AUGUSTA, Maine — Gov. Paul LePage’s plan to privatize a program that connects people afflicted with serious and often life-threatening mental illnesses with a state advocate could have disastrous consequences, according to opponents of the proposal.
Privatization of the program, known as intensive case management services, is but one of several changes included in the governor’s recently submitted bill to restructure and streamline the Department of Health and Human Services.
However, the measure is drawing sharp opposition from opponents who warn the plan could invite the kind of incident that became the impetus for the program: The 1996 murder of two Waterville nuns by a manic depressive man.
The bloody attack made national news and prompted the state to evaluate how it handles and monitors the mentally ill. Shortly thereafter the state deployed a specially trained team of DHHS employees to embed with county jails and coordinate with police, corrections officials and homeless shelters to monitor and counsel high-risk individuals who may be predisposed to violent and dangerous behavior.
The 37-member unit works in the Office of Substance Abuse and Mental Health Services. LePage has proposed eliminating the agency and the $1.5 million intensive case manager budget. The administration wants to then shift $925,000 to the Department of Corrections, which would then contract a private agency to conduct the same services.
Law enforcement, jail administrators and advocates for the mentally ill are highly critical of the governor’s plan.
Glenn Ross, the Penobscot County sheriff and head of the Maine Sheriffs Association, said county sheriffs were universally opposed to the provision.
Col. Mark Westrum, administrator of the Two Bridges Regional Jail in Wiscasset, told the Sun Journal that the proposal would have a significant effect on jail populations and recidivism rates.
Several current intensive case managers agree. They worry that their clients could fall through the cracks if a private agency takes over.
“I am not here to save my job. I’m here out of concern for the clients I work with,” said Peggy Paine, an intensive case manager from Falmouth.
Paine and Audrey Bonner, a case manager who works at the Androscoggin County Jail, argued that they had established relationships with clients and were available after normal work hours. They told the Health and Human Services Committee several anecdotes in which their familiarity with mentally ill clients had saved them and others from doing harm to others or themselves.
Bonner said she and her colleagues were often the last resort for individuals who are uninsured and refuse treatment.
Paine said community agencies are often unable to work with the uninsured or may not have the funds for charity care. She said engaging with some clients is time consuming. She told a story of how it took her four months to convince a young, pregnant homeless woman to accept her assistance.
Guy Cousins, the DHHS director of substance abuse, said the proposal strikes the right balance between streamlining without eliminating services. Cousins also rejected claims that a private agency would not be equipped to handle the intensive case managers’ caseload.
Sen. Margaret Craven, D-Lewiston, and others questioned the administration’s proposal to privatize the service given that it doesn’t appear to generate any savings.
“Why are we replacing people who have experience with people who don’t?” Craven asked.
The intensive case management program may be the most controversial of LePage’s restructuring proposal.
Most of the testimony on Wednesday opposed the bill. However, several private care agencies that stand to benefit from the reorganization supported the bill.
The governor announced the bill last week.
The 48-page bill eliminates and reassigns the duties of several agencies into consolidated departments. Ninety-one positions will be eliminated in the plan, however, another 44 will be created for a net loss of 47 positions.
Thirty-seven of the 47 positions are in the intensive case management program.
DHHS Commissioner Mary Mayhew has said that cost savings isn’t the impetus for the bill.
“The goals of restructuring are to focus more resources on the consumer, to improve frontline resources and better integrate services over the age span and across many levels of care,” Mayhew said last week.
Critics, however, are questioning the late arrival of the bill. The Legislature is scheduled to adjourn in mid-April. Barring an extension, all legislation is supposed to be reported out of committee by Friday.
The Health and Human Services Committee will hold a work session on the restructuring bill on Thursday.
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