Substance Abuse and Mental Health Services Update

December 23, 2019

Improving options for crisis care and treatment with medication

Individuals in Maine who are experiencing a behavioral health crisis too often wind up in hospital emergency rooms and the criminal justice system due to a lack of services in the community. Many are also admitted to inpatient psychiatric treatment when a less restrictive setting would better meet their needs.

Addressing treatment for those in crisis is a critical component of the Department's broader initiative to improve Maine's behavioral health system. As such, in January we anticipate that we will be seeking proposals for a behavioral health crisis center that would represent the first of its kind in Maine. The center would ensure that individuals in crisis receive needed and immediate support until the crisis is resolved and/or the individual is linked with the appropriate services. The crisis center's programming would include 24/7 rapid assessment of individuals experiencing a behavioral health crisis, triage, and when appropriate, active treatment, with the goal of stabilizing the person and reintegrating them back into the community.

The number of crisis beds will be determined through the request for proposals process, which will also include a "living room" model – a comfortable space for clients in need of support lasting fewer than 24 hours. The center would also promote the use of and linkage to statewide crisis call centers and mobile response services.

The cost would be supported by consent decree funds, which are designated and set aside for people in need of community mental health services, and insurance reimbursement when available.

The RFP seeks to establish the crisis center in Cumberland County, in order to reach the largest potential population, but will serve as a model for potentially moving forward in other areas of the state. The Department will gather valuable information about the challenges, costs, and opportunities of this approach as part of determining whether this model should be expanded further across the state. We are also examining the progress made in states including Georgia and Arizona in systematic reform of crisis care.

Our recent work to improve the behavioral health system also includes a plan to support providers in improving medication management, which involves evaluating individuals' history and prior treatment to assess their need for medication and counseling, determining the appropriate medication and dose, and monitoring patients for any needed changes or adjustments.

Providers have expressed challenges in providing these services, including workforce recruitment and retention, funding, and administrative issues. We have taken short-term steps to address these issues, including making sure providers are fully aware of reimbursement opportunities. Additionally, the Department earlier this month invited providers to submit proposals about how they could recruit or retain workforce, increase the number of clients served and the timeliness and quality of their care. The Department expects to make up to $750,000 available through contracts in the new year to support these proposals following an evaluation process.

Behavioral health workforce shortages are a concern nationally across disciplines; psychiatric prescribers are a particular pain point. Many behavioral health services require oversight of a licensed physician. Three out of five of the nation's active psychiatrists are approaching retirement age, and the entire process to train a physician takes at least 10 years. The void is unlikely to be filled by psychiatric nurse practitioners and physician assistants, with demand for these professionals at an all-time high. A recent national survey found psychiatrists represent the most severe shortage of any specialty.

The Department's new investment in the medication management workforce initiative complements our efforts to increase the number of front-line behavioral health staff. In partnership with the USM Muskie School, the Department recently began implementation of a "train the trainer" model to ensure more individuals enter the workforce by creating greater access to training options for Mental Health Rehabilitation Technician Certification (MHRT/C).