The last time Maine’s system for providing children with mental health services got a comprehensive look was in 1997.
That’s when state officials — at the Legislature’s direction, and with the help of service providers, parents and others — assembled a strategic plan for building up the range of services for children with mental health challenges that they could access without having to check into a hospital or be committed to an institution.
But once the system and its services became codified in state laws, regulations and budgets, they didn’t receive the attention needed to sustain them. MaineCare, the state’s Medicaid program, pays the same rate today for many behavioral health services for children as it did a decade or more ago.
Since costs have risen in that time, that means fewer and fewer providers have been able to afford to provide specialized services such as medication management, in-home behavioral health services, assertive community treatment for children (which helps children return to home life after a psychiatric hospitalization), and multisystemic therapy (an intervention aimed at reducing criminal behavior and aggression). The LePage administration even tried to cut funding for some of these services in 2015.
With so little investment in a system of behavioral health services for children, and no current plan for sustaining the state’s available resources and services, is it any wonder that psychiatric hospitals and the state’s youth prison are common destinations for so many Maine youth with mental illness? The result is a system that’s overwhelmed and ill equipped to address their difficult needs — many of which could be addressed sooner with less intensive services, if only they were available. There often appears to be little aside from the most intensive — and expensive — levels of attention.
That’s certainly the experience that has played out in recent years at Long Creek Youth Development Center, the state’s youth prison in South Portland. The Center for Children’s Law and Policy put it in context in its audit of Long Creek released late last year. One of the group’s key findings was that, “Long Creek houses many youth with profound and complex mental health problems, youth whom the facility is neither designed for nor staffed to manage.” And the auditors highlighted a devastating number of children harming themselves and acting out due to mental illness and traumatic experiences in their past.
Long Creek’s Board of Visitors, an independent oversight group empowered by law to inspect and report on the condition of the youth prison, has echoed those concerns periodically in recent years — as the youth prison has reached crisis levels in terms of staffing, and a 16-year-old transgender boy took his own life at the prison in 2016.
“[I]n Maine we currently have no avenue of keeping some at-risk youth safe, who are in need of services, unless we utilize the juvenile justice system or meet criteria for hospitalization,” Chairwoman Tonya DiMillo wrote in a Board of Visitors report earlier this year. “How then do we help youth in need of services?”
A start would be another comprehensive look at Maine’s system for serving children with mental health challenges — and then a commitment to invest in what the system is lacking. Lawmakers have taken small steps in that direction recently, passing a bill that raises the rates MaineCare pays for some of the community services that providers have struggled to offer and, in some cases, stopped offering.
But small steps won’t be enough to address what has become a crisis.
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