PORTLAND – Having a mental illness and no health insurance was almost a deadly combination for Jason Cook.

Last month, homeless and unable to afford treatment for his bipolar disorder, the 22-year-old walked to the Casco Bay Bridge.

“I got really low, really depressed,” he said. “I was going to jump off the bridge. Portland police ended up stopping me.”

Cook instead went to a hospital emergency room, a place he’d been several times before to get help with his illness.

A growing number of uninsured Mainers with mental illness are falling through the cracks of the health care system because of state budget cuts and financial strains on nonprofits, according to state officials and private agencies. Just as when someone goes without treatment for a toothache and ends up in the ER, the lack of access to regular mental health care means illnesses are getting more expensive and patients are getting sicker, officials said.

Youth Alternatives Ingraham, a nonprofit mental health agency in Portland, hopes a new two-year, $100,000 grant will help a lot of people like Cook, who has since qualified for state coverage.

“If we can provide the outpatient or community-based care, we can keep people out of ERs, out of hospitals,” said Patricia McKenzie, senior vice president at the agency.

The $100,000 grant arrived last month from the JTG Foundation, a Maine philanthropy founded by the late John T. “Tom” Gorman.

“That’s wonderful. We think it will definitely help,” said Ronald Welch, director of adult mental health services for the Maine Department of Health and Human Services. “But we’ve got needs that go well beyond that, to be honest with you.”

Welch said the state historically has provided grants to private, nonprofit agencies to provide community-based mental health care, such as therapy and medication management.

“That amount of money has dried up significantly,” he said. Every time there is a budget curtailment, for example, money comes out of the fund used to provide those grants.

Of the state’s $300 million adult mental health care budget, $23 million is allocated this year for grants to serve people who don’t have insurance, according to the department. That’s down from $27 million in 2008, a nearly 15 percent decline in three years.

As state money has declined, nonprofits have cut back on the services they can provide the uninsured.

Youth Alternatives Ingraham and others still provide urgent care, including crisis hotlines and short-term residential treatment and counseling, regardless of someone’s ability to pay. Much of that is still funded by the state.

But beyond 30 days of crisis care, the agencies can now provide little or no ongoing support for continuing medical management or therapy for someone who doesn’t have insurance.

“There has been a gap in services and this (grant) will help cover those people. When they hit the end of their 30 days, they’re relatively stable but they really need therapy or to see a psychiatrist or case manager,” said Steve Addario, the agency’s crisis director.

About one-third of the 2,000 calls to Youth Alternatives Ingraham each month are from people without insurance, according to Addario. Many uninsured patients end up back in crisis care repeatedly because they have no regular support to keep them well, he said.

A month of outpatient counseling and medical care for a patient with mental illness might cost about $400 to $500, according to Youth Alternative Ingraham.

A single emergency room visit for a mental health crisis lasting less than eight hours costs about $440, according to a recent analysis by Maine Mental Health Partners in South Portland. And that hospital cost doesn’t include the psychiatrist’s time in the ER or the usual follow-up crisis care by an agency such as Youth Alternatives Ingraham.

Along with the higher costs of crisis care, many patients simply get sicker if they don’t have access to regular care, Addario said.

“Someone sitting in the community without accessing services would, at minimum, have a long difficult time,” he said. “They can’t talk about it. They’re depressed and unable to think clearly. It snowballs and it gets bigger and more complicated.”

Many people without insurance also don’t ask for the critical help they need, especially in cases of mental illness, he said.

“There still remains a great stigma about mental health services. Adding to that asking for help if they can’t afford it, that stigma really gets in the way. This grant is hopefully going to reduce that barrier,” Addario said.

Jason Cook said he was a classic example of the problem.

He has bipolar disorder, an illness that affects an estimated 5.7 million Americans and can cause alternating periods of high energy and deep depression.

Cook is a certified nursing assistant, but last spring was working at a manufacturing job without health insurance. The only medical help he was getting was when his depression got so bad he called a hotline or went to the hospital.

“When you can’t get regular care because you don’t have insurance, it ends up getting to a point you have to go to the ER,” he said. “You can get crisis care, but you can’t get ongoing care.”

Cook says he guesses his numerous visits to the ER have cost thousands of dollars, but could have been avoided if he had regular care.

In March, he stopped a friend from committing suicide and then missed some work to take care of him, he said. The lack of income cost him his apartment, which is when things started to snowball. Cook landed in the city’s Oxford Street emergency shelter, stopped working and got sicker.

In the homeless shelter, he said, “you’re constantly worrying. Am I going to get my shoes stolen? What’s going to happen next?”

He steadily got more depressed until he, too, was suicidal, he said.

Cook hopes his last visit to the emergency room, last month, was the turning point. He was treated and referred to community agencies for crisis care and, this time, Youth Alternatives Ingraham helped him apply for MaineCare, a state insurance program that covers some low-income, disabled adults.

Cook now has the state insurance, at least temporarily, and is staying in a Youth Alternative Ingraham group home in Portland and getting medical help and counseling. He is feeling hopeful again.

“I’ve got support and now I have someone to go to long before I start to even think about hurting myself,” he said.

“I’m hoping I can get hired, get my own place and get my life together.”

Cook said most of his friends don’t have health insurance, either. And, partly because of his experience at the homeless shelter this past summer, he knows there are a lot of people with mental illness who are simply getting sicker, he said.

“There are probably a lot more people who need to be here.”

Staff Writer John Richardson can be contacted at 791-6324 or at:

[email protected]


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