Mental health report ‘1st step’ Task force says better recruitment, service among needs

A panel wrestling with ways to deliver better mental health services across Maine’s rural landscape says improved training, relief for overworked crisis workers, and improved recruiting and pay could be ways to tackle some persistent problems.

A task force worked over the summer to create the report to the state’s mental health commissioner. But some Tuesday criticized the report for being anecdotal and overly broad.

Still, the report likely will be the underpinning for a new “implementation committee” that will try to refine the proposals and suggest additional changes.

“The report is a good first step – this is a complicated area,” said Lynn Duby, commissioner of the state Bureau of Mental Health and Retardation and Substance Abuse Services. “The next phase to look at is the development of some action steps and strategies.”

Duby said the summerlong effort by 20 legislators, hospital administrators, physicians, law enforcement officials, educators and others was as much about getting people to talk together in new ways as it was to get a report to suggest improvements in Penobscot, Piscataquis, Washington, Hancock and Aroostook counties.

“It gets a bunch of people engaged in a way they haven’t before,” she said. That helps to break down assumptions about the problems, she said.

In its findings, the report said paperwork needs to be reduced, barriers to hiring out-of-state health workers need to be weakened, incentives should be analyzed to spur worker recruitment, transportation in rural areas should be improved, and state agencies need to communicate better.

Among the key areas addressed was crisis services.

The task force members suggested that there should be improved access to psychiatric medications for consumers and that more “drop-in” centers should be established to provide access to community care.

In addition, the task force said, short-term psychiatric beds and crisis residential units should be more available.

There were also subcommittee reports on a variety of topics.

But some said the report isn’t valuable in seeking improvements to mental health care.

“You can’t plan with that,” said Ali Elhaj, chief executive officer of Acadia Hospital in Bangor. “This is a very important issue for our region and our state, and in order for us to proceed in a meaningful way we need” a more comprehensive document.

Elhaj, who also made his opinion known in a letter included in the report, said that the committee hadn’t included enough people in the process and that the process lacked the clinical focus and structure to create a meaningful document.

One committee member, Judy Paradis, who was Senate chair of the Legislature’s Health and Human Services Committee, said the document was simply a starting point.

“It was a prodigious undertaking,” Paradis said. She said mental health issues are complex and come under various state agencies. Because of the complexity, she said, it would be up to the implementation committee to take the report as a starting point from which to make strides on the issues facing mental health care.

Duby believes the “implementation committee” recommended in the task force report has a strong chance of making good changes in the next year. The problems of delivering mental health services across a rural landscape aren’t new, but new technological tools provide new solutions.

“I think it provides a breakthrough opportunity that we’ve never had before,” Duby said.

For instance, telemedicine could allow psychiatrists to spend more time with patients and less time behind the driver’s wheel. Interactive television, she said, in a home can feed information on a patient’s activities to reduce the number of weekly visits to the home.

As electronics become even cheaper, the possibilities expand, she said.

Another problem that hasn’t gone away is the difficulty in getting trained help to the eastern and northern sections of Maine.

“Everybody’s having trouble recruiting, and everybody is generally having vacancies,” she said.

The report suggested possible remedies through analyzing compensation trends, providing additional backup to caregivers so that they aren’t endlessly on call, and creating training opportunities.

Duby believes more could be done to show applicants about the attractive features northern Maine has to offer.

The implementation committee members, numbering five to 10, have not been named.