2021 ALLIANCE ADVOCACY PRIORITIES
- Invest in Behavioral Health Workforce. Maine has seen a critical workforce shortage for behavioral health services for many years. Without adequate resources for equitable pay, many agencies see turnover rates of 40-50% for direct care staff. This adversely impacts those in need of these services by creating instability in the care provided and in the quality of that care.
- Investment in front line direct service and clinical staff wages.
- Professionalize and enhance training opportunities for Maine’s direct service Behavioral Health Professionals.
- Streamline and reduce barriers to licensure for much needed direct care clinicians.
- Maintain Access for Critical Behavioral Health Services. Many agencies have closed or reduced service offerings in recent years due to stagnant or unsustainable reimbursement rates.
- Emergency increases in MaineCare reimbursement rates for behavioral health services at risk of closure, to enhance adequacy of the provider network and maintain access to these services.
- Shift the liability risk burden for Treatment Foster Care back to the State of Maine to eliminate the threat of loss of these services. Commercial insurers are no longer providing this coverage at an affordable cost.
- Enhance Mental Health Services. Many of our mental health services have been cut back and altered due to stagnant rate investments over decades, and we have been left with some services that do not truly meet the needs of those struggling with mental health challenges.
- Restructure Assertive Community Treatment services for persons with Severe Mental Illness to more closely adhere to the fidelity of the evidence-based model of care. Assure access to care for those experiencing homelessness and or at risk of jail or hospitalization.
- Restructure aspects of Medication Management services for persons with Severe Mental Illness to provide timely access, and to accommodate the various levels of support needed to sustain independence in our communities.
- Invest in and restructure mental health services for youth to bring home youth being treated far from their family and community.
- Enhance Substance Use Disorder (SUD) Treatment Services. The need for SUD treatment continues to grow in Maine and COVID-19 has only exacerbated the problems, as access to housing, work, and basic community supports have disappeared. With generational substance use now being seen in families across Maine, there is also an increase in the number of those ever-younger presenting with an increased complexity.
- Establish services needed for the growing complexity of youth substance use, including residential treatment and detoxification.
- Expand Case Management services to all MaineCare members in substance use disorder treatment to assure access to the social determinants of health needed to support recovery.
ALLIANCE STATEMENT of NEED:
2021 Behavioral Health System
Currently our system is significantly overburdened. Maine men, women and children are unable to receive key behavioral health community-based treatment and support services that keep them healthy and productive in their home communities. Maine’s investment in these services has not kept pace with the increasing intensity of need being seen in children and in adult mental health and substance use presentations, nor with increases in inflation and the movement towards livable wages. There are many more Mainers that need intensive residential care (children and adults) with extra supports and guidance than we have spaces to treat. The Opioid epidemic has not abated and supercedes the death rate of the COVID-19 pandemic. After years of unfettered substance use growth in Maine, young children are being found that have severe polysubstance use and a high intensity of need living in multi-generational families struggling with addiction challenges. We do not have the resources to address these issues.
This lack of access to appropriate detoxification, residential, and community-based care shows up in many forms, including:
- Expensive institutional settings being overutilized, such as hospital emergency departments, hospital inpatient units or correctional facilities
- Excessive numbers of people on wait lists or having initial appointments scheduled months out
- Inability to refer for appropriate level of services along the entire age continuum (child, adolescent, adult, older adult) leaving people getting services that may not truly meet their needs.
- Inability to find comprehensive service offerings in all communities/geographies in Maine
Alliance member organizations can provide specific examples of the lack of access to behavioral healthcare services in communities throughout Maine. An example of a profound access challenge is in the medication management programs for both adults and children, where now only a handful of provider organizations continue to operate medication management clinics. Wait lists for these clinics run in the hundreds if not thousands of Mainers. Wait times can exceed 180 days to get an appointment, virtually cutting off the system to consumers who need it. Another example is in emergency department settings where patients get “stuck” awaiting access to secure stable community mental health services.
A contributing cause of this lack of access are reimbursement rate levels that are outdated and incapable of sustaining service providers to operate in an already vulnerable and overburdened system. A lack of appropriate reimbursement rates leads to an inadequate and vulnerable service network and agencies that are fiscally beholden to community Boards of Directors that have had to cut staffing levels, locations of service, and entire programs to remain viable.
Inadequate reimbursement rates lead to:
- non-competitive compensation offerings in the market causing staff shortages
- burnout and fatigue among staff, and
- overall difficulty in retaining the personnel who provide safe and compassionate care.
Then in 2020, on top of all of these existing problems, COVID-19 came and increased the need for behavioral health services and exacerbated the worker shortage as folks roll into and out of quarantine, or do not want to work on the front lines due to pre-existing immune systems or family concerns.
The safety net for behavioral health care in Maine is at a crisis point. We need swift action.