Far too many Maine kids are in residential treatment facilities outside the state. While the majority are in New England, some children are as far away as Arkansas, Utah and Illinois. We are sending money and our next generation away for treatment that we could be providing right here in Maine.

We need to bring them home – and we can, with the right structure in place. Treating these youth closer to home doesn’t just create more natural support systems but can also save the state money.

The solution? Psychiatric residential treatment facilities. These are secure therapeutic residences that provide non-hospital inpatient psychiatric care and treatment to youth under the age of 21 who have MaineCare/Medicaid coverage.

These non-hospital settings are less restrictive than hospital settings and are a safe alternative for treating children who have a less acute psychiatric illness but still require a locked structured residential setting because of their serious emotional disorder. Care is provided under the guidance of a physician.

Maine is an outlier with this model. Approximately 35 states operate psychiatric residential treatment facilities. Currently, Maine has under 100 children’s inpatient psychiatric beds and not a single psychiatric residential treatment facility. The result is that children languish untreated for days, if not weeks, and sometimes even months in emergency rooms without active treatment – or they are stuck without a discharge plan in a more restrictive inpatient hospital, the most expensive treatment option we have. Make no mistake, these are children who cannot safely be treated with in-home services.

Youth should be served in community settings when it is safe and appropriate to do so, and our collective energies and resources need to be devoted to early preventative services, but there is a place for secure psychiatric residential treatment facilities in Maine.


Youth who are too dysregulated to function in a traditional open-door residential setting, even with intensive support, are often turned away from providers. It leaves families with very little options. These trauma-stricken youth are subject to trafficking and/or running away and require the oversight of a physician-directed treatment plan, typically for medication management.

The need for this service is widely recognized by the provider community and the Maine Department of Health and Human Services. The department went so far as to establish psychiatric residential treatment facility MaineCare regulation in 2018. However, in the nearly five years since the establishment of Section 107, no provider has implemented this service. There are very specific reasons for this.

The regulation as established is onerous and overly prescriptive. It provides for excessive staffing requirements and significantly insufficient reimbursement. The upfront costs of delivering this service are high and undersupported. To be clear, the proposed psychiatric residential treatment facility reimbursement does not come close to covering the regulatory requirements.

What we see play out in other states is that children who experienced the most positive outcomes in terms of juvenile justice involvement, improved school functioning, decreased drug and alcohol use and increased social support were those youth who were transitioned out of psychiatric residential treatment facilities to home-based programs. The psychiatric residential treatment facility stay is an important part of the treatment puzzle on a child’s path toward a healthy and stable future.

We know what the gap is in our behavioral health system and what is needed to develop a more comprehensive continuum of care for our youth. We need to act now. L.D. 181, a Resolve, Directing the Department of Health and Human Services to Implement Secure Children’s Psychiatric Residential Treatment Facility Services, would create the sense of urgency we need to ensure providers can implement this type of program effectively.

Instead of spending taxpayer money out of state on expensive care that takes children away from their community, families and friends, let’s bring them home and treat them with the providers like Sweetser, which are already capable of providing these services if we simply get some key adjustments from state government.

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