Saturday Mailbox

SATURDAY MAILBOX

April 03, 2004

Health systems badly damaged by budget woes

If the Thornton plan for public education is Exhibit A for why policy-makers need to solve the state's budget problems, then the public mental health system is Exhibit B.

In February, a legislative committee approved regulations that slashed about $20 million from mental health services to reduce a deficit in the state's mental health budget that the state can't afford to make up through other means ("Mental health agencies trim staff, services," Feb. 29).

Much of the reduction is coming out of psychiatric rehabilitation programs, which provide residential and other community-based alternatives to institutional care - at a third or less of the cost - for children and adults with the most disabling illnesses in the public system.

Since July 1, community mental health service providers across the state have closed or significantly pared down essential programs, laid off 300 direct service staff personnel and abolished 200 more positions. Several agencies have lost 40 percent of their work force. Thus access to community-based treatment and support services that improve and save lives has been severely curtailed.

Like the state budget as a whole, the mental health budget has a "structural deficit" caused primarily by the fact the number of low-income children and adults seeking care has far exceeded the system's capacity for the past several years.

To his great credit, Gov. Robert L. Ehrlich Jr. has requested sizable budget increases two years in a row to try to fill the gap. And the Assembly has found new federal funds to reduce deficits carried over from prior years.

But the demand for mental health services keeps growing, and the deficits persist. Now the state has run out of miracles, and unprecedented cuts are the only way state leaders see to make ends meet.

While there is general acknowledgement that the cuts will increase homelessness, hospitalizations, emergency room admissions, incarcerations and suicides - ultimately at greater cost to the taxpayer - the money just isn't there in the state budget.

Unless and until state officials raise sufficient revenues to enable Maryland to meet its basic obligations, a model public mental health system that has nearly doubled the number of people who are able to get community-based care since 1997 and expanded critical services to every corner of the state will continue its Chernobyl-style meltdown.

Herbert S. Cromwell

Catonsville

The writer is executive director of the Community Behavioral Health Association of Maryland.

Putting treatment in the wrong hands

The Sun's article on Food and Drug Administration warnings about the use of antidepressants omits a very important fact ("FDA urges caution on Prozac, 9 others," March 23).

Currently, about 70 percent of antidepressant prescriptions in the United States are written by non-psychiatrists. Most of these non-mental health care providers are primary care physicians, and most of them are badgered by managed care insurance companies to treat mental health care issues in their offices before patients can be referred to a mental health specialist.

So physicians without expertise with these medications write prescriptions for them without specific training.

Studies have repeatedly shown for the past 20 years that antidepressants do, in fact, have a positive impact on suicidal impulses and that patients improve with responsibly prescribed and monitored medicines and psychotherapy.

But no reasonable non-psychiatrist can provide enough support to help a clinically depressed patient.

Mental health issues should be treated by mental health specialists.

Dr. Joel H. Hassman

Baltimore

The writer is a staff psychiatrist at Franklin Square Hospital.

Scandal won't stop HERO from helping

Working as a staff member at HERO this past week has been very stressful.

Our daily activities are stressful in themselves - working with HIV-AIDS patients who need help with housing or drug treatment or medical care. Our staff is hard-working, and we put our hearts into every encounter. Having this shadow of impropriety hanging over us has been shameful ("HERO director denies allegations of misusing funds," March 25).

We have been concerned about possible layoffs and told our health benefits will be drastically slashed. Staff members have donated paper and supplies to tide us over. Now we are wondering if we will be able to continue working.

But yesterday, seven clients came into my office. One was about to be evicted. Another man could not get his HIV medications. One woman just wanted to tell me she had started taking her antidepression medication and was beginning to feel better.

Several men came by to report on job searches and recovery programs. Transportation was arranged to medical appointments. A recently incarcerated client needed help with finances, and we worked on getting him into medical care, recognizing that until he was stronger, he could not go back to work.

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