Maryland ignoring needs of mentally ill

March 01, 2001|By Barry Rascovar

THEY ARE AN underclass we'd rather ignore: the mentally ill with little or no income.

There are more out there than you think in Maryland -- 75,000 deeply troubled people. State mental facilities are filled. So are psychiatric wards in community hospitals. Neighborhood clinics are bulging. And yet the state has done such an abysmal job of supporting community treatment centers that the system is on the verge of collapse.

In September, Corner Clinic, an Annapolis-based mental health group serving 2,000 people in Glen Burnie, Annapolis, the Eastern Shore and St. Mary's County, closed its doors. The reasons are enlightening.

The clinic claimed the state owed $1.7 million in unpaid bills for treating poor and low-income patients. Claims were dreadfully slow in being processed and voluminous claims were unjustifiably rejected, officials asserted.

"We were left holding the bag," said a local mental health official.

Said Corner Clinic's president: "I think the system is broken."

Others in the health care industry use similarly grave terms, such as "woefully underfunded" or "a brewing disaster."

Wherever you turn, it's a calamity.

Sheppard Pratt Health System, for instance, is losing 25 cents on every dollar of care delivered because of the ridiculously low government reimbursement rates. The state's five freestanding psychiatric hospitals lost $3.8 million a year ago, and are on track to lose $6.6 million this year and $7 million next year.

The state's bureaucratic paperwork has created such a logjam that Maryland is six years behind in paying some Medicaid claims.

So many legitimate expenses are denied payment -- and payment rates so low -- that three psychiatric hospitals have closed and the other five are on life support.

In South Baltimore, the 25-year-old Carruthers Clinic, run by the University of Maryland Medical System (UMMS), is under similar assault. State payments don't come close to matching the actual cost of running a mental health clinic. This one, at West and William streets near Federal Hill, is losing $2 million a year, an amount that is growing as state underpayments -- and nonpayments -- deepen.

"We're working harder and harder," said Eileen Hastings, the program director, "and losing more and more money."

"How far can you go," asked a top UMMS official, "without jeopardizing the institution itself?"

It's a mess. The state not only doesn't pay enough to let mental health providers tread water, there's no money in the governor's budget to change things.

Indeed, there's a $42 million deficit -- four years' worth of unpaid bills -- that was ignored by the governor. It's expected to balloon to $58 million over the next year.

The response? State officials say they may stop paying clinics that treat the mentally ill when their budget money runs out in May.

Mental health isn't a top priority for Gov. Parris N. Glendening. Smart Growth, yes. Education, yes. The mentally retarded, yes. Not the mentally ill.

His budget for paying community psychiatric clinics calls for a piddling 0.8 percent increase -- not enough to keep pace with inflation.

But what about workers at these clinics, whose pay is 20 percent lower on the average than that of state employees? What about the mountain of bureaucratic paper someone must fill out and process? Who's going to pay for all of that?

And what about the thankless tasks clinic workers perform that the state refuses to pay for -- such as tracking down patients who miss appointments and thus don't take their medication? Or the time spent helping these people get bus cards or apply for Medicaid or cope with simpledaily tasks?

Who's going to pick up the tab?

In 1997, Mr. Glendening's government imposed a private-sector model on these clinics. No more lump-sum grants, but a fee-for-service schedule. That would squeeze the "fat" out of the system, saving money for taxpayers.

Only it hasn't worked. Instead, everyone -- including the state -- has tried to shift the costs of doing business onto the clinics. Now the Mental Hygiene Administration, deep in debt, wants to squeeze clinic payments even further.

Yet these aren't for-profit groups. There's no competitive, market environment. If a clinic or psychiatric hospital closes, no one rushes to fill the void.

The sad truth is that we don't want to deal with this troublesome population -- one-third of whom live in Baltimore City. Four out of five patients have dual problems -- severe psychological disorders and drug addictions -- that require more expensive treatment.

But government doesn't want to pay.

Community clinics and psychiatric hospitals -- even the bigger ones -- can't survive if forced to constantly run deficits, or if payments shrink further.

Two weeks ago, the governor met with mental-health groups. He was knowledgeable about the situation, advocates said. But he made no commitments.

That, in itself, is progress. "We walked away not feeling we had been blown off," said one faintly optimistic advocate.

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