LEWISTON — In an effort to save money, Tri-County Mental Health Services is cutting its medication-management program, dropping a third of the 1,500 clients who receive medication help but no other services.
About 500 clients — those with the least severe problems — are being discharged from the program and decisions about prescriptions and dosages moved from the hands of psychiatrists to primary care doctors. The transition began earlier this year.
Only the most severely mentally ill patients will stay in the program. Others may receive medication management with a Tri-County psychiatrist for a short time and then shift to a primary care doctor when they become stable.
Executive Director Chris Copeland said Tri-County has lost money under the program for a long time. With cuts in government reimbursements, it could no longer function with those losses.
"I think it's probably something that's increased over the years," he said. "People get referred to us, get dropped by other services and end up getting seen by a psychiatrist only. So, by default, we started doing that. I think this is an attempt to get back to the core clinical services that our expertise is in. We're trying to reduce our losses. There's no way of doing this that we're going to break even, but we're trying to lose less money."
The nonprofit, Lewiston-based mental health agency serves 10,000 to 11,000 children and adults each year in Androscoggin, Cumberland, Franklin and Oxford counties. It has notified the state of its changes to the medication-management program and its decision to work with clients to move them to primary care doctors.
Although Copeland said only stable clients with the least severe diagnoses will be cut from the program, he is concerned that some may eventually end up in crisis.
"Some people are going to start using the emergency rooms, unfortunately, which is the sad consequence of not being able to provide for everybody that's knocking on the door," Copeland said.
If that happens, they could return to Tri-Country, stabilize, then go back to a primary care doctor — only to start the cycle all over again. That's a concern for Copeland. It's also a concern for Carol Carothers, executive director of the Maine chapter of the National Alliance on Mental Illness.
"(Medication management) is the cornerstone for this population of folks," she said. "It's kind of like insulin. If you don't take insulin and you have diabetes, you're going to get sick."
But she understood why Tri-County felt the need to remove 500 clients from the program. In the past two years, she said, community mental health groups in Maine have lost $40 million in government funding and agencies can't continue to function without making cuts.
"This is the outcome of ongoing reductions that have been forced upon us because of the economy," Carothers said.
Maine Department of Health and Human Services spokesman John Martins said the state was aware of the financial pressure on Tri-County.
"I know that is a challenge that we have to deal with," Martins said. "There are other providers out there that can provide the services. A lot of that comes through the primary care physician practices, so that's definitely a business decision for them."