Katie Fullam Harris, chief government affairs officer at MaineHealth, says Maine’s behavioral health system is depending on financial support in the state’s next budget.
“Because so many pieces are broken right now,” Harris said recently, “we’re playing whack-a-mole as we try to address the immediate crisis, without taking a step back to look at the big picture.”
But whack-a-mole will have to do, at least for a few more months.
Just about a week ago, all those involved in the behavioral health sector were waiting to see if funds sought by Gov. Janet Mills would be allocated by the Legislature. Lawmakers did that on April 19, earmarking as much as $65 million in state and federal funding to help stabilize the system in Maine.
In-depth explanations of how the money will be divided are available online from Mills’ office and are specified by categories such as the expansion of treatment options and access, crisis care, and community-based recovery supports.
Within these categories are specific amounts for necessary adjustments: $19.8 million for an initiative to add a Mental Health Intensive Outpatient program within MaineCare, for example, or $3 million to support Cumberland County’s currently operating crisis centers.
In the short term, Harris said, proposed investments like these will pay off, and providers can expect some funding to roll out as soon as July 1, at the start of the 2023 fiscal year.
Mills’ $1.2 billion supplemental state budget was left largely intact. The $65 million she sought to stabilize behavioral health was an increase from the original figure of $28 million, according to her office.
Short-term stability and solutions are what many people with mental and behavioral health problems need. But Harris said there’s a need for an even more concrete solution for the long-term well-being of Maine’s behavioral health system in the long term: a solid plan.
The behavioral health system was already struggling when its greatest challenges were exacerbated by the coronavirus pandemic. An influx of individuals in mental health crises has led to overcrowding in emergency departments and nowhere for medical staff to discharge those patients because of a nationwide labor shortage in health care.
A plan that is comprehensive, cohesive, and data-driven, Harris said, would be the best way to address what Maine’s communities need at every level of behavioral care.
The best way to implement it, she said, will not only take a long time to develop but will involve bringing stakeholders together for a regimented process.
Although Harris said she isn’t aware of any stakeholders who have been involved with the process thus far, a bill passed in 2021, LD 1262, requires the state Department of Health and Human Services to develop a comprehensive plan to improve Maine’s behavioral health system and submit it to the Legislature before the end of this year.
But while providers wait for the plan’s long-term adjustments, they hope immediate funding will address some of the most glaring issues they’re facing, including the overcrowding of emergency rooms with patients in crisis.
Not only are hospital emergency departments not the right place for patients to properly recover from a crisis, but they’re only fit to hold patients for a few hours. Along with the overcrowding comes longer wait times, which means people in need of immediate outpatient care can’t always access it when they need it most.
Spurwink, a nonprofit hired by DHHS to provide behavioral health care, believes it has a way to resolve some of those problems; it’s called the Living Room Crisis Center.
Ben Strick, senior director for adult behavioral health at Spurwink, called the LRCC “a massive deal. It adds a layer to behavioral health we’ve never had: a number to call, a person to talk to, a place to go.”
Spurwink opened the LRCC – the first program of its kind in Maine – in February at 62 Elm St. in Portland.
Before, Strick said, emergency departments were often the only option for those in crisis. Now, Spurwink offers a nurturing alternative with a warm, welcoming environment that won’t entirely end the overcrowding, but provides a new option for treatment that can keep clients from having to wait for treatment, or receive treatment in an emergency department, or be taken into custody by police.
For Strick and the LRCC, support from the Legislature created a sense of optimism that hasn’t always existed. He said the changes will help keep programs open while DHHS completes its study; it gives providers hope and “room to breathe.”
The LRCC, however, is only open from 7 a.m. to 7 p.m.; staffing issues prevent the agency from providing the 24/7 care it had originally planned. Strick said they’ll need up to 10 additional staff members to achieve that goal – an incredible feat when providers in Maine are struggling to hire at all.
Fortunately, according to LRCC Director Megan DuEst, Spurwink has been able to attract some new hires, largely thanks to excitement about the unique care the LRCC provides.
Especially for other providers in Maine that don’t offer Spurwink’s unique services, behavioral health staffing is a widespread issue. At Maine Behavioral Health, a division of MaineHealth, there are 43 licensed care positions open, compared with eight in 2019 and 16 in 2020, spokesperson Marc Glass said.
Lack of staffing means wait times for care have increased, Glass said, exceeding 30 days on average.
Part of the problem is the ability to provide adequate compensation for such high-stress positions.
“The shortage of licensed clinical social workers has driven up labor costs, which, when combined with stagnant reimbursement rates, has created a serious challenge in the ability of behavioral health agencies to compensate them appropriately,” Glass said.
Included in the $65 million state budget is a $9.8 million initiative to address this staffing shortage, making cost-of-living adjustments to create a more livable wage for Maine’s behavioral health care workers, including for positions in targeted case management, behavioral health services, community support services, and more.
In addition, there is also $20 million in the Maine Jobs and Recovery Plan to provide support for training positions in behavioral health care, part of an effort to bolster long-term staffing.
It’s hoped that these funds will help stabilize the system in the short term, DHHS representative Jackie Farwell said. Until now, she said, the department has been working with providers to ensure the most necessary items are included in the budget, addressing crowding of emergency departments and wait times for crucial care.
The importance of that incoming support is clear to Katie Harris, who said MaineHealth is grateful for the financial relief provided by the governor and Legislature.
“The pandemic has created a need that is now greater than ever, and the funds will be instrumental in supporting access to care for the Maine people who are struggling during this challenging time,” Harris said.