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.
On the Issues, People & Organizations in Behavioral Health in the Commonwealth
Friday, July 1, 2011
Wednesday, June 1, 2011
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."
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."
Tuesday, May 24, 2011
Monday, May 23, 2011
Friday, May 20, 2011
ABH Statement on Senate Ways & Means FY 2012 Spending Plan
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.
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.
Tuesday, April 26, 2011
ABH Statement on House Budget
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.
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.
Friday, March 4, 2011
ABH Testifies on Critical FY 2012 Budget Items
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
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
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