Governor must save mental health clinics

Crisis: Once again, gross underfunding takes community mental health to the brink.

January 27, 2002

THE CALCULUS of collapse could not be clearer: The statewide network of mental clinics must treat as many as 80,000 patients with a budget built for 65,000.

Gov. Parris N. Glendening knows the situation and has sent a message to the front lines: Reduce services and stay within your budget.

Period.

Legislative analysts say the system will rack up a $20 million deficit by the end of this year --"cost containment" or not.

It's not surprising, then, that 11 of these clinics have closed in the last year or so.

More will go out of business soon if some way is not found to cover costs until July, when a new budget year begins.

But solving this problem goes even beyond meeting that immediate need. Obviously, if you cover this year's deficits out of next year's budget, you're inviting disaster.

What the state needs is for government officials to stop redefining the system on the fly and halt their calls for efficiencies when they know the system can't succeed as it's now structured.

Frankly (and here's a shocker), the state must eliminate the built-in imbalances between the available mental health money and the number of Marylanders eligible for clinic services.

At a hearing last week in Annapolis, a mental health bureaucrat almost drew catcalls when he said he was staying alert for red flags indicating the system was in trouble.

Montgomery County Democrat John Adams Hurson stopped him cold. Consider this hearing a red flag, the chairman said.

Dr. Georges Benjamin, the secretary of health, declined to answer when asked by Democratic Del. James W. Hubbard of Prince George's County whether the system had been adequately funded over the years by Governor Glendening. The answer is no, the delegate said.

Then he asked whether Dr. Benjamin thought the clinics could cut their way out of the immediate problem. Dr. Benjamin said he wouldn't want to hazard a guess.

Hazard might be the operative word in that sentence -- though Dr. Benjamin does not bear primary responsibility. It's the governor who does.

For several years, experience in the clinics has illustrated the imbalance between revenue and demand.

The governor's office says he has provided money this year to offset shortfalls, and another $30 million from a tax amnesty program was dedicated to the difficulties of mental health care. But the problem, once again, is clear: When deficits must be paid out of a new year's budget, that year, too, will end in deficit -- particularly when eligibility for the program continues to rise.

Delegate Hurson, chairman of the economic matters committee, appointed a subcommittee to suggest ways of solving the problem.

The first step is to pay for the program we have -- and stop blaming the clinics, which are simply doing their jobs with declining resources.

The second step is for the legislature to decide how many people it wants to serve.

Once all of that is done, clinics would have a realistic chance of success.

In the short run, the governor represents the best and perhaps only hope, as always. The legislature can't add money to a budget.

Mr. Glendening would be smart to remember that he cannot claim to have balanced his budget program by program with no harm to anyone if he allows the mental health clinics to founder in a wholly untenable situation. He simply must find money to put them in a better position.

Almost everyone praises the current mental health clinic system, which keeps people out of the sad, old psychiatric hospitals that were near-warehouses.

Their successes are moving.

A young man from Rockville told Delegate Hurson's committee last week that he would almost certainly be institutionalized if it were not for his care in the community clinics. He has his own apartment and works at two jobs. Most people would not recognize him as someone with mental illness.

"What do you want?" asked one of the clinic operators after the Rockville man spoke. "Do you like it that this young man's doing great?"

Most of the committee members, it seemed, would have said they like it very much.

But only the governor can add enough money to save a program that responds to Marylanders in need as if they were, as Dr. Benjamin said, part of our family.

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