In the early 1980s, Maine was proactive in putting a service in place so people with mental illness and other mental health challenges could more safely remain living with their families and in their communities, as opposed to being placed in locked institutions.
That’s when the state piloted a project that put mental health crisis workers in the community — starting in Skowhegan — who would be available at all times for someone experiencing a mental health crisis.
Those community crisis workers would be there for someone contemplating suicide, for someone experiencing crippling anxiety or a severe bout of depression, for anyone who asked for help at a tenuous time. The thinking was that if someone in a precarious mental state could speak with a supportive, understanding crisis worker who would listen and help them get the follow-up care they needed, that person would be less likely to end up in a hospital emergency room or psychiatric bed. That person, with support, could continue living his or her life.
By the 1990s, that pilot program had become a statewide system of mental health crisis services, offering support over the phone and in person, as well as short-term residential units where people could stay a few days to stabilize and get back on their feet. Maine was on the forefront of developing such a system and training workers for the job, and other states looked to Maine as they set up their own statewide networks of mental health crisis services.
Now, Gov. Paul LePage’s administration is putting that network at risk.
The state recently overhauled the system with no public engagement, without a clear rationale and with little preparation for a new setup that changes how calls for support come in and are assigned to crisis workers in each of the Department of Health and Human Services’ eight service districts. A change in the way the state pays local providers of the service could render the service unsustainable long term for the nonprofit agencies the state has contracted to provide it.
Since the start of April, a call to the statewide crisis hotline from anywhere in Maine has rung at a central call center in South Portland, operated by The Opportunity Alliance, a nonprofit community services agency. When a call requires in-person support, the call center employee notifies the local crisis services agency for the relevant region of the state, and that agency sends out a crisis worker.
While the setup might ultimately get the job done, the state switched to it without soliciting input from the people who depend on the service and the agencies that provide it, and without pointing to a reason for reworking a service that had run with few problems for more than two decades.
“I still don’t know what it is that we’re trying to solve,” Mike Mitchell, CEO of Crisis and Counseling Centers in Augusta, told the BDN. Crisis and Counseling is the state-designated crisis services provider in Kennebec and Somerset counties.
In fact, DHHS’ changes might well cause graver problems for a service that deals in life or death circumstances and is expected to be available at all hours of the day, year-round.
Since April 1, the agencies that employ crisis workers in the eight DHHS regions have been paid only when they provide a billable service, which is akin to paying a local fire department only for the number of fires it extinguishes. The agencies need to be able to employ people to be available at all times, but a fee-for-service payment isn’t conducive to paying for crisis workers to be available when the call volume is low. And it doesn’t easily translate into the extra services crisis workers provide in their communities, such as police ride-alongs and crisis counseling following tragedies at local schools and businesses.
Again, DHHS can’t point to a valid rationale for the change. The department even says it doesn’t expect to save money.
A response from a crisis worker could mean the difference between life or death. DHHS’ meddling, then, has high stakes.
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