Disability Rights Maine and its many partners vehemently disagree with Jenna Mehnert’s recent assertion, made in an OpEd published in the June 3 Bangor Daily News, that investing scarce resources into the creation of a psychiatric residential treatment facility is needed to address the failures of Maine’s children’s behavioral health system. Maine no longer leads; in fact, it is moving backward.
For the last 40 years, Maine has been a national leader in home and community-based services for people with disabilities, especially children. Now the state is reversing its long term commitment to home and community-based services by proposing to spend more $3 million to create at least one institution — and as many as three — for children with behavioral health needs. Meanwhile, children with behavioral health needs who have been waiting, sometimes years, for home-based services with no end in sight. And, instead of a proposal to increase funding for home and community-based services to address this need, none has been forthcoming and these children and their families continue to wait.
Institutionalizing children with behavioral health needs is not the answer to the challenges Maine faces. At Disability Rights Maine, we know firsthand that young people with disabilities are stuck for weeks and months in emergency departments and hospitals, and sometimes for years in residential treatment programs, away from their families and their communities. The state’s failure to provide these children with desperately needed crisis and supportive services hurts them and their loved ones every day.
The state’s response to these challenges, creating locked facilities called psychiatric residential treatment facilities, which cost more than $170,000 per child per year, goes against everything that Maine has tried to accomplish over the years. Maine is proposing to pour scarce public resources into the most restrictive option to meet the behavioral health of children, one that research has shown to be the least effective and most costly.
The U.S. Department of Health and Human Services conducted a five year study with nine states participating that compared home and community-based waiver services to psychiatric residential treatment facilities. The study concluded that home and community-based services cost a third of what comparable treatment facilities services cost and produced far better outcomes for children. Those outcomes included improved school attendance, increased children’s behavioral and emotional strengths, decreased drug and alcohol use, reduced suicide attempts, and decreased contacts with law enforcement.
These are the outcomes we want for Maine children. The results are clear and obvious: high-quality home and community-based services produce better outcomes at far less cost than psychiatric residential treatment facilities.
This “bricks and mortar” solution also goes against 20 years of progress integrating people with disabilities of all ages in their communities. In, Olmstead v. L.C., a 1999 landmark civil rights case, the U.S. Supreme Court said that the unnecessary institutionalization of people with disabilities was discrimination. Since then, disability self-advocates and their supporters in Maine and nationwide have made great strides to help people with disabilities live and thrive in their communities. We shouldn’t and can’t go backwards.
According to the most recent publicly available data that we can find, Maine spent approximately $195 million on community-based programs for children on a complicated, complex and flawed system of services. That is with no plan guiding how the money is spent or outcomes measures telling us how successful we have been.
Before another taxpayer dollar is spent, DHHS needs to look at the latest research, assess the current children’s behavioral system, and use this information to develop a strategic plan with clear outcome measures and a well-developed quality improvement program. Psychiatric residential treatment facilities will cost more to sustain than community-based approaches and are have not proven to produce the type of positive youth outcomes we all desire.
The state needs to conduct this assessment, develop a strategic plan that appropriately addresses the needs of Maine children and ensure that the resources are provided to implement that plan. It’s time for Maine to lead again and this is an important first step.
We all should be ashamed of this proposal. We all should be ashamed that Maine, a nationally recognized leader in home and community based services and a nationally recognized leader in children’s services, is creating institutions for children in 2018.
Peter M. Rice is the legal director for Disability Rights Maine.
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