Association for Behavioral Health Blog

ABH Statement on the Report by the Department of Mental Health Task Force of Staff and Client Safety

2011-07-01T09:54:00.000-07:00

July 1, 2011

The Massachusetts Department of Mental Health Task Force on Staff and Client Safety issued its final report today, after reviewing the state’s resources and procedures for ensuring the safety of staff and clients at DMH-funded programs that serve individuals with mental illness.

The report is the culmination of a process that began in February, following the tragic death of Stephanie Moulton, a staff person at a DMH-funded program. Over the past four months, the Task Force solicited input from a wide array of stakeholders and the general public in an effort to help inform its deliberations. ABH President and CEO Vic DiGravio was honored to represent the association’s members on the Task Force. Many ABH member organizations and their staff provided valuable insights and testimony to the Task Force throughout this process.

The report highlighted the need for better coordination of care and greater funding for community based mental health services, including the need for increased pay and training for staff members. The Task Force’s report reaffirms the Commonwealth’s commitment to providing services to individuals in the least restrictive settings possible, but points out that chronic underfunding of community based services has created an unstable situation in some cases.

Also, the report makes the important point that most individuals with mental illness pose no greater threat of violence than any other member of society. In fact, DMH clients are more likely to be victims than perpetrators of acts of violence. At ABH, we are well aware of this reality and are opposed to any attempts to further stigma around mental illness.

The report contains seventeen recommendations for state government to undertake in an effort to strengthen the publicly funded mental health system to ensure the safety of individuals being served, program staff and the general public. These recommendations fall under six broad categories:

1. Overarching Issues, including the need for new funding for public mental health services.

2. Staffing and Coordination of Care

3. Access to Information

4. Access to Services

5. Training

6. Current Practices

ABH and our members are pleased that the state legislature is making an important down-payment in rebuilding the Commonwealth’s publicly-funded mental health system in the fiscal year 2012 state budget being adopted today by increasing funding for DMH by $20 million above FY11 spending. This is a clear acknowledgement by the legislature that they value services for individuals with mental illness and the entire legislature deserves credit for acting decisively today.

To read the report, please visit www.abhmass.org.

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

2011-06-01T07:43:00.000-07:00

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."

ABH Annual Meeting photos

2011-05-24T13:15:00.000-07:00

Association for Behavioral Healthcare Annual Meeting, May 10, 2011

2011-05-23T13:49:00.000-07:00

ABH Statement on Senate Ways & Means FY 2012 Spending Plan

2011-05-20T16:48:00.000-07:00

May 18, 2011

The Massachusetts Senate showed tremendous leadership today by continuing the Commonwealth’s commitment to provide critical services to individuals with behavioral health disorders.

We applaud the efforts of Senate President Therese Murray, Ways & Means Chairman Stephen Brewer, and the other members of the Ways & Means Committee for choosing to invest in community-based services for individuals with mental health and addiction disorders.

In today's Ways & Means Committee budget, the Senate recommended an overall increase of approximately $16.5 million in spending for the Department of Mental Health above the current year appropriation level (when taking into account the FY 2011 supplemental budget). The Senate budget recommendation is approximately $38 million higher than Governor Patrick’s budget proposal.

The Senate’s budget includes a proposed $5.5 million increase for adult community services over the FY 2011 budget and a $2.8 million increase for DMH inpatient facilities. The budget also authorizes the Department to expend $10 million from DMH Trust Funds for DMH inpatient and adult community services.

In addition, the Ways & Means Committee level funded the Bureau of Substance Abuses Services, including funding for step-down services, secure treatment facilities and family intervention and care. These services are vitally important for individuals and their families who are struggling with alcohol and drug addiction.

We look forward to working with members of the Senate to support line items affecting child and adolescent services during the budget debate next week.

Overall, the Senate acted with great responsibility and compassion in continuing to fund community-based behavioral health services.

ABH Statement on House Budget

2011-04-26T07:09:00.000-07:00

Association for Behavioral Healthcare Praises House Leadership

For Restoring Funds for Community Mental Health Services

Budget Requires DMH to Submit Bed-Closure Plan

BOSTON – April 26, 2011 -- The Association for Behavioral Healthcare, which represents nearly 100 community-based behavioral health providers, issued a statement following the House of Representatives decision to restore funding for community services under the Department of Mental Health (DMH):

ABH is pleased that the House has restored $5.5 million in funding for DMH that will support community behavioral health services and provide individuals with the services necessary to manage their illness and support recovery.

Included in this amount is $558,637 for clubhouse services, which means that the House of Representatives has fully restored the $3 million cut to clubs initially proposed by Governor Patrick.

The House language prohibits DMH from expending these funds until the Department has submitted a detailed bed closure plan to the legislature. Specifically, the money cannot be expended “until the department of mental health submits a report to the house and senate committees on ways and means and the joint committee on mental health and substance abuse services detailing the number of individuals to be discharged, the facilities from which they will be discharged and the specific community based services that will be developed to assist them in the community.”

ABH has worked very hard in partnership with other stakeholders over the past few months to stress to lawmakers that Governor Patrick’s plan to eliminate 160 DMH in-patient beds while simultaneously cutting funding for community-based services was extremely ill-conceived.

We are grateful to Speaker of the House Robert DeLeo, House Ways and Means Chairman Brian Dempsey, Mental Health and Substance Abuse Committee Co-Chair Liz Malia, and Ways and Means members Representatives Ruth Balser and David Sullivan for their steadfast commitment to community-based services.
The amendment adopted through their leadership affirms ABH’s position that new funding for community services must be part of any plan to reduce in-patient capacity if DMH clients are to have the opportunity to successfully live in the community.

ABH Testifies on Critical FY 2012 Budget Items

2011-03-04T09:18:00.000-08:00

March 4, 2011

Senator Stephen Brewer, Chair
Senate Committee on Ways and Means

Representative Brian Dempsey, Chair
House Committee on Ways and Means

Re: FY 2012 Budget

Dear Chairman Brewer, Chairman Dempsey and Honorable Committee Members:

On behalf of the membership of the Association for Behavioral Healthcare (ABH), thank you for the opportunity to comment on the Ways and Means Fiscal Year 2012 budget. As you may know, ABH is a statewide association representing eighty-four community-based mental health and addiction treatment provider organizations. Our members are the primary providers of publicly-funded behavioral healthcare services in the Commonwealth, serving approximately 117,000 Massachusetts residents daily and employing 22,000 people.

As you consider the FY 2012 budget, we strongly urge you to ensure that community-based behavioral health services are held harmless. As we explain below, our priorities for the Fiscal Year 2012 budget are as follows:

· Level fund the Bureau of Substance Abuse Services at $83,485,802.

· Reject the cuts to the Department of Mental Health’s (DMH) Clubhouse Services ($3 million) and DMH’s Children/Flex Supports Services ($2 million) proposed by Governor Patrick.

· Require that the Department of Mental Health develop a specific plan for the state’s mental health system before closing any additional inpatient beds. This should include a plan for how placements in the community system for impacted clients will be funded.

· Preserve vital MassHealth-funded behavioral health services.

Stability for Community Services

ABH strongly supports the philosophy of Community First – that whenever possible, individuals should live and be served in community settings, with minimum lengths of stay in acute and continuing care hospitals, and maximum diversion from inpatient care through use of community-based emergency services and alternative levels of care. To achieve the goal of Community First, however, the Commonwealth must commit the financial resources necessary to allow adults and children with mental illness and/or substance use disorders to live successfully in their own communities. ABH and our members believe that current community resources are not sufficient to truly support recovery and resiliency for clients.

Lack of access to critical health care services remains a significant barrier to preventing and treating health disorders before they intensify and require costlier treatment in more intensive settings. ABH providers know from experience that access barriers to community-based mental health and addiction treatment services can be debilitating or even fatal.

While we have been encouraged by the Legislature’s recognition of the importance of community mental health and addiction treatment services, the community behavioral healthcare system is still struggling with the budget cuts of a few years ago. Thousands of individuals and families are not able to access services and supports for mental health and/or substance use disorders. In light of this unacceptable situation, existing levels of services must be maintained in order to ensure that individuals are able to access needed care and to provide stability for the community behavioral health system to the greatest extent possible.

Fair and adequate reimbursement rates are the cornerstone of a stable community-based behavioral health system. Inadequate rates directly impact the ability of providers to ensure that clients have access to the services they need to live in their communities. Over the years, the erosion of behavioral health rates has forced providers to make the difficult decision to close clinics or reduce access. As the Legislature considers the FY 2012 budget, it must not ignore this critical issue.

Department of Mental Health

ABH believes that the community-based service system needs to be fundamentally strengthened, and better coordinated to appropriately serve Department of Mental Health (DMH) clients. The Governor’s FY 2012 budget proposal reduces funding for the Department of Mental Health by $21 million. These cuts include a $2 million reduction to the Children/Adolescent Flex Support program which will impact approximately 175 children, a $3 million cut to Clubhouse services which will impact approximately 2,000 clients, and a $16.4 million cut to inpatient services which will result in the closure of approximately 160 inpatient beds. ABH is extremely concerned about these cuts to an already eroded community behavioral health system and requests that the Legislature restore this funding.

The Commonwealth cannot continue to reduce DMH inpatient capacity solely as a cost-saving initiative. In addition to maintaining existing services, additional funding for community based services will be required if the Department proceeds with further reductions to DMH inpatient capacity. The final report of the Department of Mental Health Inpatient Study Commission concluded that,

The community system must be strengthened. Community based services have been the heart of the DMH service delivery system for more than 30 years. Previous state hospital closings have succeeded as consumers were transitioned to high-quality services in or near their own communities. The community system, however, experienced significant mid-year “9C” budget cuts in October 2008. An investment of funding for community services is necessary for DMH to replicate the success of earlier hospital closings.#

If the Commonwealth truly believes it can safely meet its public mental health mission with fewer inpatient beds, then increased funding for community services is critical in order to provide the resources necessary to safely and appropriately serve DMH clients in the community. To close inpatient beds as a budget-balancing measure without a corresponding investment in community services adds to the dangerous deterioration of the pubic mental health system resulting from years of budget cuts. The community-based continuum needs additional resources and staffing. Many individuals being discharged from state hospital beds need specially-focused resources to support their acute needs in the community.

Furthermore, the budget reductions of the past few years have eliminated or dramatically reduced many community services that had served DMH clients. The crisis in outpatient services most readily exemplifies this problem. In recent years, there has been a significant reduction in outpatient capacity which has reduced access to vital, cost-effective services for individuals with severe and persistent mental illness. The Commonwealth (DMH and MassHealth) need to provide adequate rates for outpatient mental health as well as sufficient resources to provide the full range of community-based services so that individuals living with mental illness may truly benefit from the Commonwealth’s commitment to Community First.

In summary, adequate funding for the Department of Mental Health (DMH) is essential in order to maintain treatment for individuals across the Commonwealth in need of mental health services. DMH offers individuals with mental illness many critical community-based services that are not available through MassHealth or private insurance. We urge you to restore funding for the DMH community accounts (line items 5042-5000; 5046-0000; 5046-2000; 5047-0001; and 5055-0000) in order to avoid a shift toward more expensive interventions such as emergency rooms, acute inpatient care and homeless shelters.

Bureau of Substance Abuse Services

While we were disheartened by the results of Question 1 in the November election, we are extremely grateful for the support of the Legislature both during and after the campaign. Going forward, we strongly urge you to continue this commitment to addiction treatment and prevention services by maintaining funding for the DPH/Bureau of Substance Abuse Services (line items 4512-0200, 4512-0201, 4512-0202, and 4512-0203). These critical addiction prevention, treatment and recovery support services are an essential part of the Commonwealth’s safety net and we are sincerely grateful for your continued support. If funding for addiction treatment is cut, access to treatment is reduced, and the state will end up paying more to serve these clients in emergency rooms, our court system and prison beds.

MassHealth Behavioral Health

Medicaid finances medically necessary behavioral health services for individuals and families and helps ensure stability for some of the most vulnerable individuals in our society. For example, MassHealth psychiatric day treatment services provide essential services for individuals being discharged from state hospitals and help ensure that individuals are able to remain in their communities. In addition, MassHealth behavioral health services also include vital addiction treatment services for individuals across the Commonwealth.

As you know, service implementation for the Children’s Behavioral Health Initiative (CBHI) is underway. As the state continues to work to develop this new system, funding is necessary to ensure successful implementation of the Rosie D. court order. This funding is essential to strengthen our community-based mental health system to better serve children living with Severe Emotional Disturbance (SED) in Massachusetts.

MassHealth behavioral health services do more than keep ill people off the streets; they keep people alive. As such, the Commonwealth must take steps to ensure that these valuable services continue to be available to the state’s residents.

Human Services Salary Reserve

At the time Chapter 257 of the Acts of 2008 (An Act Relative to Rates for Human and Social Service Programs) was enacted, it was understood that a salary reserve for human service workers would be funded until the law was fully implemented. Due to a number of implementation issues, The Collaborative (ABH, the Association of Developmental Disabilities Providers, and the Providers’ Council) and the Patrick Administration recently agreed to amend Chapter 257 by extending the implementation timetable by 15 months. As it is, the salary reserve has not been funded for the past three years.

We recognize that full implementation of Chapter 257 will, over time, rectify the fact that human service employees are too often among the Commonwealth’s working poor. However, due to the delay of implementation of Chapter 257, we are asking you to fund the human services salary reserve at $28 million until the new law is fully implemented. This is a modest request to assist direct support staff making less than $40,000 per year as they struggle with the condition of our state’s economy.

Access to Health Insurance

Human service providers struggle to provide affordable health insurance to their employees. Enabling human service providers who have contracts with the Executive Office of Health and Human Services to have access to the state’s Group Insurance Commission (GIC) would decrease employer and employee costs, increase choice and access, and reduce staff turnover. The GIC’s buying power may, in many cases, enable providers to purchase health insurance at a lower cost than that which is available to them in the open market. In addition, providers often have limited choice among health care plans for their employees. Access to the GIC will rectify this by enabling providers to choose from multiple plans, thereby increasing both choice and access.

While almost all ABH members offer health insurance coverage for their employers, cost – to both the employer and the employee – is increasingly prohibitive. As health insurance premiums rise, providers are forced to choose between affordability and quality — a decision that goes against the very nature of the state’s health care reform achievements. Access to the GIC will increase the quality of life for our workforce and improve the quality of care provided in the community.

Community-based provider organizations embrace on a daily basis the opportunity to help individuals return to live in the community and begin to recover with the support of homes, jobs, peers, family and friends. Those same organizations, however, find it extremely frustrating and sometimes very troubling to try to do so without the resources necessary to allow individuals to achieve recovery to the fullest extent possible. For these reasons, we look forward to working with the Commonwealth on the difficult challenges that lay ahead.

If you have any questions or comments, I am happy to address them at your convenience. Thank you for your consideration.

Sincerely,

Vicker V. DiGravio III
President/CEO

Time to Weigh in on State Budget

2011-02-15T07:06:00.000-08:00

With the loss of dedicated funds from the alcohol sales tax and the end of federal stimulus funding, many Bay State behavioral health causes are concerned about looming budget cuts. Though we're all in this budget battle together, there are ways you, and your members can help.

The House and Senate Committees on Ways and Means are holding joint hearings to sort out the state budget for the 2012 fiscal year. As you know, this process will determine funding for mental health and substance abuse treatment (and everything else) for the next year. It is a crucial time to ensure that our programs remain a priority, especially on the heels of Patrick's planned reduction to funding for the Department of Mental Health. We must be involved.

How can you help?
Listen up. There are a number of hearings, that anyone can sit in on.
Be heard. Testify at the public hearing on Friday, March 4th at 10am in the Gardner Auditorium at the State House.
Write in. If you can't be there in person, submit written testimony to your local representative. ABH will be submitting testimony and will provide an advance copy to our members as a potential model for your own testimony.

Community-based system must undergo review

2011-02-02T07:21:00.000-08:00

From The Boston Globe, Feb. 2, 2011

THE TRAGIC killing of Stephanie Moulton affects everyone who provides care and services to men and women with mental illness. Such tragedies are thankfully rare, but as the Globe noted in its editorial, the Department of Mental Health and private providers have an obligation to provide a safe environment for clients and staff (“Murder in Revere group home shows need for criminal checks,’’ Jan. 31).

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Yahoo! Buzz ShareThis .Both organizations mentioned by the Globe, North Suffolk Mental Health and Bay Cove Human Services, are members of the Association for Behavioral Healthcare. For decades, both have provided high-quality, professional, and compassionate care to individuals with mental illness in residential settings in and around Boston. All ABH members remain committed to providing community-based services to people struggling with mental illness to help them achieve recovery.

ABH and other mental health advocacy organizations have requested that Barbara Leadholm, the state’s mental health commissioner, appoint an independent third party to review systemic issues surrounding the publicly funded community-based mental health system. As our letter to her stated, “We believe DMH needs to forcefully and directly examine all the systemic issues raised by this tragedy, or that task could be assumed by others with an agenda to dismantle rather than to improve the system.’’

Community-based services for individuals with mental illness have improved the lives of countless men and women. The mental health community grieves Moulton’s loss, and we owe it to her, her colleagues, and clients to ensure that the community-based system promotes recovery in a safe environment.

Vic DiGravio
President and CEO Association for Behavioral

Testimony on FY2012 Budget

2010-12-14T13:32:00.000-08:00

The Executive Office of Health and Human Services is holding two hearings on the FY 2012 budget (Dec. 13 and December 29 in Northampton).

We strongly encourage ABH members to submit testimony by December 29. I have pasted below a copy of ABH’s testimony. Please feel free to use it as a model for your own comments.

Testimony can be submitted to:

Secretary JudyAnn Bigby, Executive Office of Health and Human Services

One Ashburton Place, Room 1109

Boston, MA 02108

Or emailed to: eohhshearings@massmail.state.ma.us

******************************************************************************

December 9, 2010

Secretary JudyAnn Bigby, M.D.
Executive Office of Health and Human Services
One Ashburton Place, Room 1109
Boston, MA 02108

Re: FY 2012 Budget
Dear Secretary Bigby:

On behalf of the membership of the Association for Behavioral Healthcare (ABH), thank you for the opportunity to comment on FY 2012 budget recommendations for EOHHS and its departments. As you know, ABH is a statewide association representing eighty-nine community-based mental health and substance abuse provider organizations. Our members are the primary providers of publicly-funded behavioral healthcare services in the Commonwealth, serving approximately 117,000 Massachusetts residents daily and employing 22,000 people.

As you consider the FY 2012 budget, we strongly urge you to ensure that community-based behavioral health services are held harmless from further budget cuts.
Stability for the Community Services
Lack of access to critical health care services remains a significant barrier to preventing and treating health disorders before they intensify and require costlier treatment in more intensive settings. ABH providers know from experience that access barriers to community-based mental health and substance use disorder services can be debilitating or even fatal.

While we have been encouraged by the administration’s recognition of the importance of community mental health and substance use disorder services, the community behavioral healthcare system is still struggling with the budget cuts of a few years ago. Thousands of individuals and families are not able to access services and supports for mental health and/or substance use disorders. In light of this unacceptable situation, existing levels of services must be maintained in order to ensure that individuals are able to access needed care and to provide stability for the community behavioral health system to the greatest extent possible.
ABH strongly supports the philosophy of Community First – that whenever possible, individuals should live and be served in community settings, with minimum lengths of stay in acute and continuing care hospitals, and maximum diversion from inpatient care through use of community-based emergency services and alternative levels of care. To achieve the goal of Community First, however, the Commonwealth must commit the financial resources necessary to allow adults and children with mental illness and/or substance use disorders to live successfully in their own communities. ABH and our members believe that current community resources are not sufficient to truly support recovery and resiliency for clients.

Fair and adequate reimbursement rates are the cornerstone of a stable community-based behavioral health system. Inadequate rates directly impact the ability of providers to ensure that clients have access to the services they need to live in their communities. Over the years, the erosion of behavioral health rates has forced providers to make the difficult decision to close clinics or reduce access. As EOHHS considers the FY 2012 budget, it must not ignore this critical issue.

Department of Mental Health
ABH believes that the community-based service system needs to be fundamentally strengthened, and better coordinated to appropriately serve Department of Mental Health (DMH) clients. Providers report serious concerns about their programs’ level of staffing and resulting ability to meet the acute needs of individuals being more rapidly discharged from inpatient care, including for some, following lengthy hospital stays. Issues of medical co-morbidity, forensic involvement, aging, and increasingly complex psychotropic medication needs are further challenges for community services given the limited availability of current resources.
In re-allocating DMH financial resources to open the new DMH hospital, resources must not be taken from already-vulnerable community services. The community-based continuum needs additional resources and staffing. Many individuals being discharged from state hospital beds need specially-focused resources to support their acute needs in the community.

The budget reductions of the past few years have eliminated or dramatically reduced many community services that had served DMH clients. The crisis in outpatient services is perhaps the most high profile example of this problem. In recent years, there has been a significant reduction in outpatient capacity which has reduced access to vital, cost-effective services for individuals with severe and persistent mental illness. DMH and MassHealth need to provide adequate rates for outpatient mental health and sufficient resources to provide the full range of community-based services so that individuals living with mental illness may truly benefit from the Commonwealth’s commitment to Community First.

Adequate funding for the Department of Mental Health (DMH) is essential in order to maintain treatment for individuals across the Commonwealth in need of mental health services. DMH offers individuals with mental illness many critical community-based services that are not available through MassHealth or private insurance. We urge you to maintain funding for the DMH community accounts (line items 5042-5000; 5046-0000; 5046-2000; 5047-0001; and 5055-0000) in order to avoid a shift toward more expensive interventions such as emergency rooms, acute inpatient care and homeless shelters.

Bureau of Substance Abuse Services
While we were disheartened by the results of Question 1 in the November election, we are extremely grateful for Governor Patrick’s commitment to preserve funding for substance use disorder treatment and prevention services for the remainder of FY 2011 which will ensure that 100,000 Massachusetts residents continue to receive the treatment they need to remain in the community and to be productive members of society.

Going forward, we strongly urge you to continue this commitment and maintain funding for the DPH/Bureau of Substance Abuse Services (line items 4512-0200, 4512-0201, 4512-0202, and 4512-0203). These critical substance abuse prevention, treatment and recovery support services are an essential part of the Commonwealth’s safety net and we are sincerely grateful for your continued support. If funding for addiction treatment is cut, access to treatment is reduced, and
the state will end up paying more to serve these clients in emergency rooms, our court system and prison beds.

MassHealth Behavioral Health
Medicaid finances medically necessary behavioral health services for individuals and families and helps ensure stability for some of the most vulnerable individuals in our society. For example, MassHealth psychiatric day treatment services provide essential services for individuals being discharged from state hospitals and help ensure that individuals are able to remain in their communities. In addition, MassHealth behavioral health services also include vital substance use disorder services for individuals across the Commonwealth.

As you know, service implementation for the Children’s Behavioral Health Initiative (CBHI) is underway. As the state continues to work to develop this new system, funding is necessary to ensure successful implementation of the Rosie D. court order. This funding is essential to strengthen our community-based mental health system to better serve children living with Severe Emotional Disturbance (SED) in Massachusetts.

MassHealth behavioral health services do more than keep ill people off the streets; they keep people alive. As such, the Commonwealth must take steps to ensure that these valuable services continue to be available to the state’s residents.
Community-based provider organizations embrace on a daily basis the opportunity to help individuals return to live in the community and begin to recover with the support of homes, jobs, peers, family and friends. Those same organizations, however, find it extremely frustrating and sometimes very troubling to try to do so without the resources necessary to allow individuals to achieve recovery to the fullest extent possible. For these reasons, we look forward to working with the Commonwealth on the difficult challenges that lay ahead.

If you have any questions or comments, I am happy to address them at your convenience. Thank you for your consideration.

DiGravio and Frangules: Liquor stores don't deserve a tax break

2010-11-01T07:00:00.000-07:00

Milford Daily News, October 21, 2010

Massachusetts voters face a critical choice on Election Day, and not just in the campaign for governor. Question One on the ballot will ask voters to create a special tax exemption for alcohol at retail stores - and slash $110 million from a budget already facing a $2 billion deficit. It's a reckless fiscal and public health policy measure that should be voted down.

If approved, Question 1 would change the state's sales tax law to carve out a special exemption for alcohol sold at retail stores. Alcohol would still be taxed at restaurants and bars. The only items that are exempt from the state's sales tax are basic necessities, like food, clothing and prescription medicines. Alcohol is not a basic necessity and doesn't deserve a tax break.

In radio ads currently running in Massachusetts, proponents of Question 1 argue that residents are flocking to New Hampshire and buying tax-free alcohol there. Aside from the dubious financial wisdom of spending time and gas money on a trip to New Hampshire to buy alcohol, the ads are not true. Actually, sales in New Hampshire are down slightly from their 10-year average of 5.1 percent growth. There has been no spike in alcohol sales in New Hampshire.

However, alcohol sales are up in Massachusetts by 4 percent in the past quarter, according to the Department of Revenue.

As public and fiscal policy, it makes no sense to exempt alcohol from the sales tax. Forty-five other states (all the states that have a sales tax) apply it to alcohol. The Massachusetts alcohol tax is clearly in the mainstream for all states.

Every dollar of the tax goes to essential addiction prevention, treatment and recovery and public health services, through the dedicated Substance Abuse Treatment Fund. This fiscal year, it will bring in about $110 million in revenue to support vital health programs.

The Committee Against Repeal of the Alcohol Tax is a group of more than 160 healthcare, human service, community, union and business groups that have banded together to get out the message about the impact of the alcohol tax repeal.

According to a poll conducted this spring by the Committee, 58 percent of voters are opposed to repeal. A State House News Service poll recently found the numbers had climbed slightly to 60 percent and a Boston Globe poll found similar opposition to the alcohol tax break. But proponents of the repeal are spending over $1 million to secure a Yes vote.

So who's behind Question 1? The liquor industry, which stands alone on this crusade. Not one organization outside the industry has endorsed the campaign or even contributed money to it. Even business associations have spurned the liquor industry. They argue that the state cannot afford the lost revenue, and that it would be unfair to give preferential treatment to alcohol in the state's tax code.

The alcohol sales tax, paid only by those who purchase alcohol, goes directly to a fund for treatment of addiction. We can't afford to repeal this tax. That is why people should vote no on Question 1 on November 2.

Vic DiGravio is president and CEO of the Association of Behavioral Healthcare. Maryanne Frangules is executive director of the Massachusetts Organization for Addiction Recovery. They co-chair the Committee Against Repeal of the Alcohol Tax.

Roger Oser, Principal of Ostiguy High School: Vote NO on 1

2010-10-19T12:05:00.000-07:00

Massachusetts passes criminal offender record reform law

2010-08-02T11:24:00.000-07:00

On the final day of the 2010 legislative session, the House and Senate approved a criminal records reform bill that had been near the top of ABH”s agenda. When signed by the Governor, the new CORI law will limit access to criminal record information and give first-time offenders a chance at rehabilitation.

“This is for people who made one mistake, who have shown they rehabilitated themselves, to be able to go on with their life,” said Lew Finfer, leader of a coalition lobbying for the changes.

Under the new law, when a defendant is found not guilty, or the case is continued without a finding, the charge will not show up on an employer’s criminal background check. Offenders will have a chance to seal their criminal records with five years of good behavior for a misdemeanor, and 10 years after a felony. Law enforcement agencies will have access to an unedited criminal record, and a sex offender’s records cannot be sealed.

ABH sought the changes to enable persons who have had trouble finding work because of one mistake to get their lives back on track. Many individuals with mental health and/or substance use disorders have criminal records because of the way their illnesses manifest themselves, and the old CORI system impeded their ability to live and work in the community.

In testimony to the Judiciary Committee last year, I stated:

“Access to substance abuse and mental health services, employment opportunities, and the ability to live and thrive in the community are fundamental to the recovery process.”

The Legislature did the right thing in reforming the CORI laws. This was a major step forward for individuals in recovery.

Governor Patrick Signs Substance Abuse Treatment Fund into Law

2010-07-07T13:46:00.000-07:00

June 30 was a landmark day for the public health community in Massachusetts. Governor Deval Patrick signed the Fiscal Year 2011 budget into law that day, and budget bill included creation of a Substance Abuse Treatment Fund in the Department of Public Health. Proceeds from the alcohol sales tax -- about $110 million this year -- will go into the fund and ensure secure revenues for these critically important services that help more than 100,000 Massachusetts residents.

Association for Behavioral Healthcare Statement on FY 2011 Budget

2010-06-25T06:53:00.000-07:00

The Association for Behavioral Healthcare is pleased that the Legislature level-funded some of the most critical behavioral health services provided by the Commonwealth in the FY 2011 budget. In particular, the budget largely protects from cuts essential community-based mental health and substance use disorder treatment services.

The budget plan reflects a fiscally responsible approach to the unique circumstances surrounding the stalemate in Washington over the so-called FMAP reimbursement funds, which could result in an unanticipated $650 million state budget cut. Legislative leaders established a contingency fund that would allocate FMAP funds if and when they become available.

The Legislature also established a separate Substance Abuse Treatment and Prevention Fund, which will collect all proceeds from the alcohol sales tax and dedicate the funds for addiction treatment, prevention and recovery programs that benefit more than 100,000 people in Massachusetts. This marks a significant step forward that will establish a reliable funding source for important public health services.

ABH urges Governor Patrick to sign the budget passed by the Legislature and create the Substance Abuse Treatment and Prevention Fund.

Poll Shows 58% of Public Oppose Alcohol Tax Repeal

2010-06-08T14:05:00.000-07:00

For Immediate Release Contact: Jim McManus
617-5230038
Jim@sloweymcmanus.com

Poll Shows 58% of Public Oppose Alcohol Tax Repeal
Hundreds Rally at State House to Support Dedicated Treatment Fund
Boston, MA -- June 8, 2010 – By a wide margin, Massachusetts voters oppose repealing the alcohol sales tax, according to a poll released today by the Campaign for Addiction Prevention, Treatment and Recovery, a group of more than 125 public health and behavioral health organizations from across the state that oppose the alcohol tax repeal.
The sales tax on alcohol retail sales is being challenged through a ballot initiative supported by package store owners in November that would repeal the tax.
“Massachusetts residents clearly see the importance of using the alcohol sales tax to support public health services for youths and families,” said Vic DiGravio, and Maryanne Frangules, Co-Chairs of the Campaign. “It is also clear that people understand that the state needs revenues, and there should be no special exemption from the sales tax for alcohol.”
DiGravio is president of the Association for Behavioral Healthcare. Frangules is executive director of Massachusetts Organization for Addiction Recovery.
The poll results were released today at a State House press conference and rally to support creation of a dedicated fund for proceeds from the alcohol sales tax. In the budget for Fiscal Year 2011, the House and Senate created a Substance Abuse Prevention and Treatment Fund, which will dedicate alcohol tax proceeds to such services. The tax is expected to bring in $110 million in its first year.
More than 300 people gathered at the State House today to demonstrate support for the Fund and the services it funds. The supporters heard from Campaign organizers, Senator Steve Tolman (D-Brighton), a major proponent of the Fund in the Legislature, and individuals who are in recovery from alcohol addiction.
Robert L. Monahan, PhD., president of the Recovery Homes Collaborative, spoke at the press conference, along with Elizabeth Rodriquez of Methuen and a student from the Recovery High School in Boston, two consumers who receive services funded in part by the alcohol tax.

The opinion poll released today shows deep and broad opposition to repealing the tax. Sixty-eight percent of women and 49 percent of men said they opposed repeal of the alcohol sales tax. Six percent were undecided.
The poll surveyed the opinions of 450 Massachusetts voters from May 3-5. The margin of error is 4.5 percent. It was conducted by Anderson Opinion Research of Boston.
The poll asked voters: “If the election were held today, would you vote yes or no on a ballot question to remove the state sales tax on alcoholic beverages?”
“There’s strong support for the alcohol tax across the state,” said DiGravio and Frangules. “By using language designed to elicit voters’ attitude toward this specific tax, we were able to obtain an accurate picture of peoples’ attitudes toward the alcohol tax.”
Other findings:
· Democrats oppose the alcohol tax repeal by 72 percent to 21 percent;
· Republicans support the alcohol tax repeal 47 to 45 percent
· For the general sales tax ballot question, which would roll back the state sales tax from 6.25 to 32 percent, 55 support the rollback, and 38 percent are opposed. Six percent are undecided.
During the recent state budget debate, the Campaign supported creation of the dedicated Fund for alcohol tax proceeds. The Fund would become law when Governor Patrick signs the Fiscal Year 2011 budget.
“The Senate and the House of Representatives kept faith with the people of Massachusetts by establishing the Fund for the alcohol tax, to make sure proceeds go to public health and treatment programs,” said DiGravio and Frangules. “We urge the Governor to sign the Fund into law and create a stable funding source for these critical programs.”

###

The Campaign for Addiction, Prevention Treatment and Recovery's Statement on Senate Ways and Means Committee Budget

2010-05-20T09:19:00.000-07:00

May 19, 2010

In today's Ways & Means Committee budget, the State Senate demonstrated its commitment to preserving addiction prevention and treatment and services for more than 100,000 Massachusetts residents. Critical programs across the state, from youth intervention and residential treatment services to jail diversion and counseling programs, were funded at sufficient levels in the Senate spending plan for the upcoming fiscal year.

In addition, the Senate, like the House, created a separate Commonwealth Substance Abuse Treatment and Prevention Fund that will ensure proceeds from the retail tax on alcohol are dedicated to these services. We applaud Senate President Murray, Chairman Panagiotakos and the Committee for establishing the Fund and making clear their determination to protect alcohol tax revenues for worthwhile public health and safety services.

Until last year, alcohol sold in stores was exempt from the sales tax just like basic necessities such as food, clothing and prescription medications. The legislature rightly repealed that special tax break and used the proceeds to protect vital public health programs that promote treatment and recovery.

The alcohol retail sales tax, which will bring in $110 million in its first year, is a badly needed source of revenue that supports critically important programs. We appreciate the efforts of the Senate to preserve programs that have such a positive benefit for thousands of families across the state.

Taunton Gazette Guest Opinion: Alcohol tax helps save lives at prom season

2010-05-17T08:32:00.000-07:00

GUEST OPINION: Alcohol tax helps save lives at prom season
By Vic DiGravio and Maryanne Frangules
May 13, 2010

Across Massachusetts, tens of thousands of high school juniors and seniors — including a couple hundred in Taunton tonight — are engaged in the time-honored traditions associated with the prom. Choosing dresses, renting tuxedos, washing cars, buying corsages — it's a rite of passage that provokes anxiety for everyone concerned. Especially parents.

Safety has always been a prime concern around prom season, because many teens associate prom with drinking — frequently binge drinking. And far too many, still, end up getting behind the wheel of a car after consuming alcohol.

Local school and law enforcement officials are reaching out to thwart drunk driving around prom season by an aggressive campaign of education and prevention. In Norfolk County, the Avon Coalition for Every Student released a survey showing that alcohol-use and binge drinking rates have dropped in recent years. While those numbers remain too high, the survey may help alleviate peer pressure by showing that not everyone drinks.

In Western Massachusetts, the Pittsfield Prevention Partnership, in collaboration with MADD Massachusetts, will launch the Prom Season Sticker Shock Campaign at area liquor stores.

The campaign consists of teams of young people, accompanied by an adult chaperone, placing stickers on multi-packs of alcoholic beverages (beer, wine coolers, etc.) and paper bags at participating package stores. The stickers read, “Hey You!! It is ILLEGAL to provide alcohol for people under 21!”

These and many other programs at the state and local level received a boost last year with passage of the alcohol sales tax at retail stores. The tax will bring in about $110 million this year — a drop in the bucket weighed against the billions of dollars in lost productivity, healthcare, counseling and law enforcement costs tied to alcohol and drug abuse.

The retail sales tax on alcohol funds services targeting underage drinkers such as the substance abuse hotline, youth intervention services, residential programs and recovery homes and driver education classes following OUI arrests.

For underage drinkers, alcohol’s toll is tragic. Recent federal statistics show that Massachusetts is among the highest of all states for past month’s alcohol use by underage drinkers — 32.1 to 40.5 percent of 12 to 20 year olds — and that 8.4 to 10.1 percent of those youth purchased the alcohol themselves.

Underage drinking remains a serious problem and requires constant vigilance by families, local and state officials. According to the
most recent data for Massachusetts students in grades 9-12:

• 46 percent had at least one drink of alcohol on one or more occasion in the past 30 days;

• 28 percent had five or more drinks of alcohol in a row (i.e. binge drinking) in the past 30 days;

• 5 percent had at least one drink of alcohol on school property on one or more of the past 30 days.

Despite the ongoing social, healthcare and law enforcement problems associated with addiction, the alcohol industry is pushing a
ballot question this fall to repeal the alcohol retail sales tax.

Those who have struggled with addiction understand that youths need all the help they can get to avoid destructive behaviors. We
need the resources to provide that help, and the alcohol retail sales tax is part of the solution.

Vic DiGravio and Maryanne Frangules co-chair the Campaign for Addiction Prevention, Treatment and Recovery, which seeks to retain the retail sales tax on alcohol.

GUEST OPINION: Alcohol tax helps save lives at prom season - Taunton, MA - The Taunton Gazette

2010-05-17T08:31:00.001-07:00

GUEST OPINION: Alcohol tax helps save lives at prom season - Taunton, MA - The Taunton Gazette

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Mass. House Budget Debate Starts Monday April 26

2010-04-23T10:53:00.000-07:00

As the House of Representatives begins debate on the budget, ABH asks that you contact your Representative(s) in support of ABH's priorities. The debate is expected to begin on Monday and end Thursday, April 29, so now is the time to take a few minutes to show your support.

Action Requested

Ask your Representative to oppose the following amendments:

-- Amendment 40, which would eliminate the Substance Abuse Prevention and Treatment Fund. This fund is created by the House Ways and Means FY 2011 budget and is credited with sales tax revenue from the sales tax on alcohol.

-- Amendment 43, which would eliminate the sales tax on alcohol. The sales tax on alcohol is estimated to raise about $110 million to support substance abuse treatment and prevention. In addition, using taxes to raise prices on alcohol is among the most effective deterrents to drinking and underage binge drinking that researchers have discovered; it is better than law enforcement, media campaigns or school programs.

Ask your Representative to support the following amendments:

-- Amendment 604, to restore $3.2 million to the Department of Mental Health Adult Community Services account (line item 5046-000). $3.2 million would provide funding for the P.A.C.T. (Program for Assertive Community Treatment) teams in Metro Boston and Western Massachusetts Homeless Community Support/Emergency Psychiatric Services;

-- Amendment 447, Amendment 469, and Amendment 530 to restore funding for the human services salary reserve. The salary reserve would be funded at $28,000,000 and would allow for modest but essential salary increases for human service workers earning less than $40,000.

Log on to http://capwiz.com/mhsacm/home/ for more information.

Kudos!

2010-04-16T10:50:00.000-07:00

Kudos to House Ways & Means Chairman Charles Murphy and the House Ways & Means Committee for proposing a separate Substance Abuse Prevention and Treatment Fund to dedicate proceeds from the alcohol sales tax to vital public health programs. It costs the state nothing, safeguards spending for alcohol and substance abuse treatment services, and defuses critics who say the state will spend the money elsewhere.

Nationally, only 10 percent of individuals in need of addiction services actually are in treatment. The alcohol sales tax addresses some of that gap by creating a funding source for new problems.

For the thousands of people in Massachusetts whose families have been affected by addiction, the Substance Abuse Prevention and Treatment Fund is smart public policy and sound health policy.

2010-04-13T16:01:00.001-07:00

The next frontier in health care reform is controlling costs, and Global Payment Reform appears to be on the agenda in Massachusetts. At yesterday's Association Meeting in Worcester we hosted a panel on "Global Payment Reform: How Will It Impact Behavioral Health Providers in Massachusetts?"

Sarah Iselin, CEO of the Blue Cross Blue Shield Foundation, and Amy Whitcomb Slemmer, Executive Director of Healthcare for All, outlined their respective visions for the near term future of payment reform. They did a great job, particularly in the lively Q&A section of the forum. Many members expressed reservations about the prospects for behavioral health under potential reforms.

ABH has outlined four core points as the GPR debate progresses:

1. Behavioral healthcare is a core service and any changes must include systems that allow for better integration of primary and behavioral healthcare.
2. Cost of care considerations must take account of the prevalence of co-morbid medical illness in individuals with substance use disorders and mental illness.
3. Accountable Care Organizations must protect the interests of the most vulnerable populations, including adults and children with behavioral health disorders. Inclusion of community-based behavioral healthcare providers is essential in healthcare system redesign.
4. The transition to a new payment system must be carefully implemented and adequately funded.

Stay tuned for more on this debate in the coming months.

Statehouse Rally Backs Expanded Treatment Services

2010-04-13T03:58:00.000-07:00

If you passed by the State House late yesterday morning, you may have noticed a gathering of public health advocates. Yesterday's rally at the State House was a big success. Dozens of people from across the state came to show their support for S.2281, a legislative proposal aimed at tackling the growing opiate epidemic in Massachusetts. The rally took place in advance of the Congressional Administrative Law Subcommittee's hearing to review the Oxycontin and Heroin Commission's recently released recommendation to address substance abuse issues nationwide.

During the rally, I had the privilege of introducing State Sen. Steve Tolman, (D-Brighton), who sponsored the bill and chaired the Oxycontin and Heroin Commission. Sen. Tolman has aggressively pursued the development of local and state policies to increase awareness of the crisis and the need for more addiction treatment services.

The bill is supported by a report released last November by the Oxycontin and Heroin Commission. While support for addiction treatment programs has increased, the close to 3,300 opiate-realted deaths (from 2002-2007) is proof that we have not sufficiently met the needs for this growing problem. Today's event showed that, with the support of the community and legislative leadership, we can tackle this problem.

2010-03-29T12:44:00.000-07:00

Third from left, ABH's Stephanie Hirst, Senior Director, Public Policy and Research, and Vic DiGravio, President, received the Award for Excellence in State Grassroots Advocacy from the National Council for Community Behavioral Healthcare in Orlando March 16, 2010.

Report from National Council for Community Behavioral Healthcare Conference

2010-03-22T07:28:00.000-07:00

Last week I attended the National Council for Community Behavioral Healthcare's 40th Annual Conference, along with approximately 15 representatives from ABH member organizations. The conference was three days of jam-packed plenary sessions and workshops. It was a great opportunity to hear from leaders from across the country on such issues as national health care reform, returning war veterans struggling with behavioral health disorders, integration of care, and payment reform.

Former Governor, presidential candidate and MD, Howard Dean, gave a very insightful speech about the politics and substance of health care reform. Trained as a primary care provider, Governor Dean spoke eloquently about the need to better align incentives for the integration of primary and behavioral health care. He clearly sees payment reform as a promising vehicle to accomplish this task.

A few folks from Massachusetts joined me at a riveting and moving session led by Marshele Waddell, the wife of retired Navy Seal Commander Mark Waddell. Mrs. Waddell spoke movingly of her husband's struggles with Post-Traumatic Stress Disorder after repeated deployments to Iraq and of the tremendous impact his struggles had on her and their children. Both Marshele and Mark now work with their local community mental health center in Colorado to help other veterans and their families confront the difficulties many veterans experience returning from war zones in Iraq and Afghanistan.

On a lighter note, I was honored to be joined by ABH board members Kathy Wilson and Norma Finkelstein, along with ABH Senior Director of Public Policy and Research Stephanie Hirst, in accepting an award for Excellence in Grassroots Advocacy at the Gala event on Tuesday night of the conference. ABH was recognized with this national award for our work in organizing and leading the Coalition for Addiction Prevention Treatment and Recovery and our successful effort to repeal the sales tax exemption on alcohol sold in stores. It was very exciting for ABH to be recognized in front of our colleagues from about the nation.

Cheaper in New Hampshire? You better check the receipt.

2010-03-08T11:01:00.000-08:00

It seems the alcohol sales tax has not had quite the dramatic effect on prices that some package store owners would have you think. A friend recently sent me two receipts from their favorite wine: one from Massachusetts, the other from New Hampshire. Both bottles were purchased in August -- after the Massachusetts tax took effect.

Here is what he paid for a bottle of Hess Select Cabernet Sauvignon, 750ml: 

Massachusetts: $13.80, after tax 

New Hampshire: $18.99, but it was on sale. Even with $4 off, the price was $14.99!  

So this consumer paid the Massachusetts alcohol sales tax, and still saved $1.19 on a single bottle of wine. He would have saved $5.19 a week later. In real life, the alcohol sales tax works for Massachusetts.

ABH testimony on Fiscal Year 2011 budget before House Ways & Means Committee, March 5, 2010

2010-03-08T10:23:00.000-08:00

On behalf of the membership of the Association for Behavioral Healthcare (ABH), formerly Mental Health and Substance Abuse Corporations of Massachusetts, thank you for the opportunity to comment on the FY 2011 budget. As you know, ABH is a statewide association representing ninety-one community-based mental health and substance abuse provider organizations. Our members are the primary providers of publicly-funded behavioral healthcare services in the Commonwealth, serving approximately 117,000 Massachusetts residents daily and employing 22,000 people.

While we realize that you will be faced with many difficult decisions in the coming weeks and months, we strongly urge you to hold community-based mental health and substance use disorder services harmless from further cuts.

STABILITY FOR COMMUNITY SERVICES
Lack of access to critical health care services remains a significant barrier to preventing and treating health disorders before they intensify and require costlier treatment in more intensive settings. ABH providers know from experience that access barriers to community-based mental health and substance use disorder services can be debilitating or even fatal.

While we have been encouraged by the Legislature’s recognition of the importance of community mental health and substance use disorder services, the community behavioral healthcare system has not yet recovered from the budget cuts of a few years ago, not to mention the mid-year cuts sustained in FY 2009. Thousands of individuals and families are not able to access services and supports for mental health and/or substance use disorders. In light of this unacceptable situation, current levels of services must be maintained in order to ensure that individuals are able to access needed care and to provide stability for the community behavioral health system.

DEPARTMENT OF MENTAL HEALTH
The Department of Mental Health has cut funding for community based services by over $10 million during the current fiscal year, including the elimination of two Programs for Assertive Community Treatment (PACT) teams and a reduction of over $8 million in funding for Community Based Flexible Supports (CBFS) through the Department’s reprocurement process. Adequate funding is absolutely essential in order to ensure access to appropriate community services for clients who are being discharged from Westborough State Hospital and the inpatient unit at Quincy Mental Health Center and for the system to adjust to the new community based system of care (Community Based Flexible Supports). Therefore, preservation of funding for the Department of Mental Health (DMH) is essential in order to maintain treatment for individuals across the Commonwealth in need of mental health services. DMH offers individuals with mental illness many critical community-based services that are not available through MassHealth or private insurance, including CBFS, Clubhouses, PACT, and Respite.

We urge you to maintain funding for the DMH community accounts (line items 5042-5000; 5046-0000; 5046-2000; 5047-0001; and 5055-0000) in order to avoid a shift toward more expensive interventions such as emergency rooms, acute inpatient care and homeless shelters. In addition to maintaining existing services, additional funding for community based services will be required if the Department proceeds with further reductions to DMH inpatient capacity. According to the final report of the DMH Inpatient Study Commission, The community system must be strengthened. Community based services have been the heart of the DMH service delivery system for more than 30 years. Previous state hospital closings have succeeded as consumers were transitioned to high-quality services in or near their own communities. The community system, however, experienced significant mid-year “9C” budget cuts in October 2008. An investment of funding for community services is necessary for DMH to replicate the success of earlier hospital closings.1 Individuals affected by this will require intensive care if they are to be served in community settings. Currently, the community system does not have sufficient funding and resources to serve these individuals. Funding for community services must be increased dramatically to meet the needs of DMH clients who may be moved from hospitals to community settings in fiscal year 2011.

BUREAU OF SUBSTANCE ABUSE SERVICES The passage of the alcohol sales tax demonstrated a spirit of collaboration between the Legislature, the Administration and all citizens to use these new revenues to preserve funding for substance use disorder services and to retain access to treatment. We ask that the Legislature hold true to the intent of that legislation, and keep faith with the spirit of the initial proposal by dedicating the revenues to a Substance Abuse Health Protection Fund to provide funding or supplement existing funding for a comprehensive continuum of substance abuse care. The need for such a fund has become even more urgent given that the initiative petition to repeal the sales tax on alcohol has received enough signatures to appear on the November 2010 ballot.

Furthermore, we strongly urge you to preserve existing funding for the DPH/Bureau of Substance Abuse Services (line items 4512-0200, 4512-0201, 4512-0202, and 4512-0203). As it stands now, the demand for substance use disorder treatment exceeds capacity and during difficult economic times, demand for treatment increases. In times such as these, it becomes even more essential to protect substance use disorder treatment and services. When funding for treatment is cut, access to treatment is reduced, and the state will end up paying more to serve these clients in emergency rooms, our court system and prison beds.

MASSHEALTH BEHAVIORAL HEALTH
As you know, Medicaid finances medically necessary behavioral health services for individuals and families and helps ensure stability for some of the most vulnerable individuals in our society. For example, MassHealth psychiatric day treatment services provide essential services for individuals being discharged from state hospitals and help ensure that individuals are able to remain in their communities. In addition, MassHealth behavioral health services also include vital substance use disorder services for individuals across the Commonwealth.

As you know, service implementation for the Children’s Behavioral Health Initiative (CBHI) is underway. As the state continues to work to develop this new system, funding is necessary to ensure successful implementation of the Rosie D. court order. This funding is essential to strengthen our community-based mental health system to better serve children living with Severe Emotional Disturbance (SED) in Massachusetts.

Furthermore, behavioral health services must continue to be exempt from MassHealth co-payments. We are concerned that increased cost-sharing will limit access to care. While this issue affects all individuals with significant healthcare needs, it is particularly burdensome for those with behavioral health needs because treatment is often necessary several times per week, as is the case with medication management in conjunction with therapy services, or even daily, as is the case with methadone maintenance treatment. MassHealth outpatient services will be one of the core services for CBHI and co-payments will serve as an additional barrier to treatment. In addition, children’s services routinely involve multiple family members in successive visits, and multiple co-payments can be an insurmountable economic burden for some families. If cost-sharing becomes a major obstacle, individuals will be forced to wait until the illness is more acute, resulting in increased use of higher, costlier levels of care. High out-of-pocket costs will only serve to prevent necessary treatment and exacerbate the stigma faced by individuals with behavioral health disorders.

MassHealth behavioral health services do more than keep ill people off the streets; they keep people alive. As such, the Commonwealth must take steps to ensure that these valuable services continue to be available to the state’s residents.

IMPLEMENTATION OF CHAPTER 257 OF THE ACTS OF 2008
Chapter 257 of the Acts of 2008 (formerly S. 2764) must be adequately funded. At a minimum, we ask that you include a reserve account to fund potential rate increases for the portion of the purchase of service system whose rates must be adjusted by October 1, 2010. Adequately funding Chapter 257 must be a priority and is essential in order to address currently underfunded existing contracts and improve the precarious condition of many provider organizations.

Human Services Salary Reserve
While we recognize that implementation of Chapter 257 will, over time, rectify the fact that human service employees are too often among the Commonwealth’s working poor who struggle to meet basic needs; we are asking you to level-fund the salary reserve at $28 million until the new law is fully implemented. This is a modest request to assist direct support staff making less than $40,000 per year as they struggle with the condition of our state’s economy.
If you have any questions or comments, I am happy to address them at your convenience. Thank you for your consideration.

Positive effects of the new alcohol tax: Letter to the Editor in Brockton Enterprise

2010-02-12T07:14:00.000-08:00

February 10, 2010:

In a Jan. 30 Enterprise article on the state alcohol tax, it was declared, "If you bought a six-pack of Sam Adams or a bottle of chardonnay at a store in the past six months, you've probably noticed this tax." But what they may not have realized are the positive effects of the alcohol tax.

Due to the revenue generated from the alcohol sales tax, access to alcohol and drug addiction treatment services has not been significantly reduced this year. This is vitally important because even when the economy was strong, the funding for alcohol and drug treatment services was severely inadequate in meeting the needs of the Commonwealth's citizenry.

Indeed, our agency, High Point Treatment Center, turns away individuals and families seeking services every day due to lack of resources to expand the number of treatment beds and counseling services. Last year alone in the City of Brockton, we admitted more than one thousand individuals for substance abuse treatment services to our community-based program. Sadly, we turned away hundreds more. Simply put, the alcohol tax ensures ongoing access to treatment services.

Often, out of desperation, due to a lack of enough community treatment beds, more families are finding themselves with no other recourse but to turn to the courts for assistance. Last year, more than 1,600 men and women were civilly committed by the courts to High Point.

According to recent Dept. of Public Health data, over 100,000 Massachusetts residents availed themselves of addiction treatment services. It is reasonable to state that for every person treated, at least 10 people who care about that individual are also affected. Ultimately, over a million people are therefore impacted.

The small alcohol sales tax (which still puts our tax rate lower than most New England states) serves an important purpose. Hopefully, through education, the consumer purchasing that six-pack of beer or bottle of chardonnay will agree that the alcohol sales tax is a small price to pay for the enormous positive effects on our state.

Daniel S. Mumbauer,
President & CEO
High Point Treatment Center
Brockton

Thoughts on the Governor's 2011 Budget

2010-01-27T18:14:00.000-08:00

Governor Patrick released his Fiscal Year 2011 budget recommendations today. For those of us interested in community-based behavioral healthcare it appears that the Governor’s budget recommendations contained some fairly good news. Existing community-based services for individuals with mental illness and/or substance use disorders seem to have escaped cuts in the Governor’s budget. This also applies to essential services funded by MassHealth.

Unfortunately, other human service programs were not quite as fortunate. We share the concern of many in our industry about the impact of proposed cuts in services for other vulnerable populations.

We all need to be prepared for a long, tough budget fight as the Legislature reviews and acts on the Governor’s recommendations. In a tough election year, legislators will be under a lot of pressure to limit state spending. Advocates, providers, consumers and family members need to be prepared to remind local legislators about the importance of programs that serve individuals with behavioral health needs. ABH looks forward to working with our members and coalition partners to protect existing funding for DMH, DPH/BSAS, and MassHealth.

Happy New Year?

2010-01-08T15:57:00.000-08:00

As the new year gets under way, we're looking ahead at some exciting challenges. Later this month, the Governor will unveil his Fiscal Year 2011 budget plan. Once again, the state budget will be tight. Although revenue trends began to improve at the end of 2009, mental health and substance use disorder programs are facing significant reductions in funding for the new fiscal year that starts on July 1.

Also, we have the very real prospect of a ballot campaign, organized by the state's package store owners, to repeal the sales tax on alcohol sold in retail stores. ABH will be on the front lines of that battle.

It took decades to get the sales tax exemption for package stores repealed, and we're not going backward now! The Legislature must act on the alcohol tax repeal measure by May 4. If they do not vote, or vote it down, then proponents can gather another 10,099 signatures to secure a spot on the ballot November 2.

All in all, it appears 2010 will be busy year. We welcome and appreciate your help!

Boston Globe explores impact of PACT budget cuts

2009-12-19T09:24:00.000-08:00

This poignant story from The Boston Globe about a PACT consumer in Chelsea shows the real-life impact of state budget cuts on Massachusetts residents. The Governor and Legislature can still save this important program.
Yesterday, we learned that state tax receipts are on the rise. If cost-effective programs life PACT are eliminated, the impact in the coming fiscal years will be enormous.

http://www.boston.com/news/local/massachusetts/articles/2009/12/19/more_than_100_people_have__benefited_from_a_hospital__without_walls_but_state_cuts__are_threatening_their_gains/

2009-12-18T12:10:00.000-08:00

Lobby Day to SAVE PACT SERVICES

2009-12-15T18:12:00.000-08:00

Today's State House Lobby Day was a huge success -- more than 100 people from Springfield, Boston and other parts of the state came to lobby to save the PACT services with legislators. Our rally also coincided with publication of a comprehensive story in the Springfield Republican (http://www.masslive.com/news/index.ssf/2009/12/patricia_dickson_of_springfiel.html) that will help to increase awareness of this critical program. Thanks to North Suffolk and CHD, our other ABH members and our friends at MPOWER and NAMI for helping to organize the rally today.

It was especially heartening to see so many consumers turn out to help put a face and a story to this effort. Legislators and the Governor's office need to understand that these short-sighted budget cuts will harm real people.
Now, get those postcards and emails in!

The new state sales tax in alcohol sold in stores is working

2009-12-07T14:18:00.000-08:00

From the Boston Business Journal: “The DOR said a decision earlier this year to increase the state’s sales tax rate to 6.25 percent from 5 percent and the elimination of a sales-tax exemption for alcohol sales contributed to around $88 million in new tax revenue in November. Without those changes, November’s total tax collections would have fallen by around 4.5 percent on a year over year basis, according to figures reported by the DOR.”

So the bad revenue news would have been worse without the new alcohol tax and increased sales tax. Despite the obvious need for funds to buttress badly needed services, the package store owners continue with their campaign to repeal the measure. They gathered enough signatures to move forward toward the November 2010 ballot.

Alcohol tax repeal campaign clears first hurdle

2009-11-30T19:05:00.000-08:00

According to news reports, the Massachusetts Package Store Association has collected enough signatures to place a question on the ballot in 2010 that would ask voters to repeal the sales tax on alcohol sold in retail stores. The association relied on volunteers and paid help to gather 115,000 signatures – more than enough to make the ballot. After the signatures are certified by city and town clerks, they must be delivered to the Secretary of State by December 2.

The 6.25 percent tax on alcohol was passed this summer a statewide advocacy effort by the Campaign for Addiction Prevention, Treatment and Recovery, which consists of over 70 organizations across the state. This year, in the midst of unprecedented state budget pressures, the proceeds from this revenue stream helped preserve critical services for individuals struggling with substance use disorders. Rolling back the alcohol tax would be irresponsible fiscally, and harmful to the cause of substance abuse prevention and treatment. We will follow this effort to undo a successful public health initiative very closely in the coming weeks.

2 PACT services facing cuts

2009-11-22T13:28:00.000-08:00

As I mentioned on Thursday, vigilance is critical in order to preserve specific mental health services in the coming months. On Friday, we learned that DMH has targeted for elimination PACT (Program for Assertive Community Treatment) programs at North Suffolk Mental Health in Chelsea and the Center for Human Development in Springfield. Each program works with 55-65 adults with severe mental illnesses, providing them the supports they need to live in their communities.

These individuals have not been able to engage in more traditional services such as outpatient and community rehabilitative services. They live independently in the community (not in residential programs) and the PACT team works with them 24/7 to help support their recovery and success in the community. PACT provides psychiatry, nursing, medications, vocational support, housing assistance and outreach. The program costs about $50.00 per day per client – the two contracts set to be eliminated total a little over two million dollars. There is not an appropriate substitute service or set of services for these very ill and very vulnerable individuals.

The PACT programs are being terminated as part the “swap” for the DMH case manager layoffs that were rescinded by the Governor’s office in an agreement with SEIU 509 earlier in the week. There are just 12 PACT teams in the state, with a new one starting up soon in Beverly.

The elimination of these PACT teams will severely impact the ability of consumers to remain living independently in their communities. The Department of Mental Health does not have alternative programs available to adequately meet the needs of affected consumers. Community Based Flexible Supports (CBFS) do not have the capacity to provide the intense level of nursing and psychiatry and other supports that PACT provides for these clients.

This is a classic case of making short-term budget cuts that will have much greater long-term costs in other social service and healthcare programs. There are other ways to trim costs from the state budget than to eliminate services that provide crucial community supports for the most vulnerable residents of Massachusetts.

Holding the line on funding for mental health and substance abuse services

2009-11-19T07:10:00.000-08:00

The past six weeks has been filled with great uncertainty for community-based mental health and substance abuse treatment providers. Fears of mid-year “9C” budget cuts has kept many providers and consumers up nights worrying about impending cuts to services funded by the Department of Mental Health, the Department of Public Health/Bureau of Substance Abuse Services, and MassHealth.

Fortunately, community-based treatment services were relatively spared from 9C cuts this time. This has been a great relief to members of the Association for Behavioral Healthcare and the consumers with whom we work. Our members feel particularly fortunate when we see the struggles of some colleagues and friends in other parts of the human service world.

There are many reasons why community-based mental health and substance abuse services were spared during this round. The ongoing advocacy of ABH members and our coalition partners such as NAMI – Massachusetts, the Massachusetts Clubhouse Coalition, M-Power, MOAR, and the Recovery Home Collaborative certainly played a role in reinforcing for Governor Patrick and the Legislature the vital role community-based services play in promoting recovery.

Governor Patrick deserves credit for not cutting substance abuse treatment services and thereby honoring commitments to advocates who pushed for the repeal of the sales tax exemption on alcohol. The Governor kept faith with the Campaign for Addiction Prevention, Treatment and Recovery by making sure new revenue was dedicated to expanded treatment.

Health and Human Services Secretary JudyAnn Bigby deserves credit as well for being a forceful advocate for community-based services. Her commitment to preserving community services for individuals living with mental illness as the Commonwealth shuts down state hospitals demonstrated her commitment to Community First.
The Legislature deserves credit for preserving access to vital MassHealth services for people with behavioral health needs such as Day Treatment and Clinical Stabilization Services.

In spite of all this, there are many potential pitfalls ahead of us. The Governor may need to implement further 9C cuts later in this fiscal year. And the outlook for fiscal year 2011 looks even bleaker. State agencies are preparing for potential cuts in the range of 12 – 15%.

So the message we must take away from the past weeks is that while we successfully avoided devastating cuts so far this year, this may only be a temporary reprieve. We need to stay vigilant and continue to educate Governor Patrick and the Legislature about the importance of community-based care. We need to continue to publicize the wonderful work all of ABH members are doing on a daily basis.

I look forward to hearing your thoughts on the past six weeks and the challenges facing us in the months ahead.

Welcome!

2009-11-09T08:23:00.000-08:00

Welcome to the new Association for Behavioral Healthcare (ABH) blog!

As we launch the new name and identity of our organization (formerly the Mental Health and Substance Abuse Corporations of Massachusetts, Inc.) we also begin to engage with the online community in a more direct manner through this new blog. We hope to establish an invaluable forum for people to turn to for information and perspectives on public policy issues relating to behavioral healthcare in Massachusetts.

Engaging with online advocacy and healthcare communities will enable ABH to amplify its presence and impact. We are excited about the opportunities that open up as our advocacy group enters the online conversation.

Inevitably, the backdrop of our new organizational initiatives is colored by the economic conditions that have sharply reduced public spending in Massachusetts and across the country. Knowing that we are not alone is cold comfort to the tens of thousands of Bay State residents who have had services cut, or who have lost access to critically important programs and counselors.

ABH is working with Legislators and the Executive agencies to shore up spending on these programs. The sales tax on alcohol -- one of our core policy initiatives for 2009 – has helped fund crucial programs at the Bureau of Alcohol and Substance Abuse Services.

We look to better times in the near future, and new models and ideas for delivering services in the coming year.

Meanwhile, we invite you to explore the resources on this blog, share links and information, and pass the word about ABH.

-- Vic DiGravio