February 17, 2023
Today, the Maine Department of Health and Human Services (DHHS) released a Comprehensive Behavioral Health Plan for Maine (PDF) to improve the continuum of behavioral health services available to Maine people from childhood throughout the lifespan.
This Plan includes 74 actions currently under way as well as numerous additional planned actions, documenting significant progress as well as challenges in recent years due to the COVID-19 pandemic. The Plan also charts a path forward to provide access for all Maine residents to an integrated, high-quality behavioral health system of care.
The 130th Maine State Legislature passed LD 1262 (Resolves 2021, Ch. 80), which directed the DHHS Office of Behavioral Health (OBH) to develop a comprehensive strategy that covers children as well as adults. OBH used this as an opportunity to update and unify previous plans across DHHS offices for behavioral health. To solicit input from different communities, consumers, providers, and others, OBH held two public stakeholder engagement sessions and accepted written comments and survey responses.
The Comprehensive Behavioral Health Plan for Maine includes four parts.
The first is about consumer choice: providing person-centered planning and access to preferred services for behavioral health. Examples of actions include advancing crisis system redesign that embeds choice and access to peer services, as well as the implementation of the Psychosocial Support Community Health Worker Program that connects historically underserved populations with culturally and linguistically appropriate behavioral health and wellness resources. Additionally, OBH has improved its referral process so that, for example, providers of certain services prioritize DHHS referrals and conduct an assessment within seven days, with exceptions to refuse referrals only granted by OBH, to improve timely access to the appropriate level of care.
Second, the Plan focuses on activities tailored or targeted to support different population groups, and describes actions around:
- Children and adolescents, such as expanding statewide the Early Childhood Consultation Partnership, the only evidence-based model for young children with challenging behaviors, expanding school-based health centers across the state, and utilizing telehealth to improve access to school-based mental health services;
- Justice-involved individuals, such as creating new residential treatment options such as a close supervision unit that opened in 2021 and continued expansion of medication for opioid use disorders in jails;
- Lifespan supports that allow for service adjustments over time, including for individuals with intellectual and developmental disabilities, with the central organizing activity being the development ofa Lifespan waiver through MaineCare.
Third, the Plan lays out what has been done to address gaps and expand access by major area. The types of services included:
- Crisis services such as launching the 988 Suicide and Crisis Hotline in July 2022 and establishing the first comprehensive emergency crisis receiving center in Portland in 2021 to pilot an alternative to emergency departments and jails;
- Community-based services such as implementing a new, higher-paid reimbursement model for Assertive Community Treatment (ACT) and Home and Community Treatment (HCT) programs on January 1, 2023 and expanding tele-behavioral health services in MaineCare;
- Care coordination and case management such as providing discharge planning and coordination and developing a reimbursement model for new mental health intensive outpatient programs to support step-down services, avoid rehospitalization and improve community placements from State inpatient psychiatric settings;
- Substance use disorder (SUD)-related services such as significantly increasing the number of providers and sites offering medications for opioid use disorders (MOUD), including increasing from 0 to over 80 percent of emergency departments offering MOUD; implementing the MaineMOM program to improve care for pregnant and postpartum people with opioid use disorder and their infants by integrating maternal health and substance use disorder treatment; implementing the OPTIONS program of public education and a clinician embedded with law enforcement to co-respond to SUD-related emergencies; and expanding recovery services across the state;
- Peer- and family support services such as support for training and utilization of peers at multiple levels of services delivery; through the Maine Warm Line for crisis help, emergency departments, Behavioral Health Homes, Riverview and Dorothea Dix Psychiatric Centers, ACT Teams, and seven Mental Health Peer Centers as well as family-focused interventions like the Positive Parenting Program, or Triple P, that engages families in preventing and treating behavioral health issues in children and youth.
And, fourth, the Plan describes infrastructure and related services that are pre-requisites to a high-functioning system that produces optimal behavioral health outcomes. These include housing, transportation, employment services, and behavioral health workforce development. Examples of recent actions include: expanding the Bridging Rental Assistance Program for individuals with serious and persistent mental illness; adding to MaineCare HOME supportive services for members with chronic illness experiencing long-term homelessness; and investing resources from the Maine Jobs & Recovery Plan among other sources to expand training, create stackable credentials, and support career ladders in behavioral health.
The Behavioral Health Plan also includes future actions. One example is the planning to add Certified Community Behavioral Health Centers and expanded mobile behavioral health crisis services to MaineCare. Significant work has been under way to support payment for these services to address gaps in the continuum of care. Additionally, DHHS will expand the Opioid Health Homes to include all substances and implement high-fidelity wrap-around services for children.
The Governor’s budget proposal for the 2024-2025 biennium would help advance the Comprehensive Behavioral Health Plan for Maine. It includes an historic $237 million for services and payment rate increases, adding to the $230 million in invested in behavioral health services in the 2022-2023 biennium. The Plan will be updated periodically in collaboration with key stakeholders and consumers and progress towards achieving the Plan goal will be monitored and documented.