Nearly $85 million has been stripped from the Massachusetts Department of Mental Health budget since 2009.
The privately run Providence Behavioral Health Center in Holyoke, with only 24 beds available for children in need of hospitalization, is the only in-patient facility for youngsters in Massachusetts outside the Route 128 belt.Editor's Note: The New England Center for Investigative Reporting (NECIR) is a nonprofit newsroom based at Boston University.
By BEVERLY FORD
New England Center for Investigative Reporting
Twelve days after Jared Lee Loughner shot his way into the American psyche outside a Tuscon, Ariz., grocery store on Jan. 8, a 25-year-old mental health counselor in Revere was kidnapped from a group home and savagely killed, allegedly by one of her clients. Nine days later, it happened again when a homeless 19-year-old with a history of mental problems reportedly stabbed a shelter worker to death in Lowell, just 30 miles away.
No one can say for sure whether either murder had anything to do with funding cutbacks that have decimated the state's mental health budget, but on the front lines in the war on mental illness, counselors are concerned.
“If you have one woman (counselor) and five men with mental health problems, it screams to me of mental health cuts," Barry Sanders, a social worker for more than 20 years, says of the group home north of Boston where Stephanie Moulton was working when she was kidnapped and killed on January 20. “Having these kinds of staffing levels is like playing the odds, rolling the dice with someone's life.”
Across Massachusetts, mental health agencies are feeling the strain of cutbacks that have ripped nearly $85 million from the state's Department of Mental Health budget since 2009.
“It's been devastation. Complete and utter destruction and devastation. The entire mental health system is shredded,says Laurie Martinelli, executive director with the Massachusetts Chapter of the National Alliance on Mental Illness, a mental health advocacy and research group.
Massachusetts Department of Mental Health Commissioner Barbara Leadholm takes a more diplomatic stance.
Barbara Leadholm, commissioner of the Massachusetts Department of Mental Health.“We've had to make difficult budget decisions,” Leadholm says of the fiscal crisis that sent her department's budget into a rapid downward spiral, “but responsible fiscal management has kept our state on a path toward recovery and economic growth.”
In three years of cutbacks, Westboro State Hospital and Quincy Mental Health Center were closed, social clubs and day rehabilitation programs were slashed and employment services to help mentally ill workers find jobs were cut along with programs designed to teach them computer skills. Diversion programs for mentally ill teenagers, which kept them out of locked facilities while providing treatment, were also lost. Social workers saw their caseload increase substantially and sympathetic clinical workers treated patients for free rather than deny them much needed services. Meanwhile, the demand for mental health programs created a backlog for providers, often leaving patients on waiting lists for up to six months.
“It's a very fragile situation,says Timothy O'Leary, deputy director of the Massachusetts Association for Mental Health, an agency that works with individuals and families to help them access services. “There's a waiting list for virtually every service the department or its vendors offer. There's people waiting for housing, treatment, clubhouse services. When people with serious mental illnesses are not being treated, it's not a good thing for anyone.”
Yet, things could soon get worse.
A proposal by Gov. Deval Patrick would shave an additional $21.4 million from DMH's budget in fiscal 2012, leaving that department to operate on $606.9 million - its smallest budget in the last six years and more than $39 million less than its peak funding period in 2008.
If approved by the legislature, $2 million will be cut from child and adolescent mental health services, a reduction that is expected to affect 165 Bay State families. Some $3 million more will be slashed from adult mental health services, impacting 2,000 adults The biggest cut, however, is reserved for DMH's inpatient account where a $16.4 million reduction will wipe out 160 beds for those in need of hospitalization.
“The overall situation is pretty grim,” says State Representative Elizabeth A. Malia, head of the legislature's Committee on Mental Health and Substance Abuse. “If we lose more beds, the prisons get more crowded, the courts become busier, the emergency rooms get overwhelmed and families suffer. We're not moving in the right direction at all.”
Vic DiGravio has been through it all before. As president and CEO of the Association for Behavioral Health Care, which represents nearly 100 community care providers, he unsuccessfully lobbied against the 2008 budget cuts that eliminated day habilitation, social clubs and employment and education programs for the mentally ill. One year later, he fought budget reductions that led to the discharge of 200 patients from mental health facilities to community-based programs. In 2010, he unsuccessfully fought a $5 million cut in DMH funding which resulted in the closing of a 16-bed psychiatric facility in Quincy, MA. The shuttering of that facility left just 474 beds available at DMH-run hospitals, down from 938 beds just six years earlier in 2004. Today, with a loss of 160 in-patient beds looming on the horizon, DiGravio wonders if the budgetary bloodletting will ever end.
“The entire mental health system in Massachusetts is strained and fraying,” he says. “If we're not in a crisis now, we're pretty close to it.”
The loss of patient beds has been extremely troubling to providers and advocates who believed that as Massachusetts moved away from de-institutionalization, the state would provide support for community-based patient services. That hasn't happened. Instead, both groups say, funding for community programs has slowly evaporated, forcing many programs to vanish as well.
“There's no question there has been a disproportionate cut to adult services,says Marylou Sudders, president and CEO of the Massachusetts Society for the Prevention of Cruelty to Children and former commissioner of the state Department of Mental Health. 'The adult system is decimated. The safety net is shredded.”
The Edinburgh Center, which offers outpatient services to people struggling with severe mental illness, is a striking example of just how shredded that safety net is, advocates say.
In 2000, the center closed its outpatient facility in Woburn, MA. Two years later, it scaled down outpatient operations in nearby Arlington. By December, 2010, faced with cutbacks in health care reimbursements and a tottering economy, the center cut 11 clinician jobs in Waltham, MA leaving 350 patients searching for new care providers even as the demand for services was increasing.
The loss of outpatient services at the Edinburgh Center and at other mental health facilities has sparked a ripple effect throughout the Bay State, advocates say.
“People with mental health issues are really getting whacked,says Martinelli. We're seeing emergency rooms back up. People can't get services so they end up in prisons, on the street or in homeless shelters. Employment services with the Department of Mental Health have been eliminated as were social clubs where people with mental problems go to socialize and day rehabilitation programs where they could go for skill building.”
Malia says the cutback in mental health facilities such as crisis counseling centers has put a strain on hospital emergency rooms, where some mental health patients wait for days in emergency rooms because there are no beds for them. The state's prison budget is also growing exponentially due to an increase in the number of mentally ill inmates, she notes.
Those lucky enough to secure a hospital bed often must stay in facilities longer than expected because few vacancies exist at group homes or in community housing.
“People are stuck in hospitals, in continuing care facilities, People are waiting to get into programs. There's a waiting list for virtually every service the department or its vendors offer. There are people waiting for housing, treatment, clubhouse services. The whole system is clogged up,” says O'Leary.
In Western Massachusetts, the situation appears even more grim.
The former Northampton State Hospital property, as it looked in 2002.Public in-patient acute care treatment facilities don't even exist in western Massachusetts anymore. The last public hospital with an acute care mental health unit closed in 1990 in Northampton, says David Matteodo, executive director of the Massachusetts Association of Behavioral Health Systems. Now, patients needing immediate mental health care must rely on private hospitals in western Massachusetts, he says.
Rising costs and declining reimbursement rates paid to outpatient facilities have also forced the dismantling of many mental health clinics in the state's westernmost region, adds Dr. Steven Winn, a psychologist and vice president at Behavioral Health Network. That dwindling number of clinics along with a shortage of medical staff, often means patients must wait up to six months before they can seek treatment, he adds.
“The whole state is in a crisis,” Winn says.
Maneuvering the complex maze of mental health care issues can be confounding for even the most stable individual but for those with mental issues, the trail often is rift with pitfalls, dead ends, and often frustration, advocates say.
Yet if there is a bright spot in all of this, it can be found in the children. Nine children, to be exact, all plaintiffs in a landmark court case known as Rosie D. vs. Romney. Filed in 2001, the class action lawsuit sought to compel Massachusetts to provide certain Medicaid-eligible children with therapeutic services in their home or community rather than in psychiatric hospitals or residential treatment programs. Six years after the lawsuit was filed, a federal judge ruled in the plaintiffs' favor.
The outcome of that lawsuit helped reform the children's mental health system in Massachusetts by offering a blueprint, of sorts, for developing a comprehensive plan to treat children with serious mental disorders.
As part of that settlement, the Commonwealth established the Children's Behavioral Health Initiative to help provide services, funded for the first time in 2009 through a $65 million budget appropriation. In fiscal 2010, funding for that program grew to $85 million with a proposed budget of $217 million planned for fiscal 2012.
“Because of the Rosie D. lawsuit there's been some level of protection for children's mental health,” says Sudders.
Yet all is not quite as rosy as it may seem.
While the law mandated funding of certain mental health programs for children, it did little to curtail funding cutbacks in other kids programs run by another agency, the Department of Children, Youth and Families. That department, which provides after school, diversion and other programs for Bay State youths including those with behavioral and mental issues, lost more than $33 million to budget cuts between 2010 and 2011 alone.
Compounding the problem is a shortage in the number of providers available to treat children with mental and behavioral problems. According to Midge Williams, executive director of the Massachusetts Mental Health Counselors Association, a survey of providers published in 2009 not only confirmed that shortage, but found that 50 percent of the state's current providers don't expect to be in the field by the end of five years.
“There's such a dearth of providers and more and more work is expected of them,” notes Williams, adding that with long work hours, limited compensation, and a complex array of insurance paperwork to fill out, its no surprise that many are thinking of changing careers.
In Western Massachusetts, that dearth of providers is nothing new.
Today, more than 10 years after Baystate Healthcare closed its children's unit, only one in-patient facility for youngsters can be found outside the Route 128 belt. The privately run Providence Behavioral Health Center in Holyoke has only 24 beds available for children in need of hospitalization. If those beds are filled, says Matteodo, it can mean a 100 mile drive to one of 13 other children's facilities in the Boston area.
Yet the changes that accompanied the settlement of the Rosie D lawsuit brought more community-based aid for children than ever before. Under the Children's Based Health Initiative, a result of that lawsuit, an array of new services for kids brought treatment programs into their homes and communities.
“In many ways, the system is much improved,” says Winn, rattling off a list of new programs, like the family support training, therapeutic mentoring, in home behavioral support or mobile crisis intervention programs created by the initiative.
Yet, those who work within the system wonder what will happen if even more is shaved from an already lean mental health budget, leaving programs underfunded and services understaffed. That lack of foresight has a price, they say. Sometimes the cost is homelessness, rising healthcare costs, jammed emergency rooms, higher crime and crowded prison. Other times, like for a bloody three week stretch this past January when two in Massachusetts died and six others were killed outside a shopping center in Tucson, AZ, the cost can be much higher.