Massachusetts is "way behind" in its delivery of mental health services with treatment options hampered by budget cuts since 2009, inadequate funding for police training and a shortage of inpatient psychiatric beds that is putting stress on hospital emergency rooms, according to a new report.
The report from the state chapter of the National Association for the Mentally Ill was released Monday two days before the House Ways and Means Committee is scheduled to unveil its redraft of Gov. Deval Patrick's $36.4 billion budget, a spending plan criticized by activists for raising mental health spending by only 1 percent.
The report calls for a $16 million increase in the Department of Mental Health's annual budget, and a $2.7 million increase in funding for courts that handle drug and mental health case and issues facing military veterans. It predicts Patrick's budget, if enacted, will lead to 215 children and families and 250 adults losing services, and estimates that DMH spending would need to rise by $85 million to return to 2009 levels, adjusted for inflation.
Winning a partial standing ovation for his remarks at a lobbying event, Massachusetts Trial Court Administrator Harry Spence, who once led the state's Department of Children and Families, recalled his work in the 1970s to deinstitutionalize services for individuals with mental illnesses. Calling the current situation "the great failure of deinstitutionalization," he said too many people with mental illnesses are spending too many years in prisons and jails.
Spence said the effort to create a more "just system" hinges in large part on following the path of New York which has doubled the number of specialty courts. Massachusetts has 26 courts that specialize in cases involving veterans, the mentally ill and substance abusers. Spence hopes to increase that number to 50 over three years.
"We are on a mission in the judiciary to double the number of specialty courts," Spence said, expressing hope that lawmakers will agree to a $2.7 million request by Patrick to fund eight more specialty courts.
Calling the number of people imprisoned in Massachusetts "purely because of their mental illness" unacceptable, Spence said mental health courts are in place in Springfield, Plymouth and Boston, which he said is expanding its mental health court to West Roxbury. Spence said the courts have begun the work of providing treatment rather than incarceration, and 21 drug courts are also often fielding cases involving individuals with mental illnesses.
The efforts underscore developing links between leaders of the judicial and executive branches in tackling problems. For instance, Spence said the trial court has a "wonderful partnership" with the Department of Mental Health and also has relationships with the Department of Public Health and Department of Veterans Services.
Breaking down the $2.7 million request to add eight specialty courts, Spence said it would pay for the hiring of four probation officers, a $750,000 Department of Public Health increase to provide more substance abuse beds, $800,000 to the Department of Mental Health to pay for clinicians to offer expert opinions to the courts, and $200,000 to pay for peer services to veterans.
Massachusetts also has the lowest legislative appropriation for training per police officer in New England to help police respond to cases involving mental illness, the report said. And compared to the five other New England states, Massachusetts ranks last in percentage growth of funding for mental health services since 2009 when the recession dried up state tax revenues and forced cuts in government spending, including mental health spending, the report said.
While the Patrick administration has touted community-based services as preferable to institutional services, the report describes the Department of Mental Health's community-based services for adults as suffering from "an unacceptable lack of oversight and monitoring data to evaluate quality and outcomes" and says a shortage of public and private psychiatric inpatient beds has forced hospital emergency rooms to take on more mental health patients.
"With up to half of emergency department beds being occupied by patients experiencing behavioral health issues, neither those patients nor other emergent patients can possibly receive the care they need," the report said. "The lack of available acute care beds in the state leaves these patients in acute crisis with nowhere to go."
ER beds are occupied by patients with behavioral health issues, according to the report, because community-based services are "inadequate" and there's been a 40 percent decrease in publicly-funded psychiatric inpatient beds since 2005. The report cites the closure of a 20-bed inpatient unit at North Adams Regional Hospital as contributing to the trend of reduced availability of psychiatric beds in hospitals.
"The most important point we want people to remember from this report is that despite modest progress in some areas, Massachusetts has a long way to go with regard to the way it treats the thousands of residents who live with mental illness," NAMI Mass Executive Director Laurie Martinelli said in a statement. "Massachusetts is way behind in terms of providing individuals with mental illness the services and supports they need."
Aside from the funding increases, the report also calls for passage of bills to adequately fund police training (S 1189), to eliminate discrimination against people with mental illnesses who collect long-term disability, and to create a private "right of action" for individuals who believe state mental health parity laws have been violated (S 1959). The report also calls for passage of legislation (H 840) requiring private insurers to cover emergency psychiatric services. Insurers have resisted new coverage mandates, citing efforts to keep health costs in check.
The report also dissects community-based programs, estimating they account for about $618 million of the $712 million in total spending from the Department of Mental Health's budget and serve between 20,000 and 25,000 individuals. The report says community-based services are delivered by 20 vendors working under 44 contracts, and estimates 73 percent of those receiving community-based services have a diagnosable mental disorder that "results in functional impairment which substantially interferes with or limits one or more major life activities."
The report says the department does not publish client outcomes on its website, a goal under the contracts, and instead only makes available to the public annual survey data "from a small sample of adult clients," with the most recent survey available dating back to 2011. Judging from available information, the report concludes "a lack of transparency and little to no progress in client outcomes is unimpressive for what DMH describes as 'the cornerstone of the department's community mental health system for adults.'" The report further cites a decrease in employment rates since 2009 and "only slight improvements" for individuals in less restrictive living arrangements.
Provided with a copy of the report and asked to comment on it or offer any kind of rebuttal, Executive Office of Health and Human Services spokesman Alec Loftus emailed the following statement: "Under Governor Patrick's leadership, the Commonwealth has made significant investments in its mental health systems, from opening the state-of-the-art Worcester Recovery Center and Hospital, to providing community-based services to thousands of patients near their families and support systems. The Governor's budget furthers these investments, with additional resources for mental health courts, substance abuse treatment programs and training for law enforcement around the needs of mentally-ill individuals."
The Patrick administration is again pressing this year to close the remaining mental health beds at Taunton State Hospital, which Health and Human Services Secretary John Polanowicz has said will grow jobs in the region while maintaining the number of beds in the state.
The Legislature has previously blocked the administration's move to transfer the 45 beds from Taunton to the new Worcester Recovery Center and Hospital. Polanowicz has said Taunton's closing will allow $6 million to be invested in community-based mental health services. Lawmakers opposed to Taunton's closing say it will leave southeastern Massachusetts underserved by the department.