up to 24 months, with legal representation from day one, judicial oversight, and clear exit criteria. This is reserved for situations where every other tool has been exhausted, with strict eligibility requirements reviewed annually.
In the vast majority of cases, court-ordered treatment means Assertive Community Treatment (ACT), which are multidisciplinary teams of clinicians, peer support specialists, and case managers who deliver psychiatric care, medication management, and housing support directly in the community. Compared with standard case management, ACT clients experience 37% greater reductions in homelessness and significantly fewer psychiatric hospitalizations and emergency room visits. Maine has ACT teams, and they are the intended primary destination for this pathway.
In rare cases where someone poses a genuine, documented risk that cannot safely be managed in the community, civil commitment to Dorothea Dix Psychiatric Center (Maine's only state psychiatric hospital, with 92 beds serving the entire state) may be the outcome. This represents the far end of a spectrum, not a routine one, due to the fact that there is an extensive process for admission, a high legal standard for committal, and chronic underfunding of the facility as it stands. In addition, as referenced in MaineHousing's 2019 report, those discharged from inpatient mental health care frequently return to homelessness because of a fragile and underfunded post-discharge support system.
The most important ask attached to this pathway is ensuring that the regional ACT provider has enough funded capacity to accept referrals. Without that, the structured intervention pathway leads nowhere.