Vermont mental health agencies take a hit during budget cutting

Vermont mental health agencies take a hit during budget cutting
(March 2009 Issue)

By Phyllis Hanlon

Funding of agencies and contracts in Vermont's Department of Mental Health (DMH) for FY2009 realized a reduction of approximately $7 million, according to a DMH Mental Health Update in January.

DMH Commissioner Michael Hartman reports that some savings occurred when designated agencies sliced 2.5 percent from their budgets. Adult services realized $3.3 million in reductions through staffing cuts in management and direct care positions; child services reduced its budget by $3.9 million. Twenty-seven FTE positions within 11 agencies on the mental health side were eliminated, he says. "We tried to make cuts in case management where there is some overlap. We've cut as deep into the system as we can. The next reductions would go after services and have a significant impact on large numbers of people. Right now, we are stretching resources. We can't absorb any more without sustaining long term damage."

Hartman explains that a change in the state's employment structure for mental health services has impacted services. "Mental health services is a significant employer. In our society in terms of what we do, there are so many more jobs in health care," he says. "We are trying to restructure to allow us to have a more effective system via fewer people trying to do more services."

In addition to the agency cuts, Medicaid reduced its reimbursement for therapy provided by social workers, counselors and psychologists. The Office of Vermont Health Access, the state's Medicaid agency, reports a four percent rate reduction, which averages $20,000 per agency. Hartman adds that private providers also received a four percent rate decrease.

To offset some of the repercussions from the cuts, the state is focusing on Supported Employment, a plan to provide employment to those who want to work at an appropriate level. Employers partner with Vermont's Community Rehabilitation and Treatment Supported Employment Leadership Committee to find meaningful, competitive jobs for individuals.

"The last employment picture showed that Vermont was holding pretty well on the employment side for the significantly mentally ill population," says Hartman. He points out that many of these individuals do not work full-time and hold entry-level positions, so are in less jeopardy of losing jobs.

Hartman views the proposed stimulus package as a much-needed bridge to maintain current services and programs and prevent further cuts. He indicates that stimulus funds could help keep the switch to electronic medical records on track. "Some agencies have spent hundreds of thousands of dollars already on this. We may be able to reimburse and help these agencies absorb the cuts," he says.

Peter Albert, LCSW, from the Brattleboro Retreat who advocates for mental health and substance abuse services, says that how the state manages the budget affects providers and treatment at private institutions. "As services in the local community decrease, there is an anticipated increase in need for emergency services or for elevated levels of care," he says. "We are still in the process of figuring out how it will filter out."

Albert says, "It's important to note that everyone is trying hard to figure this out. Agencies and departments in Vermont are interdependent on each other. This is a very difficult conversation to have, but the mental health community is willing to have it."

Hartman emphasizes that the expansiveness of the current financial situation requires more than a "quick fix." Unlike the 1991 recession, which lasted a couple of years, this scenario begs a different solution. "We are looking at a six-year process before things re-stabilize."