Maine’s mental health system needs an intentional and concrete reform plan built upon a belief in recovery and the principle of providing the right level of care at the right time to each person. Our current system is failing, as evidenced by the increased rates of individuals with mental illness being served at Long Creek Youth Development Center, county jails and the state prison system.
Recent media reports have focused on the loss of $20 million of federal funding because of regulation violations at Riverview Psychiatric Center, the creation of a mental health stabilization unit at Warren State Prison, emergency room holds that far exceed the permitted 24-hour time limit, and the threat level to staff at Riverview.
While there have been countless attempts to a Band-Aid approach at system reform, people living with mental illness deserve a comprehensive system redesign. Not only is fixing the system the right thing to do, it is also a fiscal necessity. In this time of limited resources, we must be smarter about the types of services that are funded and ensure measurable accountability for those who are compensated to promote recovery.
None of the current challenges to the mental health system exists independently from the other components of the system. The mental health system from early intervention of young children through institutionalization is one multi-faceted, interdependent and complicated system. A shortage of inpatient beds affects emergency room hold times. A shortage of transitional living programs forces individuals to stay hospitalized far longer than necessary.
What we all want and need is a system that is flexible enough to provide individualized care that addresses each person’s need with the appropriate level of service, not simply the level of service that we have available.
Individuals with mental illness need supportive communities. Recent public dialogue has focused on safety and security rather than treatment and recovery. Each of us knows someone who is living with mental illness, and we don’t even know it. What we collectively need to examine is how we help people to understand, treat and manage their unique health issues.
Just as we should not lock up all the smokers to protect the smoker and their community from the potential health risks of their tobacco consumption, very few people with mental illness need hospitalization to recover. Even fewer people with mental illness will ever pose a danger to their community.
A smarter system can treat people in their communities with early intervention resources and peer-led responses. Our mental health system must be client-driven rather than funder- or provider-driven. Hospitalization is simply not the answer to the challenges of our mental health system; rather institutionalizing increasingly more individuals is an easy yet expensive way to address our systemic failures.
The federal government cited Riverview because for too many years the hospital has been seen as the answer for any difficult-to-place patient, whether the person has a traumatic brain injury, dementia or diminished cognitive functioning.
An individual with behavioral challenges and reduced cognitive functioning is never going to learn to manage a mental illness they do not have. As advocates for those with mental illness, we want to ensure that only those who can respond to treatment at Riverview are placed there.
Ownership of the system’s failures belongs with each of us who thinks that all people with need are well served by a state psychiatric hospital. Not all people with obesity need gastric bypass surgery, and not every person with mental illness needs hospitalization.
The courts’ use of Riverview as the de facto dumping ground for those for whom the system lacks appropriate services only ensures the failure of Riverview as well as those individuals who can successfully begin their recovery in that setting.
NAMI Maine believes at our core in treatment. We believe that with the right combination of meaningful support, a highly trained workforce, evidence-based treatments and, at times medication, people with mental illness thrive.
Jenna Mehnert is executive director of NAMI (National Alliance on Mental Illness) Maine.