GETTING CARE SOONER

The most startling figure in the Maine Children’s Alliance annual survey called Kids Count is that the number of childhood hospitalizations for mental health or substance abuse rose by approximately 40 percent between 1999 and 2002, the last year for which data is available. Nearly 2,500 hospitalizations a year for this range of illnesses is not only a failure of less dramatic treatment but a hugely expensive means for delivering care.

The Maine Kids Count arrives at an excellent time – just as Maine is struggling over how to control health care costs while expanding Medicaid – and the alliance’s message of prevention comes through clearly. Those mental health hospitalizations cost $40.5 million. The substance abuse hospitalizations cost another $1.3 million. If that money could be used for early treatment, more care could be delivered on the same budget, the budget could be reduced or both.

This is not news to the Baldacci administration, which is trying to restructure Medicaid to provide health care to many more Maine residents. Gov. Baldacci is correct to see the need for primary-care providers for mental health and to plan on redirecting mental-health sufferers away from emergency rooms and hospitalization and more often toward physician offices, just as physical illnesses are treated now.

Lynn Davey, director of Maine Kids Count and a psychologist, recently pointed out that alternatives to improve access to mental-health services could include schools and more community sites for care. “If a kid has a cut on his finger, the doctor or parent doesn’t say, ‘Let’s do nothing and see if it gets infected,'” she said. “In a way, that’s what we’re doing with mental health because kids aren’t getting the help they need until they reach a crisis point and they need to be hospitalized.”

This is not a simple change, and the number of trained and available doctors may do more to limit coverage, at least initially, than funding. But costs of the way care is delivered now make the change important. Consider some more data from the Maine Children’s Alliance: the average length of stay for teenagers with affective psychoses, which include depression, bipolar or manic disorders, is about two weeks; for young kids, ages 6 to 12, it is 22 days. If care can be delivered earlier so that problems can be addressed before they become crises, the result would be happier, healthier children and much lower cost for care.

Maine’s current budget is approximately $130 million short of balancing. The governor plans to release his proposal Friday for patching it. Changes in Medicaid, which along with education make up the biggest portion of the budget, are inevitable and, given Medicaid’s recent history in Maine, desirable. As the Kids Count numbers demonstrate, better, less expensive care is possible through a reformed system.