DHHS Director Mary Mayhew and her hired consultants have come to two conclusions that potentially have devastating effects on thousands of Mainers:
Community Integration Services (in layperson terms, case management) we’ve provided for decades to Mainers who live with mental illness are no longer warranted except for those who live with psychosis.
Service Providers (agencies: non profits and for profits) are overpaid in providing case management.
I’m swallowing my ire and will refute Ms. Mayhew with simple facts:
“When you have someone with an illness that isn’t the same level of severity as schizophrenia, you don’t want to create a level of dependency on these high-intensity services that would be counterproductive to their recovery,” – Mayhew.
There exists no form of mental illness that can be said to match the severity of schizophrenia/schizo affective disorders. Mary Mayhew knows this. By making major mental illnesses relative, she is very clearly saying that people who live with potentially debilitating conditions like Post Traumatic Stress Disorder, Major Depressive Disorder, and Panic Disorder cannot be served without developing dependency.
This flies in the face of everything we know clinically (and by “we” I mean every nationally respected authority on mental illness).
It also flies in the face of existing Maine Care policy. Dependency is already stringently safeguarded. Community Integration Services are not freely accessed. They are authorized by Maine Care through a privately contracted company: APS and always for brief periods of time and for fixed amount of services hours.
Only by carefully documenting clinical justification that proves the need for continued services can we continue to serve clients who are currently homeless, hospitalized, or navigating life or death medical procedures. The system is already exceptionally well safeguarded.
Mayhew also uses language we’ve come to associate with welfare – “dependency.” Simple truth: People who live with severe mental illness will often require higher levels of care when not supported in the community.
Fact: Community based services are vastly less expensive than institutional care or Emergency Room visits.
“This is about what are the wages you pay staff, what is the overhead you pay for rent or other overhead costs that support the operation of the agency and what, therefore, is an appropriate cost.” – Mary Mayhew
Maine Care proposed rate cuts to Community Integration Services as proposed will pay less than $60 per hour (there is no other funding other than per hour reimbursement). That may sound like a lot of money if you don’t know the facts:
– Services are community based. The time my workers spend driving to and from appointments with clients is not paid. If my workers drive 15 minutes each way to see a client, that time is not reimbursable. In this scenario, our reimbursement is now $40 an hour.
Out of that $40 an hour, I must now pay for everything the state requires:
– An office to work out of and all the costs that requires
– Liability Insurance
– Workers Compensation Insurance
– Computers and internet access
– Compliance with APS and all forms and filings required by the state (more unpaid time in data input and collecting clinical information from other providers to justify ongoing treatment).
Then there are things that we reimburse and provide because they are essential if we’re going to require that workers serve in the community – especially in people’s homes:
– Mileage Reimbursement (that comes out of what we’re paid the state does not pay that)
– Cell Service
Then, because we are believe that people who do excellent work deserve fair pay and benefits we provide:
– Health Insurance
– A competitive wage (Community Service Integration workers usually have bachelors degrees and specialized training).
– Paid holidays, sick time, and vacation time
If you know anything about running a business and/or are good at math you’ve already come to the obvious conclusion – Community Integration Services are not profit driven – they’re people driven and offered in simple recognition that people who live with mental illness are deserving of respect and appropriate levels of support.
I am the executive director of Higher Ground Services. I employ five full time incredibly efficient and hard working Community Integration workers who help folks navigate systems, get basic life needs met, and integrate care in order to empower self sufficiency. We LOVE putting ourselves out of a job as each individual client becomes self sufficient.
It’s not as if there are a shortage of folks who need our help – quite the contrary. Mayhew knows this. I ask you to reach out to her because what she’s proposing is not cost efficient. It will not take long to see corresponding increases in institutional costs.
Please give Commissioner Mayhew your thoughts. I’ve been unable to locate contact information for her, but I note DHHS has a Facebook Page here