Mental health agencies trim staff, services

Care providers face $25 million funding cut

`They're strangling us'

State says move is to slow years of runaway spending

February 29, 2004|By Jackie Powder | Jackie Powder,SUN STAFF

Faced with $25 million in cuts to the state's mental health budget, service providers statewide are laying off employees and closing or scaling back offerings.

At stake are programs that they say keep low-income adults and children with the most disabling mental illnesses in schools and communities and out of hospitals, emergency rooms and jails.

"These are the services for people with the most severe psychiatric disabilities in the entire mental health system," said Herb Cromwell, executive director of the Community Behavioral Health Association of Maryland. "People with schizophrenia, people who have been in state hospitals for whom rehabilitation services are needed to help them establish independence, get a job and manage a house."

State Mental Hygiene Administration officials say the cost-containment measure - in the form of lower reimbursement rates to providers - is an effort to rein in four years of runaway spending and budget deficits.

"This is a budget that has an insatiable appetite," said Nelson J. Sabatini, secretary of the state Department of Health and Mental Hygiene. "No matter how much money you put into the program, the utilization of services continues to expand beyond a financially sustainable level."

Providers of care to the mentally ill agree that the deficits must be addressed, but fear that the lower rate structure - which took effect Feb. 1 - is a short-term fix with potentially grave long-term implications.

"Agencies are kind of hunkering down and trying to preserve as many services as possible," said Cromwell, whose association represents 50 of the largest providers of community mental health programs in the public system.

Kathy Seifert, executive director of Eastern Shore Psychological Services in Salisbury, is particularly worried about a 14-year-old client who attempted suicide by swallowing 90 pills of her anti-depressant medication.

"We were already giving her more services than the system allocated because she had to have them," she said.

Seifert plans to request the services her client requires, but doesn't expect to receive state approval. She said she is committed to providing the appropriate care, but under the new reimbursement rates her compensation amounts to $12 a session.

"The state will not pay for the level of services she needs to be safe in the community, so I'm faced with providing the services for free and putting my company in jeopardy," Seifert said. "I have to say to myself, `Can I ethically serve these children if I'm giving them less than what they need?'"

Dale Meyer, president of People Encouraging People, a Baltimore program that serves adults with psychiatric disorders, said the reduced rates will leave her with a $600,000 hole in her budget, a gap she's tried to close by not filling about 30 positions and asking employees to handle increased workloads.

"We've gone back, to my way of thinking, to what we had 20 years ago," she said. "It feels like a MASH unit now, more like triage."

People Encouraging People client Kenneth Schell, 53, finds himself with more time on his hands these days. The day program he attends cut its hours and afternoon activities, including bowling, museum visits and restaurant outings.

"Being left alone with nothing to do sets me in a mood," said Schell, who suffers from schizophrenia and depression.

Sabatini rejects some providers' predictions of dire outcomes for clients.

"Those are the typical kinds of arguments used to scare people into tolerating fiscal irresponsibility," he said, adding that some providers' inefficient use of resources contributed to staff and program cuts.

"If providers were more judicious in the way they delivered the care, and worried about the fiscal consequences, we wouldn't have these problems," he said.

Despite the cost-containment measures, providers say that Gov. Robert L. Ehrlich Jr. has demonstrated a strong commitment to helping the public mental health system erase its deficit and meet the demand for services.

In his 2005 budget, he included $54 million to cover a deficit carried over from 2003, and $32 million in new funds for the system.

In testimony before House and Senate subcommittees last month, Cromwell said the Community Behavioral Health Association will ask the governor for $2 million in a supplemental budget appropriation to help providers continue services to clients who are most at-risk.

"If education is Exhibit A on the need for more revenue in this state," Cromwell said, "then mental health is Exhibit B."

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