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In Crisis

Mental health advocates cautiously optimistic about state budget

Even without casino money or a jump in the gas or cigarette taxes, the $28 million Gov. Maggie Hassan wants for improved mental health care remains in the state budget headed to the full Senate this week. Advocates are cautiously optimistic it will stay there despite a looming $40 million hole in the state Department of Health and Human Services budget.

If it does, the state could see additional mental health services by fall: new space at Franklin Regional Hospital for people in crisis and waiting for a state hospital bed; more community housing for people who need mental health assistance; and additional treatment teams across the state.

Jay Couture, president of the state Community Behavioral Health Association, believes public awareness has changed the priority level lawmakers have begun giving mental health care. Hassan’s two-year spending plan is the first real increase advocates have seen since before they wrote a 10-year improvement plan in 2008, Couture said.

“I think that with the (mental health) budget cuts that have happened over the last decade and particularly over the last budget cycle, it has become apparent, not to just those who work within the system, but to the general community, just how far you can cross the line before you erode the system and it’s no longer sustainable,” Couture said. “And we are there.”

Lawmakers have not disagreed as they’ve put together the next two-year budget. “We understood that we need to fund mental health,” said Sen. Chuck Morse, a Salem Republican and chairman of the Senate Finance Committee.

Both the House and the Senate Finance Committee have passed budgets that leave Hassan’s proposed $28 million mental health care spending intact.

They have differed over expanded Medicaid, which the state’s 10 community mental health centers say is critical to helping them recover the cost of serving uninsured or under-insured patients. The House included expanded Medicaid in its budget, the Senate Finance Committee didn’t. But even without expanded Medicaid, the state Department of Health and Human Services said it can move ahead on its proposed two-year spending plan for mental health services.

∎ Later this month, the state hospital plans to open 10 additional beds so fewer people in crisis are lingering in emergency rooms awaiting a space. Over the long Memorial Day weekend, there was an average of 23 adults and 14 children waiting in emergency rooms for bed space, according to state hospital counts.

∎ By July, the department plans to add 12 community residence beds to the existing for people who don’t need a hospital bed but do need intensive treatment. In July 2014, the state would add 62 more, bringing the statewide total to about 200.

∎ By July, there would be five additional Assertive Community Treatment Teams, which offer support to people in crisis that can lead to decreased need for hospitalization. By the following July, there would be five more, and half of the 10 would be just for children. They’d also expand coverage from five days a week to seven.

∎ In September, the state plans to open a 10-bed unit at Franklin Regional Hospital for people waiting in emergency rooms for a state hospital bed.

∎ In July 2014, the state wants to open a 16-bed inpatient unit as an alternative to the state hospital or as a transition space for people leaving the state hospital.

The threat to these additional services is not specific budget cuts by lawmakers but a more complicated combination of budget reductions and shortfalls that, for now, total about $40 million. Here’s how that figure breaks down:

∎ The Senate Finance Committee, as lawmakers do every year, wants the state Department of Health and Human Services to find $7 million in budget savings over the next two years.

∎ The Senate Finance Committee also wants Hassan to cut $20 million in general fund spending for personnel across all agencies. Sheri Rockburn, director of finance for the department’s community-based and mental health care, said that could amount to an $8.8 million cut for all of health and human services.

∎ Neither the House nor the Senate finance budget includes $9 million Commissioner Nicholas Toumpas said his department owes in a federal Medicaid settlement. Toumpas has said he’ll need to find that money somewhere in his budget.

∎ Toumpas has also warned lawmakers that the delay in implementing managed care will prevent the state from saving $10 million he has counted on. That loss of savings will become an expense, he has said.

∎ Finally, Toumpas has said he expects his department to spend nearly $4 million more on aid to the disabled and on children emergency services than House and Senate finance members estimated.

As for the $7 million in savings the Senate Finance Committee is requiring Toumpas to find over the next two years, Morse said he and other committee members would have preferred to identify the cuts themselves. Morse said the department did not present a budget that made it easy to specify cuts. “I have confidence the commissioner can find a way to find $3.5 million (in savings) each year,” Morse said.

Rockburn said her department has discussed possible cuts or delays in new programs to make up for the possible $40 million hole. She said Friday that none of the recommendations include cutting mental health services. The one possibility discussed was delaying the addition of some community housing for people who need intense support. But it remains only a possibility, not a certainty, Rockburn said.

(Annmarie Timmins can be reached at 369-3323,
atimmins@cmonitor.com or on Twitter @annmarietimmins.)

Just read the news papers these days. We don't need anymore community housing, we need a nut house, a big one.

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