'Good intentions on paper' are not enough

By BARBARA WALSH, Staff Writer

Copyright © 2002 Blethen Maine Newspapers Inc.

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CASTAWAY CHILDREN: Maine's Most Vulnerable Kids Follow this three-part series on the plight of Maine children with mental illness and get more information including where to find help, a glossary of terms and how to voice your opinion, here. To top of story

Community services, coordinated care and consistent treatment.

Mental health experts say those elements are key in keeping emotionally and mentally ill children stable and out of psychiatric hospitals.

Maine has improved in some areas but has a long way to go, families, child advocates and doctors say. The state needs to continue its transition from institutional care to community-based support. At-home treatment is cost-effective and more likely to keep children out of crisis.

There are successful examples. Vermont has built strong support networks for keeping children out of crisis. Maine itself has some effective programs to expand.

But the transition will require political and fiscal commitment, at a time when the state budget is facing a substantial shortfall.

"It's both a question of money and reorientating the system," says Chris Koyanagi, a federal lobbyist for Bazelon Center for Mental Health in Washington, D.C. "We're finding that across the country a lot of states are stuck where Maine is. They've got very good intentions on paper, but not enough support and resources. They haven't been able to make the shift to community care.

Maine spends 72 percent, or $165 million, on expensive psychiatric hospitals and programs that keep children out of their homes and communities, and 28 percent, or $66 million, on community care. Mental health experts say Maine should double the amount of community dollars. The goal should be 60 percent of the mental health budget on outpatient, community care.

"The problem is Maine needs to start less expensive but non-existent community services in the state," says Koyanagi, who has consulted with Maine on improving child mental health care. "There have been groups meeting and talking about this, but implementation seems to be a problem."

Koyanagi and other mental health experts say Maine should look to its neighbor, Vermont, for advice on how to treat more children in the community.

Vermont spends the bulk of its money, 90 percent, on caring for mentally ill children in their homes. They spend little on crisis or hospital care and have had a policy for the past 12 years not to send children out of state for mental health care.

Vermont's $36 million budget helped 8,900 children last year. Maine's Department of Behavioral and Developmental Services spent nearly double what Vermont did last year, yet served a third less children, or 6,500 kids.

"We're trying to build community services and you can't be spending all your money out of state at the same time," says Charles Biss, director of child and adolescent family services at Vermont's Department of Developmental and Mental Health. "You take a kid to a hospital and he's out of school and out of his regular family contact. That's a very traumatic event, even if it's going for a tonsillectomy. We only look to hospitals to care for a kid that has acute psychiatric problems and no other community program will work."

Historically, Maine has been one of the top states in the country to send children away for psychiatric treatment. It sent 737 children out of state in the past five years and spent an average of $20 million each year in other states for care. Maine has made progress bringing children home; as of July, 89 kids were receiving care in out-of-state psychiatric hospitals and programs.

It's often easier for states like Maine to treat children in hospitals because it can use Medicaid money to pay for two-thirds of the cost. Funding community care with federal dollars is more difficult, but Vermont has found ways to do it.

"We've been able to get (federal) grants based on the fact we're trying to build community services," Biss says.

The state's department of mental health also has partnered with all agencies that offer children's services — child welfare, education and juvenile justice departments — so that families and children are not treated differently, depending which state agency helps them.

"Our kids' budget is more than $30 million (and) most of that money is a blended from mental health, the schools, child welfare and juvenile justice, along with Medicaid," Biss says.

Though Maine has made strides in coordinating resources, there is room for improvement, child advocates say.

Children in Maine often are treated differently depending on the system they enter. Kids who have psychiatric problems and end up in the juvenile justice system may be locked up for long periods waiting for psychiatric help because the Department of Corrections doesn't have the money to pay for their treatment.

Youths whose parents give up their custodial rights to the state are often able to get treatment quicker because Medicaid pays for most of their needs.

"It's as if there are three different systems," says Cindy Fagan, who oversees programs at Saco's Sweetser Family Services, one of the state's largest mental health care providers. "How a child is treated depends on what label is stamped on their head. It depends on what door they enter the system: corrections, DHS or mental health. We need one system to care for these kids."

Maine's current system forces more children into state custody because the Department of Human Services can access federal money once kids are under their care, Fagan says. There were 211 children who became wards of the state in the past decade after they entered the juvenile justice system.

Other parents have given up custody because they believed their children would receive psychiatric services quicker. DHS is unable to provide the total number of children who became wards of the state in order to receive mental health treatment prior to 1999.

It says no child outside the juvenile justice system has come into custody during the past two years for treatment costs. Child advocates and families with mentally ill children argue otherwise. They say that caseworkers and other people working in the system routinely encourage families with seriously ill children to consider giving up custody to the state.

"The nature of these departments is that when they are being scrutinized they often go into defense mode and develop a bunker mentality," says Maine state Sen. Susan Longley, a Democrat. "And getting information, good, bad or indifferent, is very difficult."

Maine needs to streamline and better coordinate services so that families don't have to struggle to make dozens of calls to several state agencies, Longley says.

"We can't divide the kid into three different agencies; that's failing the family and the child," Longley says. "It's up to us to coordinate these agencies, not the families."

There are signs of hope in Maine. Programs like Sweetser's Family Focus offer children and their families intense counseling over a two- to three-month period, helping them understand their child's illness and find ways to keep them calm and out of crisis.

Maine Medical Center also offers PIER, a program that uses schoolteachers to help identify children with psychiatric needs before they grow sicker and need intensive help.

About 1,500 teachers and social workers have been trained to watch for greater Portland children, ages 12 and older, who may be at risk for psychiatric problems. PIER is funded by donations from private companies.

"If you treat them, these kids don't need to be hospitalized and they can have ordinary lives," says Dr. William McFarlane, who heads Maine Medical Center's psychiatric program.

Maine Medical Center also runs the Anchor program, which works with children discharged from crisis or psychiatric hospital beds or kids at risk of being admitted to hospitals.

"These are kids with emotional problems so severe their caretakers are usually at the end of their ropes," says Barbara Fowler, who directs the Anchor program. "We use all the manpower we have to shore the family up and help them understand their child's illness and learn to keep their kids stable." Fowler says.

While the Anchor program has helped hundreds of families, it is limited to helping only those in Cumberland County.

"If we invest in these children early on, it's a whole lot cheaper for us as a state in the long run," Longley says. "And as Pearl Buck said, if we as a society fail our children, we fail ourselves."

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