In 2014, the Maine Department of Health and Human Services won a $1 million-per-year, five-year grant to help teenagers and young adults at risk for serious mental illness. But without explanation, the department recently turned away the remaining three years of federal funding, giving providers a month to wrap up services.
For more than a year, a half-dozen outside organizations have provided coaching and care coordination, psychiatric treatment and peer-to-peer mentoring to young adult participants in the project, which is funded entirely with federal money. On Aug. 23, those organizations received a letter announcing that all funding will cease Sept. 30.
“This letter is to inform you that the Now is the Time-Healthy Transitions (NITT-HT) Moving Forward Grant in Maine will be ending effective September 30, 2016,” reads the letter from Teresa Barrows, children’s behavioral health director in DHHS’ Office of Child and Family Services.
“As a Provider Agency, it will be your responsibility to review each young person you are currently serving under this grant and make the best possible plan to for [sic] their behavioral health care needs within the existing service system.”
A spokesman for the Substance Abuse and Mental Health Services Administration (SAMHSA), the federal agency that awarded the grant, confirmed that Maine is “winding down its participation” in the competitive grant program and said the federal agency is “in communication” with state officials.
The letter from Barrows offered no explanation for the state’s decision to end the grant and forfeit the last three years of funding. Maine didn’t have to put up any of its own money to receive the federal funds.
Alice Preble, director of the grant-funded project for DHHS, didn’t return a call seeking comment. Leaders from the organizations receiving funding through the grant either declined to comment on the funding situation or didn’t return phone calls from the BDN.
Samantha Edwards, a DHHS spokeswoman, didn’t respond to a request for comment. The state agency, whose budget accounts for more than a third of state spending, hasn’t responded to any requests for comment from the BDN, regarding a variety of topics, for several weeks.
“What’s really tragic about this is, these funds were specifically focused on this population that is underserved or not served at all,” said Arabella Perez, assistant clinical professor at the University of New England’s School of Social Work who previously led one of the organizations involved in the grant-funded initiative. “There’s no safety net at this point.”
One of 17
In 2014, Maine DHHS applied for and was one of 17 agencies across the country to receive the Now is the Time-Healthy Transitions grant. The federal grant aimed to better help young people ages 16 to 25 — who have been diagnosed with a mental health condition or are at risk for developing mental illness — access treatment and other support to live productive, fulfilling lives.
Called Moving Forward, Maine’s program expanded on a smaller initiative begun in 2009, also funded by a SAMHSA grant. The 2009 project funded services only in Androscoggin County; the 2014 grant expanded services to Cumberland and Penobscot counties.
The teenage and young adult years are the time in life when the vast majority of mental health conditions first emerge. Three-quarters of conditions have begun by age 24, according to the National Institute of Mental Health. It’s also the age range that mental health professionals refer to as the transition age.
“A lot [of young adults] are aging out of foster care, out of child services and into adult services,” said Linda Gokee-Rindal, who served as the Moving Forward statewide youth coordinator for six months until early August. “Those systems do not communicate as much as they should. Once you turn 18, it’s not as if you flip a switch and you’re an adult now. You have to learn life skills, and your brain is still developing until age 25.”
That transition requires support, especially for a young person with a mental health condition, said Gokee-Rindal. “If that support doesn’t come from family, it’s really important for the case manager to meet them where they’re at,” she said.
The Moving Forward program brought together a number of Portland-, Bangor- and Lewiston-area social service agencies with case managers who work with 16- to 25-year-olds with mental health challenges. It also involved a psychiatric treatment program at Maine Medical Center known as Portland Identification and Early Referral, and a program called Youth MOVE Maine, which employs young adults who have experienced mental health challenges in their own lives as peer-to-peer mentors for the young people participating in Moving Forward.
With state leadership, the objective was to reach out to and serve more young people in need of support at an age when they’re often reluctant to seek out help for themselves. The initiative aimed to train case managers in a model known as TIP, the Transition to Independence Process, that’s tailored to the young adult population. In addition, Moving Forward aimed to make peer-to-peer support more widely available.
“I hear young people talk about how, in the service array, that is the best piece of it,” said Perez, who served as executive director of THRIVE, the organization that runs Youth MOVE Maine, until late last year. “It’s the most effective. It’s the most genuine. Losing that just breaks my heart.”
The $1 million a year in grant funds paid for training as well as support services and treatment that couldn’t be billed to Medicaid or private insurance.
“Without those funds, we just don’t have the flexibility and the creativity to do this transformational work,” Perez said.
The psychiatric treatment component — coupled with the range of support services — is geared toward early treatment of mental health conditions. Research over the past two decades has repeatedly shown that treatment soon after a young adult’s first episode of psychosis is effective in making symptoms more manageable and helping a young person more smoothly transition into adulthood.
“This package of services is remarkably effective in the early stages,” said Dr. Douglas Robbins, the program psychiatrist for the Portland Identification and Early Referral program at Maine Medical Center. “They become less effective when they’ve had the illness longer.”
Another part of the initiative was to demonstrate the effectiveness of services not commonly covered by insurance, so insurers would begin to cover them.
Robbins said the program has gone well, that the Portland treatment program is ahead of its objectives in terms of the number of patients served, and that the young adults participating are “doing vastly better than would be expected” — with many working or attending school and not becoming estranged from their families, which is common with severe mental illness.
An evaluation of Moving Forward’s first iteration in Androscoggin County found that the program was most successful at helping young adults find and remain in stable living situations and encouraging them to continue their education.
People with mental illness experience significantly higher-than-average unemployment. In Maine, a 2014 report from the National Alliance of Mental Illness found a 93 percent unemployment rate, the highest in the nation, among people receiving mental health services. They’re also more likely to drop out of school, to be homeless and to commit suicide.
Staff at the Portland Identification and Early Referral program were prepared to begin year three of the grant when they received notice that the funding would end, Robbins said. Since that announcement, he said, DHHS staff have begun to work with PIER in an attempt to identify alternative funding.
“To refuse these dollars makes no sense, especially because other states are using these dollars and using them well,” said Perez. “We just don’t understand the decision behind this.”
Now is the Time
The funding stream that Maine is declining grew out of the Obama administration’s Now is the Time initiative, a policy agenda introduced after the Sandy Hook Elementary School shooting in Newtown, Connecticut, in December 2012. While the agenda emphasized a handful of gun control measures, it also prioritized increased access to mental health services, particularly for young adults ages 16 to 25.
In Maine, the LePage administration has stated that services to help young adults with mental illness are a priority. The state’s current two-year plan for spending its Community Mental Health Services Block Grant lists “Improve all children’s ability to transition successfully to adulthood” — with an emphasis on young people with mental illness, developmental disabilities and those who have been in foster care — as one of four strategic objectives.
The Community Mental Health Services Block Grant is a non-competitive grant that Maine and all other states receive each year; Maine’s allocation this year is about $1.8 million.
The 550-page block grant plan, which Maine DHHS submitted to the federal government, makes it clear that the Moving Forward initiative is a key part of the state’s work.
“Through training, early identification and treatment, targeted case management, youth peer support, community outreach, and on-going program evaluation, the Department expects this Initiative to: improve access to and efficacy of state-of-the art services for young people who are experiencing serious emotional and behavioral challenges; assist young people in the development of essential life skills, improve education, employment, and well-being outcomes; help youth increase their connections to the community; and keep communities safer by increasing public awareness and reducing stigma to treatment,” the block grant document reads.
Without the $1 million-per-year infusion, it’s unclear how the state will fulfill the objectives outlined in its block grant plan. Under federal law, states must set aside 10 percent of their block grant allocation to address the same issues targeted by the Moving Forward program — first-episode psychosis. But that amount works out to only $200,943 in the two-year period between July 1, 2015 and June 30, 2017, compared with $1 million per year through the competitive SAMHSA grant.
One element of the Moving Forward program was encouraging collaboration, instead of competition, among social service agencies that provide mental health services to young adults so they could serve more people, Gokee-Rindal said.
“All of these organizations were doing this or similar work before, and Moving Forward was an opportunity for them to do it in collaboration with each other with an increased budget,” she said. “Unfortunately, that’s being taken away from them, and that’s really sad.”
Maine Focus is a journalism and community engagement initiative at the Bangor Daily News.