Schools across Maine report that mental health challenges continue to be one of the biggest problems for students. A statewide survey last year found that 35% of high schoolers had felt sad or hopeless for at least two weeks in a row. And mental health care providers says there is clear evidence of an increase in an array of indicators since the pandemic.
"Whether it's the occurrence of adverse childhood experiences, the prevalence of completed suicides and suicide attempts. The number of children presenting at ERs for behavioral health issues, we've seen a dramatic increase," says Jayne Van Bramer, CEO of the behavioral health nonprofit Sweetser.
One approach to dealing with the crisis is through school-based mental health services, Van Bramer says. But as she told All Things Considered host Robbie Feinberg, budget challenges could lead to cuts in clinic operations, which could hobble an effective system for getting students the help they urgently need.
This interview has been edited for clarity.
Van Bramer: The beauty of our school-based program is it really helps us get in front of it. It really is, as I say, prevention at its best. It allows us to meet children where they are, in a natural setting that's not stigmatizing and really intervene before those challenges get to a place that's much darker and much more serious.
Feinberg: What does the financial picture look like for these services right now?
We are on target to lose over $1 million in this program this fiscal year. That's over $1 million — that kind of loss is not sustainable. Yet this program is so crucial and so important — we actually budgeted for a small loss, but not to sustain a $1 million loss. And part of it is the way the program is funded, and that it's funded like an outpatient clinic, where someone is coming in every 45 minutes and you're just billing for therapy appointments, one right after another. When you work in a school district, the thing that makes this program successful is you're part of an entire team that is supporting that youth. So you are talking to coaches, you are talking to teachers, you're going to IEP meetings and other meetings. None of that stuff is reimbursable. Traveling to a child's house — sometimes it's two hours away — not billable. Talking to a family and engaging them initially about, 'This is what the service is, this is what we can do,' getting authorization for payment with insurance companies, none of that is billable.
So what are you looking to right now that would, you hope anyway, potentially help to stop some of this financial bleeding?
Well, the bill that we put forth, LD 2002, we're hoping that gets funded. And it will help — not erase, but it really will help mitigate the loss of organizations providing school-based, in-school therapy. It creates a grant-like structure for schools to contract with a behavioral health organization, gives them a certain amount of money depending upon how many students they have in their school that they can pass through to us to help mitigate part of our loss.
We've already clearly heard from a lot of other different groups that are asking for funding from the state and trying to get more funding as part of this supplemental budget process that's going on. What has been the argument from Sweetser and others around this issue, why this needs to get funded considering all of these other competing interests as well?
Well, I think the first thing that's important to keep in mind is half of all mental illnesses exhibit themselves by age 15. So this is an opportunity for us really to do some prevention and change that statistic. The other thing is, is when you think about it, the failure to act has the grave potential to result in more incarceration, more hospitalization, more dysfunction as adults. And so what the money we're asking for, which is like $1.3 million a year, is a drop in the bucket compared to the long-term costs of not doing anything. And what we potentially will see in our youth. I mean, everyone agrees that we have this major problem, we need to act, we need to do something about it. It needs to be more than yes, we're in the mental health crisis.
If the financial picture doesn't change, if after this budget process that funding doesn't come through, do you know exactly what that would mean for a program like yours going forward?
I think we're seriously going to have to evaluate whether or not we can continue it. It's just not sustainable. So whether that means cutbacks, whether that means program closure. Those are the series conversations that will take place with our board.
