Lowell Sun: Cuts to mental health 'recipe for disaster'

By Garrett Brnger

June 1, 2011


BOSTON -- As the budget process inches through the Legislature, many programs are feeling the sharp edge of the budget ax.

The Department of Mental Health knows that process well, and fears that this time the swing of the ax will cost it and its clients important programs and services.

"We as a community -- providers, consumers, advocates -- over the past three or four years have become very good at advocating for funding because we feel we've been cut disproportionately in comparison to some other state agencies," said Vic Digravio, president of the Association of Behavioral Health Care, an organization of community-based care providers.

Deep cuts into mental-health programs began in October 2008, DiGravio said, when Gov. Deval Patrick used his emergency line-item veto powers to effectively eliminate day rehabilitation programs, the service employment and education program, and social clubs. Since then, mental-health advocates have fought for every dime they get.

"Mental health needs to be put on parity with physical health," said state Rep. Tom Golden, D-Lowell, who has been a fierce advocate for restoring state funding to mental-health services. "The quicker that people realize that mental health is just as important as physical health, we will be a much better society."

The well-practiced advocates for mental health have had minor success so far this budget cycle in

mitigating cuts proposed by the governor. The House version is $613.7 million -- $14.6 million less than the fiscal 2011 budget of $628.3 million, but $6.7 million more than the governor's $607 million proposal. The Senate budget, passed Friday, would raise total spending by about $25 million to $646.8 million. Children's mental-health services received level funding in the House budget. It was cut by $2 million by the governor and the Senate budget, but the Senate added $2 million to the state's Child Psychiatric Hotline to keep it open five days, rather than just four days, per week.

The House provided near-level funding for adult services, according to the Massachusetts Budget Policy Center. The $16.4 million cut to hospital services, however, was softened by only $1 million, said Laurie Martinelli, executive director for the Massachusetts chapter of the National Alliance on Mental Illness.

"I don't think mental health gets the respect that it deserves, and it certainly doesn't get the respect physical illness gets," Martinelli said. "Our systems have always been underfunded, but it's been particularly acute these past few years, and some people have said they've never seen it this low before."

While the Department of Mental Health budget is declining again, its umbrella office, the Executive Office of Health and Human Services, got a $2 billion increase in the governor's budget, according to a March report by the alliance's state chapter.

The cause of the inverse relationship in funding can be attributed to the department's largest program, MassHealth, the state's Medicaid program.

Because MassHealth must support those who qualify for it, its budget is determined by its obligation. Programs like mental health, however, can be cut much more easily.

Although Massachusetts touts itself as a leader in health care, annual cuts have decreased mental-health funding here more than any other New England state in the last two years, according to the alliance report. All others except New Hampshire increased funding.

Figures from the Massachusetts Budget and Policy Center, an independent research and analysis center, show that from fiscal 2006 to fiscal 2011, the department was cut by $107.9 million, a 14.5 percent decrease over those five years.

Jennifer Kritz, a spokeswoman in the Executive Office of Health and Human Services, said the department has faced some tough choices.

"In the face of unprecedented economic challenges, we have had to make some very difficult budget decisions across state government," she wrote in an email.

The biggest cuts this year are to inpatient hospital services, which provide care to chronic mental-health patients. The governor's proposed budget cut $16.4 million from the program and eliminated 160 inpatient beds -- about 20 percent of current capacity. The program suffered a 20 percent hit in fiscal 2009, when 170 beds were eliminated.

The alliance report estimated the cost of each of the 100 to 150 people who would be "discharge-ready" into the community to be $50,000 to $55,000, totaling an additional $8 million in community program funding.

DiGravio said the cuts proposed to the hospital services would have the unintended effect of raising costs for community-based systems that are already underfunded and over capacity. Patients will have nowhere to go, he said.

"They're going to end up in the emergency rooms or they're going to end up in jail," he warned. "That's why it's a recipe for disaster."

The report said the elimination of hospital beds requires "a simultaneous commitment of $8 million to increase funding for new community-based housing and support services."

Clubhouses are a staple of the Department of Mental Health's existing community services that the House budget saved from cuts. The organizations help the mentally ill reintegrate into society by working side by side with the clubhouse staff to find gainful employment.

Elaine Walker, program director for the Renaissance Club, a Lowell vocational program for adults in recovery from severe and persistent mental illnesses, said the Senate's budget bodes well for the funding of her clubhouse and others statewide.

The Senate passed a budget for community mental health and clubhouses that calls for $9 million more than what the governor proposed, and $6 million more than what the House proposed.

"It's great for the Department of Mental Health," she said. "It's kind of hopeful. There's so much bad news, and we are really, really thankful to our legislators. Rep. Tom Golden has been particularly helpful to us all across the state."

Golden said that if the number of mental-health beds is cut, it's crucial that community programs, such as clubhouses, that cater to mental-health patients be properly funded.

He said the Lowell area has suffered numerous setbacks in servicing the region's mental-health patients in recent years with the elimination of the 16-bed inpatient facility at Solomon Mental Health Center in the mid-1990s and the closure of Lowell General Hospital's 34-bed psychiatric unit in 2002.

State Sen. Jennifer Flanagan, D-Leominster, a former counselor and former chairwoman of the Joint Committee on Mental Health and Substance Abuse, also strongly advocated for increased mental-health funding in her current role on the Ways and Means Committee.

The Senate budget also includes a substantial increase in funding for mental-health beds, with plans to open a Westboro inpatient facility.

"Usage of the mental-health system has gone up, especially with the recession," said Carly Antonellis, a spokeswoman for the Flanagan's office. "And with the increased usage of the system and the cuts that were made over the past four years, it was priority to raise funding."

But things are still uncertain until the final budget numbers are hammered out in conference between the House and Senate by July 1, for final approval by the governor.

"It's really not enough," Antonellis said of the approximately $25 million increase in mental-health funding in the Senate budget. "In the grand scheme, we're still not where we need to be, but we're getting there."