SHAPLEIGH — The COVID-19 pandemic is unsettling to all of us. People like my loved one – who has a serious mental illness – are among those who are least able to withstand the destabilizing impact of this crisis, but they are among the ones who are being affected the most.

It has taken my family years to find a resource – Maine’s life-saving progressive treatment program – that has allowed my loved one to live and be well on his own. Now I’ve been informed that his care provider will no longer provide the psychiatric medication management that has made it possible for him to take part in progressive treatment. Because our leaders are unwilling to pay medical professionals what they deserve, services that benefit our most vulnerable citizens are now less accessible, and they are at higher risk.

Pre-pandemic, our country’s mental health care system was already dismal. In a 2017 report, the Medical Director Institute of the National Council For Behavioral Health pointed out:

“Seventy-seven percent of counties are underserved and 55 percent of states have a ‘serious shortage’ of child and adolescent psychiatry. Even in urban and suburban geographic areas with adequate ratios of psychiatrists, the supply of psychiatrists who work in inpatient and outpatient psychiatric facilities has been reduced by psychiatrists who practice exclusively in cash-only private practices. These practitioners now make up 40 percent of the workforce, the second highest among medical specialties after dermatologists.”

My loved one has both schizoaffective disorder, a mental health condition that includes symptoms of schizophrenia and symptoms of depression or bipolar disorder, and anosognosia, a neurological condition that deprives him of the ability to recognize that he’s sick and needs help. Anosognosia is the No. 1 reason why people with schizoaffective disorder, schizophrenia and bipolar disorder refuse treatment.

He‘s been enrolled in the progressive treatment program – court-ordered treatment – since 2013. Before his enrollment in the program, he had been hospitalized 43 times (all but one of those admissions involuntary because he cannot recognize his illness). His life had become a revolving door, in and out of hospitals, jail and homelessness. With the progressive treatment program, he’s been able to live independently and thrive in our community.


Medication management services are absolutely essential when treating people who are unlikely to take their medication on their own. His treatment team consists of a psychiatric mental health nurse practitioner who monitors his condition and prescribes medication to manage his illness; a nurse who administers his medication – a long-acting injectable antipsychotic medication that is often prescribed to people suffering from anosognosia – every two weeks; a case manager, and a peer support person.

As a consequence of our refusal to provide a livable wage to psychiatrists and psychiatric mental health nurse practitioners, primary care physicians are being charged with caring for people with serious brain disorders. Primary care providers are not equipped to provide this service.

Sadly, it came as no surprise that my loved one’s care provider is no longer able to provide medication management services. Every mental health center throughout Maine has had to scale down its programs and many have closed over the years, making it increasingly more difficult for people to find timely access to care. My loved one will now have to obtain treatment and medication management at a facility almost an hour away.

When will our leaders learn that not providing this service always leads to increased emergency room visits, higher demand for psychiatric beds, increased cases of domestic violence, an increase in homelessness and incarceration of those suffering from serious brain disorders?

The cost of one night spent in a psychiatric hospital is equivalent to many outpatient visits. When will the state of Maine learn to embrace and promote its progressive treatment program, pay its mental health providers what they are worth and provide people with the services they need to remain safe and to actually thrive as productive members of our communities? When will Maine learn that the #CostOfNotCaring far exceeds the cost of caring?

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