As Massachusetts continues to grapple with its budget deficit, state agencies are reeling from cutbacks and fearing more to come.
The Department of Mental Health has lost about five percent of its $685 million budget for this fiscal year. For the next one, the DMH is looking at a potential cut of $10 million more.
As a result, the agency has already eliminated some programs and laid off staff.
WBUR's David Boeri visits one Boston woman who lost her longtime case manager.
Sitting in her apartment in Mattapan, 51-year-old Helen Cheltenham is playing her African drums to the music of BB King and Bobby Blue Bland. She calls herself a "consumer" of the Department of Mental Health, known as DMH for short. Twin diagnoses of post traumatic stress and clinical depression brought her into client status with the DMH in 1993.
MUSIC: Hey everybody, when you're dead you're done. Let the good times roll.
Good Times music belies the mood of a bad time budget that's caused DMH to make severe cuts in services. In January, it eliminated one-fourth of all its case workers. Suddenly, 3400 patients lost their case managers. Helen is one of them.
HELEN CHELTENHAM: It was devastating to me. All I could do was sit and cry. You had people in your life who cared for you. And that's the kind of care I had from Paul Jean, my DMH case manager. He went the whole nine yards with me. There were times when I was in such turmoil. I'd call him and by the end of the day he was at my door.
Helen describes Paul Jean as the most exemplary of public servants. On average, he met with her four times a month and spoke on the phone to her about eight times she says. He helped her manage medical appointments, crises and everyday problems.
CHELTENHAM: He would call and say Helen, I know it's snowing really heavy and I'm going to pick you up and take you to your appointment. That's what a case manager does. A doctor doesn't do those things.
But it's those things and that support, Helen says, that helped her become independent. Paul Jean encouraged and enabled her to move into this apartment on her own, embrace recovery and gain confidence to become a public speaker and certified counselor to her peers. All of which kept her out of hospitals and emergency rooms.
CHELTENHAM: I became confident enough to move out of my comfort zone. I got up there and gave a speech and was shocked the words came out. But I had him behind me.
Until the recent cuts in services, what's happened to Helen Cheltenham during her years as a client of DMH can be said to reflect the change of philosophy and attitudes toward mental illness. The horrors of warehousing at state hospitals led to reforms in the '70s and '80s and gave way to the idea of integrating people into the community in group homes.
Resignation to a lifetime of low expectations gave way to the recognition that patients were people first, with full rights and potential. And at the turn of the century treatment and programs turned to socialization, jobs and the idea that recovery was possible.
RUTHI POOLE: We do recover. We get better. It's not like we're cured. But recovery is possible.
Helen's friend, Ruthi Poole, leads the group M-Power, a consumer- run group that advocates for better services and works to remove the stigma of mental illness.
POOLE: Which for years, those of us with mental illness were told you'll never get better. It used to be take your meds, be quiet, you just have to get used to it.
Case managers like Helen's, community programs and peer support groups all take the direction of promoting recovery. But now that DMH has laid off a quarter of its managers when it needed more, not fewer, the road to recovery for many is going to be rougher, Helen says.
CHELTENHAM: I understand economic crisis 100 percent, but why do you want to take people largely helpless and demoralize them by taking away those services that are life and death in a lot of instances. I wager that you're going to find a lot of them in the emergency rooms, in the streets, or in the morgue.
Ruthi Poole says it marks a return to the idea of the mentally ill as throwaway people.
POOLE: What happens when case management is cut, day services are cut. We see it as immoral. Because people need it but it's really stupid fiscally. Hospitalizing someone costs over $600 a day.
It's not clear how many of those 3,400 DMH patients who lost their case managers will get new ones. And with some of the DMH-funded day programs and social clubs closed altogether by other budget cuts, Helen sees a dim future for many clients.
CHELTENHAM: They're sitting there at group home, doing what most people do when they have nothing to do — smoking cigarettes, have dinner, take their medications and go to bed.
As I left, Helen who successfully fought to be assigned a new case manager to replace Paul Jean is about to meet him. He has big shoes to fill.
MUSIC: When my life was dark I had someone who was there for me.
She was on the drums, accompanying the song that's one of her favorites.
This program aired on February 20, 2009. The audio for this program is not available.