AUGUSTA, Maine — As the pandemic puts more of a spotlight on mental health care, some advocates and hospitals in Maine are calling for more funding to address the issue.
Christina Feeney said her own family’s experience proves Maine has a problem. Her 13-year-old son has high-functioning autism and bipolar disorder, she said, and sometimes needs a hospital stay to adjust his medication.
But to get admitted, he needs to go to a hospital emergency room. And for those with mental or behavioral health conditions, the ERs have often become roadblocks to care.
“My son in 2021 spent seventy-plus days in different emergency rooms in Maine,” Feeney said. She added, before finally getting into a hospital mental health bed, he waited in one ER for more than 20 days. And she said the ER staff could not provide any mental health services.
It’s a problem hospital leaders around Maine know all too well.
“The month of January, we had 125 adults and 42 children who waited more than 48 hours in one of our ERs, waiting for behavioral health services,” Katie Fullam Harris, government affairs officer for MaineHealth, said.
Harris and others said the problem of mental or behavioral health patients languishing in emergency rooms shows Maine's behavioral health system is “crumbling” because of decades of inadequate funding.
“The entire system has been underfunded for a long time,” Dale Hamilton, head of Community Health and Counseling Services in Bangor, said.
“So now, with resources that have come in, more should be directed to the mental health system to support it," Hamilton said. "Not that it will immediately change things, but it will get it into a more stable footing so the system can recover from this and move forward in a way it can help people.”
Hospital leaders, including Scott Oxley, president of Acadia Hospital in Bangor, said the major problem causing extended patient stays in emergency rooms is a lack of community and residential mental health services. They said the chronic underfunding of those programs, coupled with a worsening shortage of mental health workers, have made treatment hard to find.
In the short term, Oxley said more mental health beds, including at his hospital, could help.
“The backlog we see with people boarding in ERs for days or weeks, we know initially we need to provide more relief to emergency departments and provide relief to ERs and reduce the waitlist," Oxley said.
However, he quickly added that more beds are not the long-term answer. Instead, he and others said that it requires more robust funding of community-based mental health treatment.
“I don’t think we measure our success as a state around treatment for mental illness by putting more beds online. Long term, the secret to our success would be measured by how well we did keeping people with mental illness out of the hospital. And that’s by putting more funding and resource on the front end, which means more community resources,” Oxley said.
Rep. Lori Gramlich, D-Old Orchard Beach, a social worker, said there had been growing bipartisan agreement on that point in the Maine Legislature. And Gramlich noted there is also a lot of agreement on the need for permanent pay raises for those working in the behavioral health field to keep and attract workers.
“When you are graduating with a master's [degree] in social work with lots of student loans, and you will take a job that’s hard work … and you are competing at salary rates with McDonald's and Walmart, all of whom pay at least $5 to $10 more per hour. You have the fire in your belly to do this work, but how do you pay your student loans and pay your rent?" Gramlich said.
Maine DHHS said it's working on a salary study that will eventually adjust pay rates and MaineCare reimbursement rates for all those services. An agency spokeswoman said that DHHS has already provided millions of dollars in one-time funding for bonuses and cost of living pay increases in the interim.
The Mills administration is also asking for millions in added funding in the current supplemental state budget.
However, lawmakers and others said it's time for the Legislature to go beyond that and make an even more significant investment into mental health programs to finally give proper funding to needed services.
“These services will potentially prevent high-cost hospitalization,” Gramlich said.
The lawmaker said several measures were passed last year by the Legislature but not included in the eventual state budget. She said they’re hoping the larger-than-expected revenue surplus will allow them to be funded this year.
“The services we are hoping to get into the governor's supplemental budget are things like increasing outpatient therapy reimbursement rates for Medicaid. That’s huge,” Gramlich said.
There are also several new bills to provide funding for more behavioral health treatment.
The budget process in the Legislature is moving forward, with roughly six weeks until adjournment. Katie Fullam Harris of MaineHealth said lawmakers must look for ways to finally provide the total funding the behavioral health system needs.
“We have to do better as a state. It’s a call to action for all of us to step up and create the system that’s needed,” she said.