Maine’s behavioral health care infrastructure is woefully lacking. For kids in crisis, it’s especially inadequate. Maine does not have any psychiatric residential treatment facilities to care for children with significant behavioral and mental health needs. As a result, children often get shuffled between insufficient care options, sometimes languishing for days, weeks or months in emergency departments or jails without treatment.
These places aren’t equipped for children experiencing behavioral health issues. They cannot meet their needs, they are not cost effective and they set these kids up for failure. Years of insufficient funding and coordination have led us here, but my colleagues and I in the Legislature are taking steps to address these shortcomings.
In 2021, the Legislature required the Office of Child and Family Services to collect data on youth seeking crisis services through Maine’s emergency departments. Across the 34 hospitals that provided monthly reports from January to October 2022, 861 youth sought crisis services through an emergency department. Many children also had their stays extended because there were no appropriate alternatives after they no longer met the psychiatric levels of care.
This year, the Legislature passed a measure directing the Department of Health and Human Services to study the root cause of this issue. The bill also directed the department to convene a stakeholder group to develop a policy requiring residential behavioral health providers serving children in crisis to obtain written approval from the DHHS before refusing to deliver care. This “no eject, no reject” framework has been used successfully in other states to get children in crisis appropriate care outside of emergency rooms.
Hospitals aren’t the only institutions that end up taking in kids in crisis. According to the National Center for Mental Health and Juvenile Justice, 70% of youth involved in the juvenile justice system have a diagnosable mental health condition. Youth in detention have also been found to be 10 times more likely to suffer from psychosis than those who aren’t. In a recent report, the U.S. Department of Justice found that the lack of appropriate crisis services in Maine is one of the factors leading to the unnecessary institutionalization of youth.
When we allow the criminal justice system to act as a stand-in for behavioral and mental health care, entire communities suffer. Establishing a holistic framework for meeting these needs is essential for breaking the cycle of incarceration for these populations. That’s why this session, the Legislature established a working group with members from the DHHS and the Maine Department of Corrections to create coordinated policies to serve the needs of children in the juvenile justice system.
Experts recognize that chronic underinvestment in reimbursement rates for behavioral health care providers is a key barrier to opening and operating residential treatment facilities like the kind needed to divert youth from emergency rooms and jails. This session, the Legislature delivered those badly needed rate increases, bolstering services that are traditionally understaffed but critical to a community-based crisis response network.
All of this progress is worthy of celebration, but we can’t stop here. Without a place for children to go, “no eject, no reject” policies and rate increases won’t have their maximum benefit. In the upcoming legislative session, I am hopeful that the Legislature will prioritize establishing a crisis receiving center for children. The Maine DHHS, in partnership with Spurwink, already employs a similar model that has proven effective for adults. The Living Room Crisis Center in Portland is staffed with experienced peer support providers, case managers, nurses and clinicians. Our children also deserve this level of care.
We cannot continue to allow youth experiencing behavioral and mental health crises to languish in emergency rooms and jails. It does a disservice to them, to the providers in those facilities and to all of our communities. We made progress this year, but to truly provide adequate care for Maine’s children who need it most, we must do more.
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