Maine is forging ahead with plans to establish a residential psychiatric treatment facility for children, a move that has ignited debate among advocates and healthcare providers about its effectiveness in addressing the needs of young people with severe behavioral health challenges.
On Wednesday, the Maine Department of Health and Human Services issued a request for proposals seeking to create a facility with at least 16 beds for young people grappling with behavioral health issues such as substance use disorders, intellectual and developmental disabilities, or those identified as needing treatment related to problematic sexualized behaviour.
Known as psychiatric residential treatment facilities (PRTFs), these centers provide intensive psychiatric care for children and young adults under 21 who are struggling with serious emotional disturbances and behavioral disorders. They are not hospitals.
The state’s decision to issue the request for proposals stems from an initiative passed by the Legislature as part of the 2024 supplemental budget, according to department spokesperson Lindsay Hammes.
“The intent is to provide care that avoids children and youth ending up in hospital emergency departments for long periods of time or avoids them being placed in out-of-state facilities that are even farther from home,” Hammes explained.
Disability Rights Maine, an association advocating for the rights of people with disabilities in Maine’s schools, workplaces, and public spaces, swiftly criticized the plans. In a written statement, the group asserted that by issuing the RFP, Maine is “seeking to introduce a failed model of treatment, increasing the risk of further harm to Maine’s children.”
Though, Jayne Van Bramer, president and CEO at Sweetser, a saco-based behavioral health nonprofit, expressed support for the proposed facility. Sweetser has long advocated for such a center in Maine as a way to bring children receiving services out-of-state closer to home.
“This can also help address the children who end up languishing in ER’s for weeks if not months on end because their acuity and illness are too much to be managed at home or in the current child residential structure that we have,” Van Bramer said.
RFP Follows Settlement
The RFP comes a week after Maine reached an agreement with the U.S. Department of Justice, settling a federal lawsuit filed in September alleging that the state violated the Americans with Disabilities Act by unnecessarily segregating children with behavioral health disabilities in hospitals, residential facilities, and Maine’s juvenile detention facility.
The settlement mandates that Maine strengthen its community-based services for children with behavioral health challenges to prevent them from being placed outside the home.
“In light of the historic agreement reached with the DOJ last week, which is based on the assumption that all children can have their needs met in their homes and communities if provided appropriate behavioral health services, it makes no sense for Maine to spend time and resources building new institutional beds for children,” said Atlee Reilly, managing attorney for Disability Rights Maine.
“Maine should instead focus on meeting its obligations under the agreement, which can only be done through developing and delivering a system of community-based services.”
In 2019, Disability Rights Maine staff visited Maine children in out-of-state placements at PRTFs in Arkansas. They found that children were not receiving the critical treatment they were supposed to be getting and instead were receiving only one hour per week of individualized therapy with their clinicians. They were largely confined to cinder block units with little to no structured programming, the group said in its report.
Maine is considering establishing a Psychiatric Residential Treatment Facility (PRTF) to address the growing need for intensive mental health care for children and youth. The proposal has sparked debate, with some advocates praising it as a necessary resource while others express concerns about its potential limitations and the need for a broader range of services.
The state’s Department of Health and Human Services (DHHS) is committed to developing a comprehensive continuum of care for children and youth with behavioral health needs. This includes expanding community-based services, as outlined in a recent settlement agreement. though, DHHS acknowledges that PRTFs can play a role in providing intensive treatment for a small number of children with complex needs.
“PRTFs are a part of the continuum of care and are limited to a small number of children and youth who have intensive behavioral health needs and require an intensive level of clinical care and treatment based on a clinical diagnosis,” said DHHS spokesperson Jackie Hammes.
Sweetser, a leading mental health provider in Maine, supports the concept of a PRTF. CEO Joanne van Bramer describes it as a “locked and secure residential facility that is between a hospital and a child residential program.” She emphasizes that it offers a safe and structured environment for children experiencing acute mental health crises, providing intensive clinical care, medical supervision, and therapy.
“It’s a little less restrictive than a hospital setting, but they really are a safe option to children experiencing really high levels of acuity,” Van Bramer said. “It’s a locked, structured clinical setting. It’s not a secure correctional facility, it’s a clinical program where active treatment is used on a daily basis.”
However, some advocates, including Nancy Cronin, executive director of the Maine Developmental Disabilities Council, express reservations about the PRTF model. They worry that it could become a default solution for children who might benefit from less restrictive settings and that it might not address the underlying systemic issues contributing to the need for such intensive care.
“I’m concerned people think this will be a silver bullet,” Cronin said. “I’m worried we’re going to build these beds and they’re going to fill up and we’ll have a waitlist when we really need to work on offering a continuum of services.”
Cronin emphasizes the importance of investing in a wide range of community-based services to support children and families, preventing the need for such intensive interventions in the first place. She believes that Maine’s focus should be on creating a robust system that addresses the root causes of behavioral health challenges.
The state is currently exploring funding options for the proposed PRTF, including capital costs and daily reimbursement rates. Sweetser is awaiting further details on these rates before deciding whether to submit a proposal to operate the facility. Van Bramer stresses the importance of lasting funding to ensure the long-term viability of the program.
The debate surrounding the PRTF proposal highlights the complex challenges facing Maine’s mental health system. While there is a clear need for more resources to support children and youth with behavioral health needs, there is also a need for a balanced approach that prioritizes prevention, early intervention, and a wide range of community-based services.
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While the exact mechanisms by which ultra-processed foods contribute to dementia risk are still being investigated, researchers speculate that the inflammatory effects of these foods, coupled with their potential to disrupt gut health, may play a role.
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This article discusses the controversy surrounding Maine’s proposal to establish a Psychiatric Residential treatment Facility (PRTF) for children and youth with intensive mental health needs.
**Here’s a breakdown of the key points:**
* **The proposal:** Maine’s Department of Health and Human Services (DHHS) is considering building a PRTF to provide intensive care for children who require a higher level of support than traditional community-based services can offer.
* **Arguments in Favor:**
* **sweetser, a major mental health provider in Maine, supports the PRTF concept, arguing that it would offer a safe and structured environment for children experiencing acute mental health crises, providing intensive clinical care and therapy.**
* **DHHS acknowledges that PRTFs can play a role in the continuum of care for a small number of children with complex needs.**
* **Arguments Against:**
* **Disability rights Maine criticizes the proposal, viewing PRTFs as a “failed model of treatment” that could further harm children by placing them in a restrictive and potentially isolating setting.**
* **Some advocates, like Nancy Cronin of the Maine Developmental disabilities Council, worry that the PRTF will become a default solution, diverting resources from community-based services that could prevent the need for such intensive interventions in the first place.**
* **Context:**
* **Maine recently settled a federal lawsuit alleging that it violated the Americans with disabilities act by segregating children with behavioral health disabilities in hospitals and other institutions.**
* **The settlement emphasizes the need for Maine to strengthen community-based services to support children in their homes and communities whenever possible.**
**Key considerations:**
* **Funding:** The article mentions that Maine is exploring funding options for the potential PRTF, but details remain unclear.
* **Sustainability:** Sweetser stresses the importance of ongoing funding to ensure the long-term viability of any PRTF program.
* **Alternatives:** Advocates argue that Maine should prioritize funding for a wider range of community-based services as a more effective and humane approach to supporting children with mental health needs.
The article presents a balanced outlook on this complex issue, highlighting the challenges Maine faces in addressing the mental health needs of it’s children and youth while also raising important questions about the most appropriate and effective solutions.
