A bill that would have extended mental health benefits for young adults was passed by both houses of the Maine legislature and then vetoed by Republican Gov. Paul R. LePage on April 29.
Maine Bill LD 1367, sponsored by state Rep. Anne Graham (D-No. Yarmouth), carried provisions for an Assertive Community Treatment plan that would have covered adults through age 26. The original version of the bill called for coverage by MaineCare (the state’s Medicaid program) as well as private insurers. It was later amended to place responsibility for this care on the state’s Dept. of Health and Human Services (DHHS).
When state funding for Assertive Community Treatment fell through, the DHHS applied for a federal grant to run the program. At this point, Gov. LePage vetoed LD 1367, citing that “legislative authority is not necessary for that application.”
The bill was Graham’s response to the Newtown tragedy. “I’d rather be proactive than reactive,” she says. “Instead of waiting for a significant tragedy to happen, we have these systems in place and they’re proven.
“We look at the Newtown tragedy, we look at Aurora, Colorado, we look at the Giffords [shooting in Tucson]. These were caused by people who were young adults, were disconnected from support, who are manifesting significant psychiatric disease and ending up doing some really terrible things.”
Assertive Community Treatment requires an extensive outpatient network that has regular, sometimes daily, involvement with the patient.
“It involves flexibility on the part of the people doing the treatment,” says Douglas R. Robbins, M.D., Director of Child & Adolescent Psychiatry Services at Maine Medical Center in Portland. “That means going to the homes as much as necessary, seeing people as many times as need be, rather than having rigid schedules in clinics. It’s a much more active follow-up.”
Robbins, who consulted with Graham on the drafting of LD 1367, has been involved in several studies that examined the effects of early intervention with young adults. The years from late teens to early and mid-20s are critical, he says. Funding for mental health services through MaineCare, however, ends at age 21.
“It’s important to get in there and get working early,” explains Robbins. “With early intervention, you are clearly delaying the onset of major mental illness for a significant number of people. You don’t usually prevent it but people get ill later in life and have a lower level of severity. That’s huge.”
In addition, community-based programs save money. “The biggest savings come when you can prevent hospitalization,” says Robbins. “Psychiatric hospitalization for an adolescent is about $20,000. [The community-based] treatment process is about $2,000 to $2,400 a month and might run as much as three months.
“Compared to ordinary outpatient treatment, it seems very expensive but when you compare it to the hospitalizations that are prevented, then it becomes extremely cost-effective.”
Moving forward, Graham is doing what she can to facilitate federal funding of the Assertive Community Treatment program, encouraging local advocates, such as NAMI, to support the grant application.
“We have made some inroads,” she says. “We’ve really brought the idea to the fore. We’ve gotten people talking about the fact that if we paid attention to adolescents and young adults at a time when they fall through the cracks and don’t get the care they need, that’s good in itself. Even though the bill failed, I still feel a strong message was sent.”
By Howard Newman