By Cliff White 

Staff Writer

Heather Luke, who has been diagonsed with depression, and Joanne Collins, who has bipolar disorder, were two of hundreds of people walking together on a snowy day in Biddeford March 12, participating in a walk in Biddeford’s Thatcher Brook Business Park to protest budget cuts to mental health services proposed by Gov. John Baldacci as a method for trimming the state’s deficit, which stands at more than $200 million.

Organizers of the mile-long walk focused attention on Luke and Collins, who both said that counseling they receive has helped them to live more stable and happy lives. But there was equal visibility given to those whose health kept them away from the protest.

They were represented along the route by cardboard cutouts, some dressed in hats and coats, with signs hanging around their necks explaining the reason for their absence. One had lost its case worker. One’s schizophrenia had gone untreated. One had been hospitalized. One had committed suicide.

Cecile Payette, the walk’s lead organizer and a clinician at Counseling Services Inc. (CSI), a Saco-based company that provides mental health services in six Maine communities  said previous cuts  already greatly damaged the organization’s ability to provide adequate care to those in need, and more reductions would exacerbate the dire situation.

“Cutting even another dollar would be a disaster,” Payette said. “The cuts have already been made. There’s nothing more to cut. We’re at bare bones coverage already.”

The state’s financial shortfalls are combining with cuts to Medicaid funding proposed by the Bush administration. Under previous regulations, the federal government contributed $3 to every $1 the state contributed to Medicaid services. Federal cuts, if passed, would cost the state between $30 million and $50 million of matching funds, according to Tim Feeley, communications director for Speaker of the House Glenn Cummings (D-Portland). In addition, Baldacci has asked for $82.9 million in cuts to the Department of Health and Human Services, which will slash funding or eliminate entirely many programs designed to help those with mental health needs.

On the same day as the walk, hundreds of opponents of the proposed cuts packed into the State House in Augusta, including CSI CEO Sherry Sabo. One argument being made by the protesters – that the proposed cuts would actually end up costing the state more money in the long term – has found a wide range of backing among those whose workloads could increase as support groups and counseling services are scaled back.

Without such services, those with mental illnesses are exposed to higher levels of stress and a feeling that they have to “go it alone,” Payette said. Such a situation may lead them to a “crisis” – a sudden mental instability caused when patients are overwhelmed by feelings of disorganization, hopelessness, sadness, confusion or panic, or a combination, she said. Clinicians such as those at CSI are trained in how to help their charges through a crisis, but if they aren’t available – a situation which could become much more common if the budget cuts pass, according to Payette -– a call to 911 and a visit to the nearest hospital’s emergency room may become a necessity.

Over the past six months, the Saco Police Department has responded to calls of a psychological nature at the rate of 3.5 per week, according to Saco Deputy Police Chief Charles Labonte. Labonte said he expected that number to rise if cuts are made to mental health services.

“I think there’s a definite connection between the two,” Labonte said. 

He said more calls would mean more police resources taken away from other community needs.

Another service likely to feel the strain of dealing with mental health patients abandoned by their coverage would be local rescue departments. According to Lt. Steven Kerner of the Saco Fire Department, a paramedic who rides in the town’s ambulances, the chance he will be running more trips to transport people having mental crises is “very likely.”

“It’s pretty basic – you cut mental health services then you are going to see more problems, and that means then relying on emergency services to take those people to the hospital,” Kerner said. 

Kerner said all the paramedics in the fire department are comfortable and familiar in dealing with mental issues, but none are mental health professionals. Their job, Kerner said, is to bring the patient safely to the hospital to receive more extensive care.

“It’s a very costly way of doing business,” Kerner said. “An ambulance ride isn’t cheap and once you get through the doors of the emergency room, you’re talking hundreds if not thousands of dollars in expenses.”

Sanford’s Goodall Hospital CEO, Darlene Stromstad, said cuts to mental health services would put a greater strain on her hospital’s resources.

The hospital provides adequate care through its emergency room and primary care doctors, Stromstad said, but has neither inpatient psychological facility nor outpatient psychological services.

“Our primary care physicians and emergency room doctors are very capable of handling mental diseases,” Stromstad said. “However, the best primary care is provided when those doing the caring know you real well, and it’s the same thing with mental illness – the most effective providers at managing those with mental illnesses are the case workers.”

Currently, Goodall Hospital has two rooms designated as work areas for CSI, located near the emergency room. 

Losing those clinicians who provide preventative measures – leaving patients on their own – increases the likelihood of additional future crises and also passes a great part of the responsibility of care onto police, EMTs and hospitals, Stromstad said.

Another consequence of loss of preventative care is the increased likelihood those with mental illness may end up incarcerated, according to Cumberland County Sheriff Mark Dion, who is in charge of operations at the county jail.

“If you cut funding to mental health services, you’re going to see more people end up in jail,” Dion said. “If the funding disappears to aggressively monitor mental health in the community, these people could become more harmful to themselves and others, not necessarily intentionally. But you take away their safety net, the social connection of the case worker, and you start to fall through the cracks, and that can lead you down the road to ending up in custody.”

Jails, Dion said, with no windows, stainless steel, and minimal resources for psychological treatment are not conducive to recovery from a mental crisis.

“Recovery from crisis isn’t likely to happen in jail,” Dion said.

For Joanne Collins and Heather Luke, jail is an unlikely destination even if there is a reduction or elimination of their services or their ability to attend. However, they say they still stand to lose a lot.

“I’ve been coming to CSI since 1981, and I’ve come a long way in that time,” Collins said. “I don’t want to lose that progress. These services are necessary for the health and happiness of so many people, myself included. I don’t want to go back to the way I was.”

“I don’t want to become a statistic of the failure of the system,” Luke said. “I don’t want to get left behind.”