Sunday, November 19, 2006

Awful news in mental health

I just read this notice from the Massachusetts Hospital Association:

"Department of Mental Health Commissioner Beth Childs has just informed MHA that, effective Wednesday, November 22, 2006, DMH will no longer accept inpatient admissions to any state DMH hospital or unit. In addition, DMH will restrict access to its residential programs. The Commissioner indicated that this action is being taken due to Governor Romney's recent 9C cuts to the DMH budget. This action will have a far-reaching negative impact across the entire health care system."

This is deeply troubling. Please understand that the state's funding for mental health programs was in no way overly generous before these cuts. We and others had already seen an overflow of violently disturbed patients from state facilities into our own hospitals, patients who were putting themselves, other patients, and caregivers in physical danger.

In the posting below, I termed the Governor's words on another topic to be "nasty." As I read the items in italics below, I realize that my focus on his speeches was misplaced and distracting from something far more important. Here, we are not discussing rhetoric: We are facing executed deeds. It makes me incredibly sad to be in a state where these actions would be taken. Read the items below and tell me if you agree.

Here is a detailed description of the cuts made by the Governor, sent to me by our chief of pyschiatry:

5011-0100 Administration 9C Cut $454,289
Elimination of 17 DMH staff positions, effective January 28th. Identified personnel positions include Central Office and Area program managers, licensors, housing coordinators, quality assurance staff, and managers who oversee services. As a result of significant staff reductions in previous fiscal years, these staff reductions will severely impact DMH’s ability to manage and operate ongoing client care functions.


5042-5000 Child/Adolescent 9C Cut $844,668
Elimination of 40 DMH positions comprising 37% of the DMH employees who provide direct care to children and adolescents in the community. 880 seriously emotionally disturbed children, adolescents, and their families will no longer receive case management services. Children/adolescents who are clinically screened for DMH continuing care inpatient/community services will wait longer in acute psychiatric settings, and there will be an increase in out of home placements. The affected employees are the linchpins of the child-adolescent system. They play a critical role in assuring that services from multiple providers are coordinated such that the child/adolescent’s mental health needs and all related issues, such as substance abuse, medical problems and educational problems are addressed.


Reduction in case management revenue in Fiscal Year 2007 of $600,000.
5046-0000 Adult Mental Health Services 9C Cut $1,900,000
Elimination of DMH research funding currently provided through contracted services with university medical schools. The DMH funding leverages over $10 million in external funding to support these programs. The direct service impact will be:
150 individuals with early signs of major mental illness who received treatment currently supported in research protocols will be terminated from the treatment protocols; elimination of training in crisis management; 90 families will lose supports and interventions for dealing with parental mental illness; and service system evaluations capacity will be eliminated.
Termination of 96 individuals from residential supported housing services providing essential in home supervision and supports. These supports include medication management, maintaining activities of daily living, maintenance of employment and housing. The residential services and supports currently enable these adults to effectively manage their symptoms and enhance their functioning, so they can live independently. Without residential supports many clients run a substantial risk of becoming homeless. This cut will lead to a shift toward more expensive interventions such as emergency rooms, acute inpatient care and homeless shelters.
This reduction will result in a loss of rehab option revenue in Fiscal Year 2007 of $390,000.

5046-2000 Homeless Services 9C Cut $ 260,098
5047-0001 Emergency Services and Community 9C Cut $ 369,812
5047-0002 Retained Revenue 9C Cut $ 787,427
The reduction in the three accounts listed above amounts to $1,417,337 in reduced funding. This will result in 243 individuals being terminated immediately from residential supported housing services. These individuals will lose essential in home supervision and supports. These supports include medication management, maintaining activities of daily living, maintenance of employment and housing. The residential services and supports currently enable these adults to effectively manage their symptoms and enhance their functioning, so they can live independently. Without residential supports many clients run a substantial risk of becoming homeless. This cut will lead to a shift toward more expensive interventions such as emergency rooms, acute inpatient care and homeless shelters.
This reduction will result in a loss of rehab option revenue in Fiscal Year 2007 of $552,762

5055-0000 Forensic Mental Health 9C Cut $500,000
Elimination of 9 FTE clinicians in Adult Court Clinics and 6.1 FTE clinicians in the Juvenile Court Clinics. Loss in will result in inability to provide needed evaluations and consultations to 6,942 adults in the District and Superior Courts and 366 children, adolescents and families in the Juvenile Court. Additional expected impact includes increased inpatient hospitalizations for statutory evaluations; increased reliance on DYS detention and adult bail incarceration, and increased utilization of adult detox services (particularly MASAC and Framingham State Prison)


5095-0015 Adult Inpatient Facilities 9C Cut $1,909,961
Reduction in DMH inpatient staffing in two critical areas: 57 direct care staff (nurses, and mental health workers) will be eliminated at the DMH operated continuing care inpatient facilities; and a reduction of 16 psychiatrists funded through Comprehensive Psychiatric Services contracts.
Direct Care and Psychiatrist staffing cuts at this level would jeopardize DMH’s JCAHO Certification and our ability to meet the Medicare/Medicaid Conditions of Participation. A cut of 16 psychiatrists will result in the lack of required attending physician capacity for 267 beds. DMH will therefore be forced to freeze all civil admissions to DMH inpatient facilities while it attempts to reduce its inpatient census. The simultaneous reduction in community services required by these 9C cuts grossly impairs DMH’s ability to discharge individuals safely.

12 comments:

Anonymous said...

My god. I feel physically ill. I'm a grad student in mental health counseling, and I did my practicum in a 10-bed residence for dually diagnosed women. This is monstrous. There is nothing between most of those women and freezing to death on a sidewalk but the charity of the state. They are mostly unemployed and unemployable, unable to even use a stove unsupervised, because (if nothing else) of the severe drowsiness that is a side effect of their maintenance meds. Words fail me.

Anonymous said...

I expect Patrick will cancel this as soon as he takes office.

Margalit said...

Ths is so distressing. I've dealt with the DMH for youth services and knowing that Mitt is planning to cut 37% of the almost non-existant budget is frightening. These kids NEED help, and their families need services that DMH provides to reenter the children back from residential treatment. It is criminal to cut this budget. I'll be posting about this on a national blog.

Paul Levy said...

I certainly hope that Gov. Patrick will reverse this, if he can, but I worry about people during the next two months.

Anonymous said...

I've been practicing mental health and guardianship law for 12 years and I've seen a lot of cuts. This is the first time I've felt physically sick over it.

One issue that utterly boggles my mind is the cut to children's mental health services. On January 30, 2006, Judge Posner, of the Federal District Court in Springfield, issued a strongly-worded order finding the Commonwealth in violation of Medicaid laws by failing to community-based services to children and adolescents in a manner which preserves their right to live in the least restrictive enviromnent most suited to their needs. The Commonwealth was ordered to expand DMH services. [http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=35074] or [http://www.mecf.org/articles/2205_2006-01-27.pdf]

I strongly suspect that if this matter is brought to his attention, Judge Posner will not hesitate to hold the Commonwealth in contempt and enjoin these particular programs from being cut. He already said that if the Commonwealth and the plaintiffs could not come to an agreement, he would order reforms himself. Paul -- I think you know something about the Commonwealth being ordered to do things they don't want to do. Your thoughts?

Paul Levy said...

I don't know anything about this aspect of the law, but I will pass along your thought.

Bwana said...

Today's Boston Globe reports that state psychiatric hospitals will stop accepting patients.

Here are some excerpts from the article that show the Romney Administration's approach was to treat this as a simple matter of placing the onus on the Department to run with a lower budget.

The decision to stop accepting new patients is viewed as a ploy to have funding restored.

What a cynical approach.

One can sympathize with the need to cut the budget -- Massachusetts requires a balanced budget, so there is, in effect no choice other than borrowing via bonds, etc. However, one would think that there would have been advance consultation to determine whether the budget cuts for this or any other department were realistic and could be implemented without diminishment of services as the Governor's spokersperson seems to assume.

<<"This is just a horrible Thanksgiving for people in the state who have mental illness," said Toby Fisher, executive director of the Massachusetts branch of the National Association on Mental Illness. "This will block up the entire mental health system."

Romney's spokesman, Eric Fehrnstrom, defended the cuts, and accused Department of Mental Health officials of resorting to a "Washington Monument" strategy to try to get out of reducing the budget: "You take something highly visible and shut it down, so the public will complain and funding will be restored," he said .

The agency should be able to absorb its 1.1 percent cut without reducing services, Fehrnstrom said.

"We think any good manager should be able to absorb a 1.1 percent cut through payroll and administration," he said, and budget specialists will work with the department "to put forward a more realistic plan.">>

Where were the budget specialists before the cuts were announced?

cheerz...Bwana

Anonymous said...

A horror and just another way that it's easy to victimize and stigmatize the mentally ill. Especially at the holidays when more people may need extra care. Thank God we've spoken through our votes to forego a tax reduction. This is where our money should be going...

Paul Levy said...

Today's notice from the MHA:

The Department of Mental Health (DMH) notified MHA this morning that it is holding off on closing admissions to state-operated facilities through the weekend.

DMH will provide a further update on Monday, November 27, and MHA will pass that information on to you.

Anonymous said...

As a teacher, the hardest aspect of my job is dealing with students who have untreated mental illness or substance addiction or both. Already, our school nurse is the primary health care provider for a significant percentage of our student body of 1,000 teens. How does Romney expect kids who are seriously ill survive, let alone pass MCAS?

Jesse said...

Mr. Levy,

I would be curious to hear your critique of the department 'closing its doors.' Surely there must be a more constructive way to deal with budget cuts, and you as a healthcare manager would have insight into this. It is my understanding that the entire budget was only cut by less than 2%. Is this correct?

Regardless, this is really too bad. Even as a fiscal conservative myself, I realize the need for federal funding for our most needy. However, I find it difficult to place 100% of the blame on Romney.

Paul Levy said...

It is a department that has been chronically underfunded even before these cuts. There is a point at which further cuts require that you just have to shut certain things down or remove certain services.

I know Commissioner Childs and know her to be an honorable and thoughtful person. I am guessing it is tearing her apart about having to cut these services, and I am guessing, too, that she considered many alternatives before making the choices she made.

BTW, this appears to be one of those cases in which you can place the entire blame on the governor. He personally decided which accounts should be cut.