Alliance for Addiction and Mental Health Services, Maine
The unified voice for Maine’s community behavioral health providers
July 3, 2020
Governor Janet Mills
1 State House Station
Augusta, ME 04333
Dear Governor Mills,
Let me first acknowledge that we are all working under severe time and financial constraints due to the COVID-19 pandemic and its impacts on our state. Given this we know that you and your leadership team are trying very hard to juggle many things at once, and some issues that are critical to the membership of the Alliance may not always be at the forefront. However, it is important right now to bring your attention to a matter that is very time sensitive. As you are aware, we are in the midst of a trifecta – the COVID epidemic, a rapid economic collapse based on this epidemic, and a long overdue demand that we shift our policing and corrections, imbued with systemic racism, toward community-based services, mental health services in particular.
Behavioral health systems and services are at the center of each of these crises.
You have already heard from us how fragile and underfunded the community based behavioral health system was before these crises. Many agencies and programs have been barely holding on. Agencies were already facing work force shortages and an inability to compete for workers and retain them due to inadequate reimbursement. Efforts to bring children and adults home from out of state placements were already stifled. We have experienced program closures and agency closings, and a resulting reduction of access to services at a time when the public need for these services has been increasing.
And then COVID hit.
The services Alliance member agencies provide as community behavioral health providers were severely impacted by COVID – both in the ability to deliver outpatient and residential services and the dramatically increasing needs of Maine citizens as they endure this pandemic. The economic collapse has had a severely negative impact on their workforce – one that was stretched to the limit before any of these crises hit.
A critical piece that you also need to understand is the wide variation in the types of mental health and substance use services provided by agencies across the state. These range from congregate care settings such as residential treatment programs and inpatient detox programs, crisis response services both in the community and in stabilization units, and outpatient programs of various types and intensities – including many that could not be moved to telehealth, as well as programs serving both children and adults.
So, it is important to note that the impacts of COVID on the operation of these agencies and programs is just as varied as the range of the programs themselves, with some more severely impacted than others.
We want to make sure you understand also how much we appreciate the collaboration and open communication we have had with leadership in your administration. They have provided guidance and created flexibilities in rule many times to allow for continued access to services, and have made available some targeted, time-limited rate increases.
These targeted rate increases have been helpful, but have only skimmed the surface of the need for many providers. Depending on the mix of services, the number of services that could move to telehealth options, and the geographic location where they are located, some providers have weathered this storm with only minimal loss. Some have been able to access federal funding through the PPP loans to retain workers, they have received some of the CARES Act Provider Relief Funds to offset additional costs associated with COVID-19 such as PPE and hazard pay to their employees, and at this point are basically left intact.
Other providers, with a different mix of services, or less capacity to move these services into Telehealth, or ineligible for some of the federal assistance, are teetering on the edge of a precipice. Some are looking at annual losses in the hundreds of thousands, or millions, of dollars.
Here is a rather incomplete list of the ways in which agencies were affected in their ability to serve their clients, all of which required them to find additional funding:
- The purchase of PPE for all direct staff workers. There were also huge shortages and wait times even though they needed to continue to work face to face with clients and residents
- Many staff moved to telehealth services. That meant the purchase of equipment, internet, phones, and phone minutes for staff and our clients
- They had to pay bonus pay for many of employees to ensure that they continued to come to work to serve clients.
- Residential/special purpose schools were unable to continue, greatly diminishing the census of students while sustaining the costs of maintaining staff, facilities, etc. While public schools were guaranteed funding to cover these costs, many of them did NOT continue to provide these providers with the tuition they receive that is usually transferred.
- They lost staff due to an inability to find child care for their own children or due to illness and had to pay overtime
- The calls to the crisis system and warm lines increased with a need for additional staff hours
- The need for mobile crisis also increased
- Agency revenues cannot cover the cost of maintaining residential services as the census must decline due to social distancing and safety. There will also be an increased need for residential beds and new facilities as the census must go down.
- Several agencies had outbreaks in their facilities and had to do major building, air system and physical plant changes to accommodate social distancing, disinfecting, etc. Others are just starting this process to move forward.
- Agencies that had to quarantine workers or clients in residential care sustained huge losses in overtime and at times, paying double teams to ensure coverage
- Staff has had to be tested frequently, and the repeated tests are not covered, making it difficult for staff to be in compliance with recommended protocols.
All of this costs money. Our internal surveys of providers have shown year-end losses predicted to be between 10 and 15 % of revenues, if not higher for some.
We do not believe this pandemic is over and are very nervous about predictions of a fall spike. It is also very important to note that the need for mental health and substance use services has not peaked. Any time we go through a national crisis that effects people’s lives so dramatically, it often takes time (3 -12 months) for the mental health impacts to manifest and for people to seek treatment. Also, the needs of people with chronic and persistent mental illness tend to increase in severity over time following a crisis.
A recent poll found that the pandemic and its resultant social and economic impacts are already taking a heavy toll on Americans’ mental health. 45 percent of respondents reported that the pandemic is negatively affecting their mental health, up from 32 percent just a month prior.  Experts have even suggested that long-term social distancing from friends, loved ones, and a departure from routine may have both short- and long-term psychological effects. Anecdotal reports have also indicated that rates of consumption of alcohol and other addictive substances are on the rise.[3
We want you to understand that we face the risk of further compounding this situation without some relief for the providers of these services. We face the very real possibility of doors closing on services that are desperately needed.
What we want to do today is share with you a request we presented to the Appropriations and Financial Affairs Services Committee in one of their recent fact-finding hearings. We are sharing our request with you to create a streamlined, straightforward, two-part COVID relief fund for community behavioral health organizations from the CARES Act funding:
- An emergency relief fund available to these organizations now that FY 20 has come to an end. Providers will be able to demonstrate their lost revenues and what added costs they have had to sustain due to the virus. This relief fund (with an estimated need of $15M) could be accessed by organizations who are ending the year in a deficit and whose continued operation is in jeopardy without financial assistance.
- A second COVID relief fund for the coming fiscal year (estimated need of $20M based on the recent experience) available to be accessed by these organizations as we head into another fiscal year with great uncertainty and no knowledge of any continued federal funding to come.
Again, adequate community mental health services are a central piece of everything that is going on. And the system is in trouble. Please direct a portion of the CARES Act money to address these needs.
I recognize that there are many demands on the CARES Act funding and on public dollars in general. However, the future is uncertain and the need to preserve an intact system of community-based behavioral health services is going to only increase in importance as the critical social safety net for our fellow Mainers.
Thank you for your consideration of this request,