Her testimony, all 700 words of it, lasted only a few minutes. But in that short time last week, Chloe Beattie raised a fundamental question that should make all of Maine squirm: What do we value more, someone who helps troubled kids get well, or someone who waits tables for summer tourists?
“While Maine’s hospitality industry is an essential part of Maine’s economy, it is not more important than ensuring that the mental health care needs of children and families are met,” Beattie told members of the Legislature’s Appropriations and Financial Affairs Committee on Monday.
She should know. This spring, Beattie will receive her bachelor’s degree in social work from the University of Southern Maine. This summer, she’ll dive right back in and start work on her master’s.
Upon clearing that hurdle, she told lawmakers, “I will have a master’s degree and a professional license and will be lucky to start at $40,000 a year. That was a lot back when my parents were first starting out, but now it is just barely a living wage. I know I can wait tables here in Portland and earn significantly more than that.”
If ever there was an overdue statewide conversation, it’s the one Maine is now having about mental health.
Just over a week ago, nurses at Maine Medical Center stood outside in the cold to protest the ever-increasing number of patients in full mental-health crisis who languish in the hospital’s emergency department because there’s no place else for them to go.
And during that virtual legislative hearing on Monday, a parade of witnesses pleaded with lawmakers to apply some of that $1.3 billion in surplus state revenue projected over the next 16 months to the ever-growing gap between Maine’s mental health needs and the money available to meet them.
Surplus funds aside, the timing couldn’t be better: As the two-year anniversary of the COVID-19 pandemic fast approaches, we’ve all learned a thing or two about anxiety, depression and the other stresses that, at one time or another, have undermined everyone’s sense of mental well-being.
“We’re in this perfect little moment where there’s more recognition that mental health is a huge issue – partially because of COVID – and almost everybody is being impacted by it,” Betsy Sweet, who testified to lawmakers last week on behalf of the Behavioral Health Community Collaborative, said in an interview. “So, we have an opening that gets us beyond the stigma which has kept us chronically underfunded for the last three decades.”
At the same time, Sweet quipped, “We have more money than God.”
The issue facing lawmakers: How much of that surplus – half of which appears headed back to taxpayers in the form of one-time rebate checks – should go toward mental health treatment? And, just as important, how quickly?
Gov. Janet Mills’ administration, to its credit, last month funneled $116 million in American Rescue Plan funds toward bonuses aimed at recruitment and retention of some 20,000 direct-support health workers among 311 providers around the state. According to Commissioner of Health and Human Services Jeanne Lambrew, $50 million of that money was earmarked specifically for behavioral health providers. Also in the mix are cost-of-living wage increases scheduled for this July.
“We heard loud and clear from our own stakeholders, our own providers, that the urgent need was workforce,” Lambrew said in an interview late Friday.
That sounds like a lot of money. But to appreciate the depth of the need, consider the situation at Pathways of Maine, which provides community-based counseling and behavioral health services to families all over Maine. It’s also the place where Beattie, the social work student, has worked part time and as an unpaid intern since last June.
Scott Hayward, Pathways’ state director, told me last week that in 2014, the agency had a $22 million annual budget and served about 2,100 families.
“Last year, our total revenue was around $11 million,” Hayward said. “So we’ve shrunk by about half.”
More recently, Maine’s labor shortage has hit the behavioral health field hard – not just because there are fewer workers to go around, but also because those who are looking for a job can make the same money in a retail store or restaurant with a lot less stress.
“At the end of 2019, I had 265 employees,” Hayward said. “And today I have about 130.”
All of which explains why, as Beattie pointed out in her testimony last week, more than 650 children across Maine remain stuck on waiting lists for treatment at home or in their communities.
“Many of these children are overfilling emergency rooms, crisis units, psychiatric hospitals, or are at risk for juvenile detention or entering foster care. All of these services are more expensive than home-based treatment and less effective at making lasting, impactful change,” she said.
Meaning, as the Maine Medical Center nurses so aptly pointed out late last month, the time to act is now. While the Mills administration is currently conducting a rate study aimed at increasing MaineCare payments to providers – again, with an eye toward attracting more workers – the process takes months and the new rates wouldn’t be implemented until 2023.
Rep. Lori Gramlich, D-Old Orchard Beach, sponsored a bill last year – as she did in the previous legislature – that would eliminate the waiting lists by immediately increasing MaineCare rates by 25 percent – the first rate increase of any kind in 14 years. Approved by the Legislature last year but never funded, that bill now sits on the appropriations committee table along with three others aimed at shoring up Maine’s mental health support system. Altogether, the bills would collectively cost just under $17 million.
“I’m glad that the administration has put some money into the budget in terms of addressing components of behavioral health,” Gramlich said in an interview. “But it’s not enough.”
What is enough? That brings us back to Chloe Beattie, who personifies – or so we hope – the future of mental-health treatment in Maine. She grew up in Harpswell, is the daughter of two social workers, and sees this work not just as a job or career, but as a calling.
Beattie told legislators that her job with Pathways these past nine months – providing intensive in-home behavioral treatment for children and adolescents with an eye toward keeping them in their homes – has been “the most challenging job I have ever worked.”
But it’s worth it. As Beattie noted, one year after successful discharge from Pathways’ home and community based treatment program, 94 out of 100 children are still in their homes. Even better, they’re four times more likely to enter the workforce and less likely, by half, to require services as an adult.
“It is full of on-your-toes problem solving, modeling empathy and teaching healthy behavioral skills for the whole family,” Beattie said. “While we are working on treatment goals, we are oftentimes confronted with aggressive and abusive behaviors that require immediate intervention to secure safety. This can include conflict with the client or even between other family members. While it’s clear how effective home-based services are, this is a difficult service to provide.”
Thus, at the very least, it should pay as well as waiting tables.
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