Go slow on DHHS reforms

For years issues of mental health have splashed across our newspapers – consent decrees, good service, poor service, moving people from state facilities to our communities, bringing kids in out of state residential facilities home. You name it; it has been in the news.

And despite the roller coaster of news, people with mental health issues in Maine have fared well overall. In fact, in a recent national survey of services done by consumers (National Alliance for the Mentally Ill) – we ranked 5th in the nation! That’s something to be proud of.

The Department of Health and Human Services stands poised to make major changes in our mental health care delivery system. We want services to be more effective, more efficient and more consistent. The state is hoping to do this through a new system of managed care. Essentially managed care is ensuring that consumers receive the right service in the right setting for the right duration at a reasonable cost.

As members of the Health and Human Services Committee, we are willing to conditionally support this effort. We believe it is a potentially a good way to deliver services to people with mental illness, their families, and taxpayers in the state of Maine. But we are anxious, too. We are concerned that this is a big change. We are concerned that the state does not have the pieces in place to meet an arbitrary budget deadline.

This is a challenging system to put into place. In order for managed care to deliver on its promise of better and more efficient services, the state must be certain that everyone is ready. We have to be sure that the financing mechanisms work. We have to be sure that the services and the providers of those services on the community level are ready for the change and up to the task. And we need to make sure that people with mental illness and their families are educated about the changes that are coming and what it will mean for them.

Last year the mental health budget was reduced $10 million state dollars (and an additional $20 million in federal funding) for the next fiscal year based on savings expected from managed care. We don’t think the state is as far along as it had hoped or expected to be in planning for this complex system change. As it stands today, we don’t see how we can realize these savings without reducing services. Where will the $30 million dollars come from? Where will administrative and overhead costs of the managed care organization itself come from? Will there be reductions in mental health administrative functions at the Department of Human Services? These critical questions remain unanswered.

Our recommendation is to go slow. Let’s do this right. Let’s answer the administrative questions. Let’s make sure we have community services in place and ready for the changes and most importantly, let’s make sure consumers and families know what changes they can expect. Let’s restore some the money taken out of the mental health budget and reduce some of the pressure for immediate change. Let’s do the smart planning, not implement any changes until most of the aspects of delivery are ready, and then make this system something all Maine citizens can be proud of.

Sen. Richard Rosen, R.- Bucksport, and Rep. Lisa Miller. D.-Somerville, serve on the Legislature’s Health and Human Services Committee.