BANGOR, Maine — In anticipation of ongoing budget cuts in mental health programs funded by the state, Maine’s leading mental health advocacy group has released recommendations aimed at reducing costs and improving the delivery of services — including a recommendation to close the 100-bed Dorothea Dix Psychiatric Center, formerly the Bangor Mental Health Institute.
But hospital superintendent Linda Abernethy said Monday that the Bangor center serves the “very, very sickest” of mental health patients and should be maintained as a critical element of the social safety net for Mainers with mental illness.
The report released late last week by the Maine chapter of the National Alliance on Mental Illness, calls for integrated changes statewide that prioritize community-based services such as housing and vocational placements. Only by strengthening community support, supervision and training, says Carol Carothers, executive director of NAMI-Maine, can the state break the Catch-22 cycle that perpetuates an inequitable system that fails to serve the best interests of Mainers living with mental illness.
Traditionally, the two state-run psychiatric hospitals, Dorothea Dix and Riverview Psychiatric Center in Augusta, serve patients with chronic mental illness who need longer inpatient stays than patients at the two private psychiatric hospitals, The Acadia Hospital in Bangor and Spring Harbor Hospital in Westbrook. While longer lengths of stay may be needed by a small group of Mainers, Carothers said, the state’s inadequate funding of community-based services perpetuates the need for public hospital beds.
“We are suggesting that [providers at Dorothea Dix] develop individualized plans of care for those who are there now that shifts the focus from institutional care to supervised housing and vocational support, so people can be more successful at living independently and are prepared to be employed,” Carothers said Monday.
Closing the 100 inpatient beds at Dorothea Dix and providing appropriate care in the community not only would improve patient well-being but also would save an estimated $370,555 per patient per year at a time when the state faces an estimated $860 million shortfall in the biennial budget, according to Carothers’ report.
The report also calls for an assessment of the cost and efficacy of community-based mental health services delivered by state employees versus those provided by private agencies. Particularly for Mainers covered by MaineCare, the state’s Medicaid program, Carothers said there is substantial duplication of services and a history of state services being paid at higher rates than private agency services.
With a new conservative administration and Legislature moving into Augusta, she said there may be increased support for relying on private agencies.
About 200 people are employed at the Dorothea Dix Psychiatric Center. The center is named for Dix, who was born in Hampden and became a pioneer in the field of mental health advocacy in the 1800s.
Reached Monday for comment on the NAMI-Maine report, hospital superintendent Abernethy said Carothers is “not wrong” in calling for strengthened community services. But thinking that the complex needs of Dorothea Dix patients can be met through a combination of community services and short stays at private hospitals is not realistic, she said.
Instead of closing the hospital outright, Abernethy said other proposals to streamline costs and improve care, including a proposed administrative merger with the Riverview Psychiatric Center, should be allowed to take effect.
Incoming House Minority Leader Rep. Emily Cain, D-Orono, said on Monday that she had not yet reviewed the NAMI-Maine report. But Cain, who served four years on the Appropriations Committee and two as its co-chair, said continued wrangling over mental health budgets is a given for the incoming Legislature.
“Funding for mental health has consistently been one of the most challenging areas of the budget,” she said. Closing Dorothea Dix is not an impossibility if community services can be ramped up to support the needs of area patients, she said, although much more information will be needed.
Sen. Richard Rosen, R-Bucksport, will chair Appropriations when the Legislature reconvenes in January. While the NAMI-Maine report will be useful in considering the needs of the mental health budget, Rosen also said a more comprehensive review is needed.
Other recommendations in the NAMI report include enforcing mental health parity mandates in health insurance plans, integrating mental health care into outpatient medical settings and encouraging community hospitals to provide short-stay psychiatric beds at the local level.
The report may be read online; visit www.nami.org and click on “find your local NAMI.”