(NEW YORK) — In the more than two weeks since a mass shooting in Lewiston, Maine, occurred at a bowling alley and local bar and restaurant, questions have swirled about mental health care in the state.

The alleged gunman displayed glaring signals that his mental health was declining, which his family was aware of and had warned law enforcement about, according to documents obtained by ABC News.

It’s unknown why he was not taken into protective custody and then evaluated by a medical professional, but mental health experts and advocates told ABC News that, separately from the shooting, the state has been struggling to address the needs of residents for years.

Long waitlists for programs and a reduced workforce have led to a small-scale version of the larger mental health crisis sweeping across the United States.

Greg Marley, clinical director of suicide prevention at the National Alliance on Mental Illness (NAMI) Maine, has been working in mental health in the state since the 1980s and said there is currently a “perfect storm” of people needing help and not enough resources to address it.

“During the pandemic, people’s levels of anxiety, levels of depression, reliance on substances in an unhealthy way, rose sharply as did people’s sense of isolation,” he told ABC News. “At the same time, the pandemic did more than anything I’ve ever seen to break down the stigma about asking for help around mental health issues.”

He continued, “And so, as a result, there was a wave of people saying, ‘I need help.’ At the same time, we were seeing people getting burned out in mental health, clinical work or support work and so we had a reduction in our mental health workforce.”

Mental health care workers have left the state

Experts told ABC News there has been a lack of in-person services in the state because many health care professionals are leaving for a variety of reasons.

Stress and burnout from the COVID pandemic have caused health care workers to leave the field across the U.S., including Maine. Some people have reduced their hours or are now exclusively focusing on telehealth services, experts told ABC News.

“We’ve had an increase in people doing what’s called telehealth and telehealth is a wonderful way of accessing care, particularly if you’re in a remote area of the state, but working with someone on a screen doesn’t serve everybody,” Marley said.

In January 2023, Gov. Janet Mills proposed $94 million to support mental health and substance use disorder services, including funds to reimburse MaineCare, Maine’s version of Medicaid, according to local ABC News affiliate WMTW.

Additionally, in March 2023, Mills proposed an additional $19.7 million in state funding to address immediate needs in Maine’s behavioral health system.

Experts said these are great first steps, but more is needed to draw more workers into the state to meet the demand for services.

Jayne Van Bramer, president and CEO of Sweetser, a nonprofit community mental health provider statewide in Maine, said she would like to see more state and federal solutions to incentivize people to become behavioral health care workers in Maine.

“I think more student loan forgiveness, tuition assistance, paid internships, sign-on bonuses,” she told ABC News. “I think there’s a lot we could do to encourage folks and we are working collaboratively with the governor, the legislature in the state, but we really do need these things to happen.”

Malory Shaughnessy, executive director of the Alliance for Addiction and Mental Health Services, Maine — a statewide membership association for community behavioral health organizations — said she would like to see more resources invested in emergency responses, so that people who are having crises are met by a crisis worker, as well as the creation of more crisis receiving centers throughout the state such as the first one that opened in Portland.

“We should have crisis receiving centers everywhere, where somebody can just walk in and say, ‘I’m in the middle of this and I need some help,"” she told ABC News. “There should be one in every major community and a couple in every county that people could walk into and get the help for themselves and their child.”

“Maine has somewhere around 100 crisis response workers for the entire state, which just is not anywhere near meeting the needs,” Shaughnessy added.

Patients left on waitlists for months

Due to the reduction of the workforce, patients are often left on waitlists for months as they try to access mental health services.

Kennebec Behavioral Health told WMTW last month that it has 1,200 people on its waitlist, almost double compared to three years ago.

“By the time people call, by the time they pick the phone up and call, they already need service,” CEO Thomas McAdam said. “So, to be on the waitlist longer just makes things worse.”

Sweetser has a waitlist that it says it tries to manage aggressively via its coordination team but is still quite extensive.

“It is approximately 2,000 people [on the waitlist],” Van Bramer said. “We are one organization. You can be on a waitlist anywhere from a couple of months to up to a year. We do call you every month, check in, see if you still need services, see what we can do to help you, see if you’ve found services elsewhere. But it is difficult and it’s not acceptable.”

Van Bramer said these needs are only going to increase as people cope with the trauma experienced from the Lewiston shooting,

“I was at a program [recently], and I was hearing things like some of their clients, every time they hear a hunter’s rifle, they’re terrified,” she said. “So yeah, I think we are definitely seeing an increase in fear and anxiety, that the trauma from this event is reverberating through our community.”

Julie Redding, a licensed therapist and clinical director at the Community Caring Collaborative in Maine, said it is going to be hardest for people who were already dealing with trauma they experienced in the past.

“If we’re thinking about who might be at risk for having felt something like the mass shooting in Lewiston the hardest, one of the best predictors of who will struggle with that is actually people who have a past trauma experience,’ she told ABC News. “For people who have experienced any form of trauma in the past, but particularly if they have experienced traumas that include a violent nature…could disproportionately be more affected and have a recurrence of symptoms.”

Leaving people on a waitlist can sometimes result in people slipping through the cracks, experts said. The majority of people with mental illness may never become violent, but experts say, sometimes, help comes later than they would like it to.

“What we see far too often is an intersection of somebody who is in a mental health crisis and unable to get help, family is unable to get them help, and they can sometimes either do damage to themselves or others because of the lack of that support that they need in that moment,” Shaughnessy said.

“It appears that is a situation that happened in Lewiston, unfortunately, and we see it in small ways every day where somebody who is in a mental health crisis or a psychotic break or something and interacts with the police. Law enforcement shows up because they’re called, and, oftentimes, it’s not a good outcome,” she continued.

To try to address some of these needs, the city of Lewiston has approved funding for a long-term community center to provide resources for victims and Gov. Mills announced last month a new website dedicated to providing resources for Maine residents affected by the Lewiston shooting and to connect them with behavioral health support.

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