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Malory Shaughnessy is the executive director of the Alliance for Addiction and Mental Health Services. Betsy Sweet is senior advocate with the Behavioral Health Community Collaborative. Katie Fullam Harris is the chief government affairs officer of MaineHealth.
At the end of June, the Mills administration began issuing one-time payments to Maine behavioral health providers totaling $36.8 million in state and federal funds as part of the bipartisan supplemental budget passed by the Legislature. These payments could not have come at a more critical time.
Earlier this year, hospitals, behavioral health providers, health care workers and people with lived experience sounded an alarm: the COVID-19 pandemic coupled with more than a decade of neglect left our behavioral health system in crisis. And those services that remained of our fragmented system were insufficient to meet the needs of our most vulnerable residents.
At the height of the crisis, one-third of MaineHealth’s emergency department beds were filled with behavioral health patients awaiting access to appropriate levels of care. Patients regularly languished for days — some for weeks and even months — in our emergency departments because the services they desperately needed had months-long waiting lists — or worse — the service was not available at all.
Not only did the system fail these patients and their families but also our health care heroes — once celebrated at the onset of the pandemic — who literally bore the brunt of the system’s failings as they experienced unprecedented levels of physical and verbal abuse, though it is important to point out that the vast majority of people with behavioral health needs are not violent.
The Legislature and the Mills administration recognized the pandemic’s toll in this arena, and they made an historic investment to help stabilize the behavioral health system. Just as importantly, the administration worked in collaboration with providers to develop a plan to distribute the targeted relief funds quickly. These funds have done what they were intended to do — stem the bleeding and stabilize a system in crisis.
To be clear, however, the relief funds have only patched a problem that took more than a decade to create. It has not been fixed. People with behavioral health needs, and particularly children, continue to languish in our ERs for days and weeks. There are still long waiting lists and insufficient access to home and community services. And our care team members are still experiencing unacceptable levels of violence on a daily basis. Though the magnitude of the crisis has stabilized, the underlying gaps in the system persist.
Rebuilding a system in shambles will require further investments and collaboration to fill gaps in care and advance structural reforms that will ensure the financial stability of the community-based behavioral health system. A comprehensive plan is needed to identify where investments should be targeted to support the needs of our communities — whether you live in Fort Kent, Eastport or Biddeford.
The Department of Health and Human Services is working to advance some of these structural reforms, such as creating a process to regularly review and update MaineCare reimbursement rates. Some of these rates have stagnated for more than a decade, not keeping pace with rising costs and inflation, which has directly impacted access to care. The MaineCare rates for many of the behavioral health services are currently in review, and new rates should be announced soon. These new rates must be adequate to cover the cost of providing these services, or we will see another round of service closures and cutbacks.
This is a critical first step.
However, we also must invest in a data-driven, collaborative planning process that identifies what is needed to support the behavioral health needs of our population now and into the future.
With the worst of the pandemic hopefully behind us, now is the time to finally develop a statewide strategic plan to rebuild our behavioral health system and ensure that our most vulnerable residents have access to community support and the services necessary to live safe and productive lives. Our system is simply too fragile to endure another crisis. We can and must do better.