Maine has never been particularly good at prioritizing mental health. Lawmakers recently learned many police departments and municipalities are not conducting the legally required mental health checks before issuing a permit to carry a concealed handgun, for example.
And the state has done more than push mental health out of mind. In 1989, poor conditions and overcrowding at the Augusta Mental Health Institute led to the deaths of 10 residents. The new facility that replaced AMHI, the state-run Riverview Psychiatric Center, this year lost its federal certification after inspectors asserted it was not in compliance with federal law, putting $20 million in Medicaid funding on the line.
And those who need mental health help are often stuck waiting for care. As Penobscot County Sheriff Glenn Ross described in an OpEd recently, the mentally ill do not disappear when institutions downsize. They fill Maine’s jails and prisons if no effective services are available.
The state’s system of treating mental health issues needs intentional direction. And any reform must prioritize early detection, treatment and prevention. For so long, a culture of avoidance and blame has emphasized treatment too late — instead of investing in measures that could catch mental health challenges as soon as possible.
Some of those early detection strategies include: having a standard protocol for mental health screenings for children, creating incentives for mental health professionals to develop the expertise necessary to work with children and youth, transitioning to an integrated care model where mental health and primary care providers work in a more coordinated way, and boosting responses within schools, such as by adding social workers.
About three-quarters of mental illnesses emerge during childhood, adolescence or young adulthood. Yet 20 percent of children ages 2 through 17 who need mental health services do not get them, according to the 2013 Maine Kids Count data book, prepared by the Maine Children’s Alliance.
There are a number of reasons for this unacceptable statistic. There is still wide variety in the types of screenings schools do — if at all — for mental health issues. For younger children, mental health screenings are most likely to be carried out by Head Start, home visiting programs and within the medical community, according to the Maine Children’s Growth Council.
For those children who are screened and referred to a provider, it can be difficult for parents to follow through. Families may not be able to afford services, or it may take a long time to get a response from an outside referral agency. There are also few psychiatric professionals throughout Maine who specialize in comprehensive assessments for children.
In schools, valuable resources are seldom allocated to hiring social workers, who can help students address issues like cutting, eating disorders, aggressiveness, depression, anxiety and bullying. Instead, guidance counselors often find themselves filling the role, drawing them away from their job of advising students on options for life after high school.
Maine knows what works to help solve mental health challenges: early detection and treatment. And it largely knows how to make that early detection and treatment happen — through screenings and comprehensive follow-up. The state needs to take a leadership role in seeing the reforms through.
“There are some great, evidence-based projects out there that are tried and true. What’s our willingness to make the investment to bring them to Maine?” said Jenna Mehnert, executive director of Maine’s chapter of the National Alliance on Mental Illness.
It’s still common for people to judge others for a mental illness or for people to put off getting help because they’re afraid of the stigma. Along with specific changes, the state’s cultural view of mental health must improve, too. Those who suffer from some type of mental health challenge deserve to have it recognized and treated early, as if it were a broken leg. Preventing the problem from building up, year after year, benefits everyone, down the road.