Maine Behavioral Healthcare tackles opioid crisis with holistic approach
Photo / Tim Greenway
Stephen Merz, the new president and CEO for Maine Behavioral Healthcare, in the Spring Harbor Hospital courtyard in Westbrook. Merz leads a division of MaineHealth that provides a continuum of behavioral health services, from inpatient care and residential services for adults with mental illness to crisis and outpatient care.
Photo / Tim Greenway
Stephen Merz, the new president and CEO for Maine Behavioral Healthcare, talks with Mindy Knight, director of residential services at Maine Behavioral Healthcare, in the Spring Harbor Hospital lobby about a recent meeting they both attended in Westbrook.
Through the first six months of this year, the Office of the Chief Medical Examiner recorded 189 deaths in Maine due to drug overdose — a 50% increase over the same six-month period in 2015 and on track to reach 378 deaths by the end of 2016. That puts Maine on pace to surpass 2015's record of 272 overdose deaths and 2014's record of 208 deaths. Pharmaceutical painkillers, often trafficked from out of state and frequently used in combination with illegal opioid drugs such as heroin, contributed to roughly 45% of those deaths.
“Fentanyl, heroin and painkillers are exacting a tremendous toll on our state,” Attorney General Janet Mills said in a statement announcing the half-year analysis of drug overdoses completed by Dr. Marcella Sorg of the Margaret Chase Smith Policy Center. “These figures are very distressing … People should know there is no safe amount to sniff or shoot … If it doesn't kill you, it will lead to a lifetime of addiction, illness and hopelessness.”
For Stephen Merz, the new president and CEO of Maine Behavioral Healthcare, Mills' comments highlighting Maine's epidemic of fatal drug overdoses underscore the importance of the mental health and addiction services that MBH provides at 34 locations in Maine. Substance abuse is frequently linked to mental health, with a 2014 report by the Center for Mental Health Services showing that roughly 42% of adults served through Maine state mental health agencies had a “co-occuring mental health and substance use disorder.”
Merz was hired this spring to replace Dennis King, who retired as CEO of MBH in June after a long career serving a variety of roles in Maine's mental health care system. For 21 years Merz worked at Yale New Haven Hospital, the country's fourth-largest hospital with more than 1,500 beds and 13,500 employees and the largest provider of behavioral health services in Connecticut. In his last position as the hospital's vice president and executive director of behavioral health services, his primary focus was finding ways to integrate behavioral health care services into general health care. “Treating the whole person” is how he puts it.
It's a focus well suited to tackling Maine's drug overdose epidemic, which Merz says is as much a public health crisis as it is a law enforcement issue.
“It's a sobering thought, when we just get a report yesterday that Maine is on track to have another record year of overdoses,” Merz says. “The chief medical examiner is predicting up to another 50% increase next year. People literally are dying because of this.”
On the front lines
In his new role at Maine Behavioral Healthcare, Merz oversees a division of MaineHealth that was formed in 2014 when Spring Harbor Hospital, a 100-bed private psychiatric treatment and recovery center located in Westbrook, merged with Community Counseling Center, Counseling Services Inc. and Mid-Coast Mental Health Center.
That merger of three community health centers with an acute-care facility, combined with a continuum of community mental health services that are integrated with general health care services throughout the MaineHealth network, he says, is what puts MBH in the front lines of the state's three-pronged response to the opioid problem, involving law enforcement, education and treatment.
In one initiative, Merz says, MBH will be training local doctors and providers in those communities how to prescribe opiate painkillers appropriately, as well as the opiate addiction treatment medicine known as suboxone.
“We're leveraging all the strengths and talents of MaineHealth and MBH to do that,” he says. “So in the 12 counties we serve, 11 hospitals are coming together with all of their facilities' doctors to support that model. It's a key goal for MaineHealth.”
Another initiative, which Merz says probably won't be completed until next year, is the creation of what he calls a “hub-and-spoke system” to ensure that people with alcohol and drug problems will receive timely appropriate care in their local communities. The system will be modeled after The EMBARK Program, a comprehensive treatment program in Mid-coast Maine that MBH is developing with Pen Bay Medical Center in Rockport and Mid Coast Hospital in Brunswick.
The program offers three levels of care to ensure treatment is appropriate to the severity of a patient's addiction:
- Intensive inpatient care, which can range from two to seven days, at the Pen Bay Medical Center's Psychiatric and Addiction Recovery Center in Rockport.
- Intensive outpatient services at Mid Coast Hospital Addiction Resource Center's offices in Brunswick and Damariscotta, which help patients withdraw from the drug they are addicted to and eventually stabilize, a healing process that can range from three to 12 weeks.
- Long-term substance abuse counseling at Maine Behavioral Healthcare's Rockland office for 12 to 18 months, including a full-time psychiatrist and nursing support.
“I visited the program and it's really outstanding,” Merz says. “It's led by an addiction treatment team and it provides a stable setting for people to work through their addictions. There are medicines out there to treat addictions, but if you don't provide the therapy along with the medicine you're just going to be spending a lot of money on medicines and people are going to fall back on their same patterns. So you have to do the two together. And that's what the hub-and-spoke system does. The 'spoke' provides the medicines and the 'hub' provides the therapy — and that's what's really going to make Maine an innovative model.”
'Treating the whole person'
On the legal front, Merz says Maine lawmakers enacted in the 127th Legislature one of the nation's most progressive opioid prescription laws. It limits opioid dosages and establishes how long prescribed doses can be used for treatment of acute (seven days) and chronic pain (30 days), with some exceptions being allowed in hospitals, long-term care and residential care facilities for cancer, palliative, end-of-life and hospice care and treatment of substance abuse disorders.
The new regulations take effect on Jan. 1, 2017.
The Maine Opiate Collaborative, a coalition of law enforcement, health care providers and other stakeholders, issued final recommendations in May that place a high premium on collaboration, public education and improving access to community-based programs for treatment of substance abuse disorders, which often co-occur with various mental illnesses.
Merz says MaineHealth and MBH are in a good position to meet those pro-active goals.
“We were early adopters of this strategy of putting behavioral health leaders and clinical staff in primary care settings,” he says. “We're at more than 90% penetration and the goal is that every practice will have a behavioral health provider. That will significantly improve the quality of care that's delivered to people who actually have behavioral health needs. By bringing those together, we will significantly save costs for the overall health care system.”
Removing barriers
Even so, Merz acknowledges that significant barriers remain.
The state's failure to expand Medicaid coverage under the Affordable Care Act, he says, puts an estimated 70,000 Maine people into a health insurance coverage gap because their income is too high to qualify for Medicaid and not enough to qualify for a subsidy to help pay premiums for insurance obtained in the ACA's marketplace. “That just perpetuates this problem of lack of access,” he says.
Maine, like most of the nation, doesn't have enough behavioral health specialists, particularly child psychiatrists, to meet all of its needs. That's complicated by thinly populated regions typically not being able to provide enough patients to sustain the salary requirements of highly trained specialists.
In partnership with MaineHealth, MBH is bridging those geographic and demographic barriers by using telemedicine to connect urban-based specialists with rural patients via two-way videoconferencing technology. “It improves access, it delivers the right care more quickly, it reduces costs because we're taking one individual and using them much more efficiently than we would if we had to have somebody physically located in each of those communities,” he says.
Another initiative with MaineHealth taps into Maine Medical Center's teaching hospitality capabilities. “By bringing people to Maine, to learn and train here, they're much more likely to end up practicing here,” he says. “So that's a huge advantage of being partnered with the MaineHealth system.”
Finally, Merz says Maine businesses have an important role to play in supporting employees with a behavioral health condition — between 20% and 25%, according to national studies. The Mental Health Parity Act of 2008, for example, requires group health plans and health insurance issuers to ensure that financial requirements such as co-pays and deductibles and treatment limitations (such as visit limits) for mental health or substance use disorder benefits are no more restrictive than the requirements for physical health problems.
“There is a general stigma involved in mental health illnesses,” Merz says. “So we need the employer community to help provide stable employment, because if we don't do that, those are the same people who are going to go on social assistance. It's way better when people are gainfully employed.”
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