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.