By Cliff White 

Staff Writer

Nurse practitioner Patsy Leavitt, a volunteer at Leavitt’s Mill Health Center in Buxton since it opened in 2003, storms into the small lunch room, red-faced, and begins to yell.

A man with bipolar disorder, depression and anger management issues has just walked into the clinic. He has recently been released from Portland’s Maine Medical Center, where he had been under intensive observation for a week. He came in after running low on the few days’ worth of free samples of drugs that help him control his disorder, but which neither he nor Leavitt’s Mill can afford.

“What are we going to do about this?” she screams. “It makes me furious that this happens in the richest country in the world!”

Leavitt tells the story of the man. 

“He needs the meds to stay stable. If he doesn’t get them, he could end up in jail or worse. With them, and steady psychological help, he can be a productive member of society,” she says. “But instead, the system ignores him until he goes into crisis, where he can become dangerous and takes more resources to treat. After he is treated, he is immediately thrown back into the same vicious cycle. It’s crazy! The system is worse than broken. It’s shattered.”

Leavitt’s Mill offers health care to those without insurance or with limited insurance coverage, Leavitt says. The center has a “pay what you can” policy, and no one is refused care. Leavitt says organizations offering similar services already function at extreme financial distress, but additional cuts, like those recently proposed in the Maine Legislature, could tip the scales and force many to significantly scale back services, or suspend them entirely. 

The Legislature’s Appropriations Committee is working to make more than $200 million in budget cuts in order to balance the state’s budget over the next two years. Contributing to that figure is federal cuts to Medicaid totaling around $30 to $40 million. That money is currently used to fund healthcare services for the elderly, school-aged children, those with developmental disabilities and those with mental illness in the state, according to Tim Feeley, communications director for Speaker of the House Glenn Cummings (D-Portland). President George W. Bush’s veto of SCHIP legislation on Dec. 29 has pushed the federal government to cut back on its payment of matching funds to state Medicaid programs, including Maine’s.

This could mean the loss of all grants to organizations like Leavitt’s Mill, which relies on grants for 16 percent of its annual income, Leavitt says. Donations, fundraisers and voluntary client fees make up the remainder.

“What they’re cutting out of the budget is money used to provide basic services to working-class people,” Leavitt says. “And these aren’t couch potatoes. The people we see who come into the clinic have lower-paying jobs or are self-employed. And isn’t that what a government is there to do? To take care of all citizens, especially those who need the help the most?”

Shantel Wood, a mental health counselor at Leavitt’s Mill, says she is particularly worried about how the budget cuts will affect those with mental health problems. 

“The ones who can afford to go to private clinics are going to be OK,” Wood says. “It’s the ones who can’t who are going to be stuck out in the cold. The question becomes, how many more people can free clinics like this one support?”

Wood says she is already forced to commit most of her time at the center to counseling people at or near crisis. Such people require significant time and effort to get them out of crisis, keeping those who are in counseling to prevent such a crisis situation are forced to wait, consequently putting them at greater risk of entering into crisis themselves, Wood says.

“The sad truth is, free clinics like ours just can’t provide effective service to the numbers we have now, much less the additional people we’re expecting to see as they are moved out of government-sponsored healthcare,” Wood says.

Some legislators are questioning whether the state should have pursued federal Medicaid matching dollars as insistently as was the case, with knowledge of potential future cuts to Medicaid could occur.

“Maine has taken advantage of the Medicaid system since the 1980s, with aggressive expansion of the program in every conceivable way to extract as much federal matching money as possible,” Rep. John McDonough (R-Scarborough) says. “That approach has now come back to bite us. We will be hit much harder than other states by the rule change, because other states have not pushed the envelope on eligibility standards so brashly.”

Several mental health administrators from around the state, including Maine Association of Mental Health Services President Chris Copeland, have recently testified in Augusta that proposed cuts to mental health programs would endanger those currently undergoing treatment and would ultimately cost the state more money.

“As a result of these cuts, a great number of people would become ineligible for treatment,” Copeland says. “For many of these people, their case managers are the only people with whom they have a long term relationship. They get them through difficult situations and crises. This relationship, for most, is the best and only way to help them. If there is a disruption in that relationship, that can trigger mental illnesses to get worse and start a chain of events that leads people to feel so unsafe that they end up in the hospital.”

The cost of a year’s worth of case management is $3,114 per person, Copeland says, while the cost per hospitalization averages $6,500.

“This huge budget difficulty is ultimately forcing the Legislature to find short-term savings that will create higher long-term costs,” Copeland says. “What we’re trying to argue is that there is going to be a cost for these cuts, not just in money but in human suffering.”

Biddeford Health and Human Welfare Director Vicky Edgerly says mental health services are important in allowing those who depend on them to live free of further government dependence.

“These people are going to have the door closed on them. There going to be left without help,” Edgerly says. “People who have jobs, families – people who want to be independent of government support – are going to lose their ability to do so when they lose their treatment. They don’t want that but they’re being forced into it.”

Budgets cuts are inevitable, Edgerly says, but the state should look into ways of avoiding cutting mental health services.

“There have to be places we can cut that wouldn’t affect the most vulnerable,” Edgerly says. 

McDonough was not optimistic this could be done.

“There’s always a price to pay when you overdo it. I just don’t know where we’re going to get the money to overcome this shortfall,” he says. “There’s going to be blood on the streets over this.”

Wood says she was exasperated that mental health services are often among the first options chosen for budget cuts.

“The sad truth is that mental health disorders are not treated with appropriate importance by those doing the cutting. The lines in regard to psychological health issues are softer,” Wood says. “There’s this idea that Americans should be able to pull themselves up by their bootstraps, that they should be entirely self-sufficient and self-supporting. The people I treat want so bad to be that, to live that ideal, but the truth is that in order to be successful and productive members of society, they need the support we give them. 

“It’s not their fault. It’s the way they were born or the result of traumas they have faced in their lives,” Wood continues. “To blame or punish them for that, as is happening in these cuts, that to me is criminal.”