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By Dexter Van Zile
The economy's downturn has mental health directors in New England
anticipating budget cuts.
Although it's too soon to predict precisely where the reductions
will occur as of July 1, 2003, several administrators feel budget
cuts are inevitable and will impact the field.
Nicki Sahlin, Ph.D., executive director of the National Alliance
for the Mentally Ill of Rhode Island (NAMI-RI), says it will be
more difficult for psychologists to obtain psychiatric help for
indigent clients who benefit from psychological counseling, but
also require psychiatric supervision and medication.
"I've seen frustration on the part of psychologists already," Sahlin
says. Repeated attempts to contact the Rhode Island Department of
Mental Health were unsuccessful, but Sahlin says administrators
were told to prepare for an eight percent spending decrease in the
next fiscal year. That cut would cause problems for everyone in
the helping professions, regardless of whether they work in the
private or public sector, Sahlin says.
"The public and private systems are so much more entwined than
they used to be," she says.
A budget deficit in Connecticut forced the state's Department of
Mental Health and Addiction Services to rescind job openings and
impose reductions in substance abuse and mental health services
funded by the agency during this fiscal year. It's too early to
tell what will happen in the next fiscal year, says Wayne Dailey,
Ph.D., spokesman for the agency, but Connecticut is still grappling
with a $390 million shortfall. The state spends $13 billion on services,
with $550 million allocated to mental health.
"The full extent of the changes required by this budgetary problem
are not yet known," Dailey says. "I can tell you that one of the
concerns in Connecticut is that we had a $600 million rainy day
fund which got used up in FY2002 [which ended on June 30, 2002].
We are looking at a budgetary shortfall which really is a problem."
Over the past 14 months, Vermont has made three cuts to its current
budget, according to Susan W. Besio, Ph.D., commissioner of the
Department of Developmental and Mental Health Services. Despite
the reductions, mental health spending has actually increased from
$26.2 million in FY 2002 to $27.6 million in FY2003. Most of the
increases have been targeted toward cost-of-living increases to
the agency's workforce and staff at community health centers.
Reductions have been imposed, however, on staff training and mental
health outpatient treatment.
"In general our mental health system has faired relatively well
given the reductions that have occurred in state government," Besio
says. Still, cuts may very well take place in the upcoming budget.
"We've done exercises for level funding and for minus five percent,"
she says. "It was really horrible."
In New Hampshire, officials are now dealing with a $40 million
deficit, but it probably won't translate into large reductions at
the Department of Mental Health and Human Services, according to
Associate Commissioner John Wallace.
"The message here is that New Hampshire's economy and state revenues
have not been as badly affected as other states in the region,"
he says. "Whether state revenues will hold up over the next few
years, I don't know. But for now, we're fairly stable and not facing
substantial cuts."
That outlook doesn't mean the mentally ill, their providers and
advocates can remain complacent, says Michael Cohen, M.A., C.A.G.S.,
executive director of NAMI New Hampshire. The $40 million deficit,
when spread across the entire state budget, probably won't hurt
the state's mental health budget for the short term, Cohen says,
but over the long term, mental health cuts are likely.
The state is under court order to spend more money to improve public
education. This mandate, coupled with an expected decline in revenue
could impact the 2004-2005 budget. Level funding for education is
not an option, Cohen says. The money has to come from somewhere
and mental health is a likely source. "We're worrying about cuts
in health and human services, particularly in behavioral health,"
Cohen says.
Maine's Department of Behavioral and Developmental Services has
so far remained relatively unscathed by budget cuts, despite a current
statewide deficit of $290 million, says Deputy Commissioner Sabra
Burdick. The state, (which spends $171 million on adult mental health
and $85 million on child mental health), has reduced its mental
health spending in three areas. First, Maine obtained a waiver from
the federal government increasing the eligibility limits for Medicaid.
Burdick says the change will result in $1.8 million of the state's
mental health spending to be shifted over to Medicaid. Administrators
also achieved savings worth $1.1 million by eliminating duplication
within the agency and another $2 million was saved by not replacing
employees who left the agency, according to Burdick.
"We are not anticipating any disruption in services," Burdick says.
Nevertheless, state budget analysts are anticipating a shortfall
of $300 million to $600 million in the upcoming fiscal year.
Carol Carruthers, L.C.P.C., L.A.D.C., executive director of NAMI
Maine, says the cuts to this year's spending will have far greater
impacts than those acknowledged by state officials. The cuts made
in anticipation of the Medicaid waiver will deny people services,
Carruthers says. "The people who will be eligible [under the new
requirements] are new clients who want services, not existing clients."
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