The United States Department of Justice announced last week it has sued Maine for discrimination against children with behavioral disorders due to our state’s failure to reform its mental health services system. Maine spends the most per capita on mental health, yet still our system is incredibly non-reactive and relies far too much on both committing children to juvenile detention centers and sending children with behavioral problems to other states for treatment.
The American Disability Act requires the state not to discriminate against people based on disability status. In 1999, the Supreme Court ruled that this involves creating an effective communal-integrated psychiatric treatment system. In short, if psychologists clear someone to be treated outside of a mental institution, the state should be able to accommodate that. Maine needs to reform its system to accommodate this type of treatment more, as we currently over-prioritize committing children with behavioral issues compared to treating them at home.
Maine’s child mental health system is incredibly ineffective, as it has long waiting lists and an almost nonexistent community-based treatment program. We used to have a wraparound program that was a proactive and family/child-centered way to deal with child behavioral issues, but Maine discontinued it in 2013, and despite claiming to have dedicated millions of dollars in funding to the program, Maine still hasn’t initiated it again. While spending more on an extra program may seem unintuitive to reducing spending, preventative measures like this reduce long-term spending by preventing more drastic measures like institutionalization.
Another program, ACT, is an intensive community treatment program that is still running. However, there is only one ACT Mainecare provider in the entire state, and very few Maine children can access this service. Another program Maine offers is called Target Case Management, which coordinates care for children with disabilities. However, on average, the wait time for this program was 328 days in 2020 and some children had to wait over 650 days. While this program appeared to have the worst waitlist of any of the programs, often children with behavioral disabilities in Maine had to wait hundreds of days to receive treatment, and more waited in juvenile treatment centers for over 30 days to access community treatment programs.
Long Creek Youth Development Center is Maine’s only youth prison, but due to the under-supported community treatment system, it has been operated as a de facto mental hospital. This should be concerning, as it primarily operates as a justice facility with a law enforcement focus rather than behavioral/mental health treatment. Because our state’s mental health system is poorly structured, we currently have children from throughout the state being placed in prison on suicide watch instead of being treated in their homes.
Not only does this seem counterproductive, as prison is possibly the worst place to put children with mental health issues, the US Department of Justice is arguing in a lawsuit it is unconstitutional. Two years ago, the DOJ wrote a notice to Maine that it severely needed to reform its child mental health system, and Maine has not moved fast enough in response. So, just as it warned it would two years ago, the DOJ is suing Maine in federal court to force it to reform the system.
The Department of Justice is applying a 1999 Supreme Court case, Olmstead v. L. C., where the court held that it is discrimination against disabled people to keep them in mental institutions when psychologists state communal care would be appropriate. In that case, the court felt that as long as the mental health system did not need to be severely reworked to accommodate the communal programs, then it was discriminatory to force those with cognitive disabilities to remain in mental institutions to receive treatment.
Similarly, in many cases in Maine, children have been kept in Long Creek not because they could not handle communal treatment but because, as the Department of Corrections Commissioner said, “there are no other options.” Ironically, we are having to spend more on committing children to behavioral programs in prison because we want to spend less money on community-based programs. The DOJ is trying to reform Maine’s mental healthcare programs, and is willing to sue Maine to do it.
This appears to be a problem Maine’s leadership is not equipped to handle, largely because you can’t solve it by simply throwing more money at the child healthcare system. Instead, we have to effectively design the system to keep kids out of prison, rather than send them there as early as possible.