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Mental Blocks, Part 11: Maine's Evolving Mental Health System
01/08/2014   Reported By: Patty B. Wight

Compared to other states, Maine offers a more than adequate supply of mental health resources. The problem, say some insiders, is connecting those resources to the people who need them.  Tonight, in the final installment of our series, Mental Blocks, Patty Wight reports on where some say improvements are needed most.

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Maine's Evolving Mental Health System
Originally Aired: 1/8/2014 5:30 PM

Here's a sobering statistic: People with mental illness tend to die 12 to 25 years earlier than the average population.

"Many of these folks have case managers. Why are they not getting their health care needs met? What's wrong with a system where folks who may be hooked up to services are still dying 25 years sooner?" says Peter Driscoll, executive director of Amistad, a Portland-based mental health organization. "It's really, I think, a pretty severe indictment of a system that's not meeting people's needs on a very basic level."

It's a system that, starting about 50 years ago, embraced deinstitutionalization. The idea was to shift from lengthy - even lifetime - stays at psychiatric hospitals, to treatment at the community level. Penobscot County Sheriff Glenn Ross says Maine was partially successful.

"Well we were great at downsizing," he says. "The hard part is creating those services that are supposed to be in play. So we're seeing the effects of that within our system. We just transferred those people into a whole other system that wasn't designed to take care of them."

Ross says jails have become the defacto mental health institution in the state. All too often, he says, this is where people who don't get mental health treatment wind up. For Ross, the underlying question is this:  are the state's 140 psychiatric beds in two separate hospitals enough? The answers are mixed. Some fear that adding beds will lead to warehousing patients.

Others, like Dr. Michael Kelley, say consider the premise behind downsizing. "If you get rid of them, they won't need them. And it was a lie," says Kelley, chief medical officer of Behavioral Health at St Mary's Hospital in Lewiston. "And I've got patients that beg for those hospital beds, that beg for those group home beds, because they know they can't live in the community."

Some mental health advocates say shoring up community services will help relieve demand. One glaring hole is the lack of supported housing. This creates a bottleneck at psychiatric hospitals, where some patients stay months longer than necessary. Ed Blanchard is clinical director of Shalom House, which provides supported housing in southern Maine.

"Particularly in some of the rural areas where clients have to travel long distances to get supports, I think we could use more of a variety of residential kinds of supports," Blanchard says. "That's not where the money is being put right now, The emphasis is really on developing supports to help people live independently."

That works for some, Blanchard says, but not everyone. Sharon Sprague, superintendent of Dorothea Dix Psyhciatric Hospital says the same is true with community services. She says as different agencies have sprung up over the years, services have become fragmented and difficult to navigate.

"Very few of them have psychiatrists on board," she says. "So I've now come full circle thinking that and have thought, OK - the competition didn't work. It didn't make it better. And the best thing for our patient is to have really high quality services in an agency that has a full continuum of care."

To further ensure high quality of care, Jenna Mehnert of the National Alliance on Mental Illness in Maine says there also needs to be more clinical expertise to handle the complexities of mental health.

"We're really asking our clinicians to be experts in everything without any ability to support that," Mehnert says. "It's not our clinicians' fault - it's how do we provide the right kinds of reimbursement or incentives so they can develop those areas of expertise?"

The challenge, Mehnert says, is it's often expensive to get further clinical training. While others agree that clinical expertise needs a boost, mental health consumer Chuck Veit says he thinks there should be more emphasis on peer support.

"Because they treat you as a human being, not as a number," he says. "They don't treat you as a body part, they treat you as a person. They look at you for who you are, not what you don't have. They take you for face value. They don't judge you. They don't criticize you. And they meet you where you're at."

At its core, peer support is about relationships. Forging personal connections can be difficult for individuals with mental illness, and consumers and providers often cite the stigma of mental health as a barrier to treatment. Helen Bailey is with the Maine Disability Rights Center.

"We never talk about the stigma of being a woman," she says. "We never talk about the stigma of being African American. Or the stigma of being Jewish. Or the stigma of being Muslim. What we're talking about is discrimination."

There are many issues to address in Maine's mental health system and no easy answers. But as Peter Driscoll points out, the system is supposed to be about community. And he says everyone can help remove the most basic blocks to treatment by being more aware, empathetic and kind.



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