Imagine having a debilitating and life-threatening mental illness, with symptoms that can result in social isolation and estrangement from family, friends and community.
Imagine being unable to buy food, clothing or even interact with other people because of the interference of a mental health condition’s psychological and emotional symptoms.
Imagine not having a family support network or even a close friend to call and help out.
Imagine feeling all alone in the world with little support.
All of us have, at some point in our lives, relied on the help of others to do basic things. Young adults transitioning from their parents’ homes to independent living often rely on their families to help them figure out how to shop for food. Older adults who have mobility issues often call adult children or friends to help with shopping or even to drive them to medical appointments. All of this is quite natural and part of the fabric of community and community connections.
However, when someone suffers from mental illness, those natural connections are often not available. Maybe it’s because relatives live far away or because poverty and poor health have led to lack of mobility. Whatever the case, people who are coping with mental illness may need help, just like most people who might be struggling to live independently.
For those who are mentally ill, have low incomes and qualify for MaineCare, that help can come from Section 17 MaineCare community integration services. This is a case management program that provides home-based services such as helping people shop for food when their psychiatric symptoms make this difficult; helping them schedule and keep critically important medical and psychiatric appointments, and, just as important, helping them find and maintain housing.
The program assists in establishing social communities for clients by connecting them to their neighbors and friends. Case managers are directed to develop a caring, professional relationship with their clients, assist them in meeting basic human needs, and become a steady, calming presence in a client’s life.
Case managers work with many clients who have complex and chronic medical issues related to their mental health diagnosis and aging. This vulnerable population benefits from the regular, consistent presence of a case manager. One important result of effective community integration case management services is a reduction in the number and length of psychiatric hospitalizations for clients.
The MaineCare community integration program currently helps 4,000 residents of southern Maine. But this critically important program is targeted for severe rate reimbursement reductions as a result of Maine Department of Health and Human Services rate reviews.
Proposed changes in funding would slash reimbursement for community integration services by 23 percent; this is on top of flat funding for these services since 2007. These reductions would force many of the nonprofit community-based organizations that provide these services to discontinue community integration programs because they cannot absorb the planned cutback in funding.
These reductions in the social service safety net for vulnerable people will increase the likelihood of clients experiencing more social isolation and housing problems and the need for more expensive and unnecessary psychiatric hospitalizations. It makes no sense to reduce community integration reimbursements when that can lead to increased psychiatric hospitalization costs.
Two studies at Temple University’s Collaborative on Community Inclusion of Individuals with Psychiatric Disabilities suggest that when people have expanded personal communities, they do better at integrating with the community. Other research on community integration and employment support clearly suggests that community integration services help people find and maintain jobs – not an easy task for those who have mental illness. Many recipients of community integration services stabilize and need less case management involvement as they strengthen their community connections and increase their self-sufficiency.
Imagine living in a state that treats its most vulnerable and at-risk populations by providing effective and cost-saving community integration services at their current levels. Imagine these funds making the difference between living a life of dignity and connection to communities and living alone, isolated and disconnected. We can prioritize these services and make sure they are not eliminated by the current proposed DHHS rate reductions. Supporting the most vulnerable in Maine is the right thing to do.
Send questions/comments to the editors.
