October 16, 2018
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Maine is getting psychiatric institutions when it really needs a strategy

Andrew Harnik | AP
Andrew Harnik | AP
Maine Gov. Paul LePage speaks to members of the media before a meeting to discuss health care and tax reform in the Eisenhower Executive Office Building on the White House Complex in Washington, Sept. 22, 2017.

The LePage administration recently revealed the outlines of what a new kind of psychiatric institution for Maine children would look like.

The administration is proposing that the state start paying for locked, psychiatric residential treatment facilities, which would be new to Maine but not new to the U.S. There are nearly 400 such facilities in more than 30 states that house people under age 21 with intensive mental health needs. They’re a step down from a psychiatric hospital in terms of the intensity of treatment.

It’s unclear when a facility in Maine would be up and running, who would run it and how many children it would house. In addition, it’s not yet clear how many such facilities there would be. But children with diagnoses such as schizophrenia, depression, bipolar disorder, anxiety, conduct disorders that cause aggressive behavior and personality disorders would be candidates for admission. According to the Maine Department of Health and Human Services’ proposed rules regulating the facilities, “all other community based resources must have been determined to be inadequate” before a child is admitted into the treatment facility.

Therein lies the problem.

The proposal for a new kind of psychiatric institution in the state comes precisely at a time when those community-based resources are in a fragile state.

Over the past two decades, as the result of court battles and legislative action, the state worked to build up mental health services that children and their families received in their homes and communities. It moved decisively away from using expensive institutions to house children with high needs. But policymakers didn’t pay adequate attention to maintaining the in-home and community services once they established them.

The organizations providing those services receive the same reimbursement from the state today that they received a decade ago or more when the services first came online. As a result, providers have been gradually paring down the list of services they provide.

After a period of progress, Maine in many ways is back to the way it was two decades ago. Today, as in the late 1990s, hundreds of children have been waiting months for services in their homes and communities to address their mental and behavioral health needs, despite a federal law that guarantees eligible children access to the Medicaid-funded services within six months of being screened for them.

In addition, dozens of children are receiving treatment at residential facilities outside of Maine because it’s unavailable here. Others are stuck in psychiatric hospital beds long after they need hospital-level treatment, while others are stuck in hospital emergency rooms with no other, safe place to go.

As if stagnant rates weren’t damaging enough, the LePage administration in recent years has targeted a number of those community-based services for cuts — the same services it says must be “determined to be inadequate” before children are admitted into new psychiatric institutions.

By definition, the state’s network of community-based resources for children with mental health needs as it exists today is inadequate.

The proposal for a new kind of psychiatric institution comes at just the time the state should be working to build up the range of services available to kids in their homes and communities, where the services are cheaper and often more effective.

For too long, the state has neglected its system of mental health services for children — services that, provided early enough, can prevent the need for more restrictive, institutional treatment down the road.

It hasn’t undertaken a complete review of the system, its services and its spending since 1997. No complete analysis has led to the conclusion that new, locked institutions for children will address the deficiencies in Maine’s mental health system for children.

As it proposes institutions that would cost millions of dollars a year to run, the LePage administration is showing no signs that it will stop neglecting a system that desperately needs attention.

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