At Tri-County Mental Health Services, Catherine Ryder sees kids dealing with the manic highs and hellish lows of bipolar disorder.

She sees kids with autism and mental retardation, and kids struggling with behavioral problems that alienate them from friends and family.

Ryder is responsible for children’s case management, and she has never turned a child away. State aid ensured that everyone – even those without insurance – got the medication, counseling and other help they needed.

But she is afraid that soon will change.

“What concerns me most? The potential for having to say no,” Ryder said.

Statewide, mental health services for the uninsured will take a $6.9 million hit today, the first day of the 2005 fiscal year. The reductions were approved by the Legislature to help balance the budget. They include:

• Outpatient services, including geriatric and medication management, cut 60 percent.

• Case management and flexible funding to pay for housing, medication and other services for the uninsured, cut 50 percent.

• Crisis services, cut 8 percent.

It has left Ryder and others scrambling to find ways to provide the same services with less money. And worrying that they’ll have to start turning away the very people who need their help the most.

Business decisions

The cuts, effective today, affect Mainers who can’t afford private insurance but who aren’t part of MaineCare. Many of them get help from nonprofit agencies who rely on funding from the state.

“We know that we’re now going to be less available to people,” said Greg Shea, retiring executive director of Tri-County Mental Health Services, the largest provider of mental health services in the area.

A nonprofit agency that provides counseling, crisis services, rehabilitation and other programs to 7,000 western Maine children and adults every year, Tri-County relies on state funding to pay its bills when clients don’t have insurance. Some Tri-County programs are losing between 2 percent and 87 percent of their state aid.

The agency’s geriatrics program, for example, is going from $193,000 in state aid to less than $75,500, a drop of about 61 percent. That program provides training and support to area nursing home workers whose patients are mentally ill.

The drop in funding means Tri-County may not be able to offer that help anymore.

Tri-County’s child case management program will see the most dramatic drop in state aid. It is going from $40,000 to $5,000.

That program helps children returning home from a corrections center. It also helps children get the support they need after being hospitalized for mental health problems.

“That’s when children and families are most fragile and most need us,” said Chris Copeland, incoming Tri-County executive director.

With the budget for such kids cut by 87 percent, Tri-County officials say they won’t have enough money to help everybody. They’ll have to prioritize who gets service.

“As the year wears on, then we’re going to have to – to use a phrase we don’t like around here – make some business decisions,” Copeland said.

The Legislature made such a decision this spring.

In March, Gov. John Baldacci proposed drastic cuts to social service programs in order to stem a $128 million Medicaid shortfall. The cuts would have affected a host of programs, including mental health, dental services and physical therapy.

After protests, most of the proposed cuts were restored. But the Legislature took $6.9 million from money set aside to help the uninsured and used part of it to compensate the state’s Medicaid program. Known as MaineCare, it greatly expanded eligibility two years ago to insure more of Maine’s uninsured. The rest of the money went to balance the budget.

Safety net

Across the state, officials say they don’t want clients to panic about losing services.

Those who receive help will likely continue to get it. If funding cuts force an agency to move someone out of a program, workers will try to get that person insured through MaineCare or will look for other alternatives.

But as programs shrink to accommodate their smaller budgets, those who aren’t already enrolled in a program may find it harder to get into one.

Common Ties Mental Health Coalition, a Lewiston-based group, received $14,000 from the state last year to help uninsured clients find counseling, housing and other help. This year, Common Ties will get about $7,000.

“We estimate that amount of money will not last any more than three months,” said Executive Director Craig Phillips.

The 17-year-old nonprofit has never had to place clients on a waiting list. Last week it started one.

For more than 15 years, Maine has worked to install community programs that help the mentally ill without removing them from their homes. But as those community programs are cut, some experts worry people will be forced once again to rely on hospitals and other crisis services.

“By cutting them, you’re really cutting the safety net,” said Scott Mullen, clinical social worker for St. Mary’s Regional Medical Center.

Agency officials say they don’t yet know how the funding cuts will affect every program. Some will continue unchanged. Some will have to limit participants.

For some, officials will go back to the state and ask for more money.

“That’s going to be my first port of call,” Copeland said.

But he and others aren’t confident the answer will be yes.

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