Without access to behavioral health services, too many Maine children are being treated in emergency rooms and psychiatric treatment centers. Credit: Courtesy of Central Maine Healthcare

The findings of a report on the state’s youth mental health services are straightforward — and rightfully harsh.

Behavioral health services for children are not available quickly — or, sometimes, at all. Too often services are not available in the communities where the children who need them live. When Maine children do get services, the quality is inconsistent, and there is little coordination, especially as they transition to adulthood.

In being so direct, the report and its recommendations offer state policymakers a straightforward framework for remaking the state’s Children’s Behavioral Health Services program to put the needs of Maine children, and their families, first.

The Dec. 15 report, produced for the Maine Department of Health and Human Services by Boston-based Public Consulting Group, is part of the first major review of Maine’s children’s behavioral and mental health services since 1997.

It makes 24 recommendations. They include changes that could be made fairly quickly, such as developing a strategic plan for Children’s Behavioral Health Services with specific goals, and hiring an in-state full-time medical director for the Office for Children and Family Services instead of relying on a Massachusetts contractor to oversee and coordinate services.

Other changes that will take more time include developing behavioral health urgent care clinics and growing the state’s health care workforce. In 2017, Aroostook, Penobscot, York, Androscoggin and Waldo counties had severe shortages in child and adolescent psychiatrists, according to the report. Washington, Lincoln, Sagadahoc, Oxford and Somerset counties had none of the psychiatrists at all.

By not investing in needed services, Maine has worsened the lives of children with behavioral health needs and their families, and spent more money in the long run. More than 65,000 Maine children, ages 2 to 17, have been diagnosed with a developmental, mental or behavioral issues including autism, depression or anxiety, post-traumatic stress and attention deficit disorder.

Without accessible community-based services, too many of these children have been held in hospital emergency rooms, psychiatric treatment centers and the state’s youth correctional facility. Many have also been sent out of state to receive services.

The BDN has documented how hundreds of children are on waitlists for services delivered in their homes and local towns, as providers have struggled to hire, pay and keep qualified staff. In addition, the BDN has written about how the state has sent dozens of children to out-of-state treatment facilities due to a lack of available treatment in Maine, while other children spend extended periods in psychiatric hospitals and hospital emergency rooms.

According to the report, the majority of children on waitlists for the intensive services of functional family therapy and multisystemic therapy are waiting longer than 120 days for care to address needs that are generally urgent. The average child waited 59 days for residential services in state fiscal year 2018, up from 37 days in 2016.

The lack of access has pushed children into hospital settings. Of the 27 youth surveyed for the report who had been to the emergency room, the average length of stay in the ER was about eight days, with the longest stay being 90 days.

Eighty-seven children were placed in out-of-state residential facilities in state fiscal year 2018, up from 46 in state fiscal year 2016. Some are as far away as Arkansas, Missouri, Illinois and Utah.

These failures of Maine’s system is detrimental to children and families that need these services, and the taxpayers who fund them.

The report offers a thorough blueprint for needed changes. Now, it is up to the Department of Health and Human Services and lawmakers to implement — and fund — changes that will improve the lives of more than 65,000 Maine children.