Poor Hurt by Mental Health Cuts
Several decades ago, national and state advocates for people
with 'catastrophic' psychiatric disabilities decried policies that routinely
offered the least amount of service to those with the greatest mental health
needs. Increasingly, over the past decade, those policies have been reversed,
with people with 'high needs' being moved to the front of the line. Currently,
state budget downturns in neighboring Massachusetts have had the opposite
effect: depressed moms, struggling college kids and ex-cons in need are no
longer eligible for free public mental health care and are being routinely
referred to private mental healthcare providers.
Cuts end free mental help for many poor
By Ellen Barry, Boston Globe Staff, 9/9/2002
For decades, the state has supplied Boston's working poor with a mental safety
valve: If they were overcome by depression, anxiety, or an explosive temper,
they could walk into a community mental health center and walk away with a
regular appointment for free therapy.
That service quietly disappeared this summer as part of a $13.8 million cut to
the Department of Mental Health budget. Commissioner Marylou Sudders has given
new orders to community health centers to provide free services only to people
who are severely mentally ill, bypassing the pool of depressed mothers, recently
released inmates, and illegal immigrants whose care has cost the state about
$1.8 million a year.
About 800 people in Boston currently use the free therapy service. It is no
longer accepting new clients, and the department's medical director, Kenneth
Duckworth, said the affected people will be shifted gradually to private
health-care providers, a process that has no deadline and could take many
months.
The change, like the shuttering of a partial-hospitalization program in Quincy
and a day-treatment program in the South End, has attracted little notice during
a summer of gathering fiscal woes. But providers say successive budget cuts are
not just fraying a safety net, they are removing it.
''The whole system of community care for people with mental illness is being
dismantled, and the impact is going to last for generations,'' said Dr. Mary Ann
Badaracco, chief of psychiatry at Beth Israel Deaconess Medical Center.
Since August, clients who are not ill enough to be eligible - those who are
suffering but functional, without debilitating psychiatric illnesses such as
schizophrenia - have been referred to private hospitals that draw from the
state's free-care pool, which funds health care for poor families.
But officials at those hospitals say that transition will be frustrating at
best. Demand for psychiatric outpatient services, they say, already far
outstrips supply, and such clients are likely to take their place at the end of
long waiting lists.
''Right now we have about four referrals for every opening we have,'' said Dr.
Jerrold Rosenbaum, chief of psychiatry at Massachusetts General Hospital. ''The
idea that we could absorb more patients is just not the case.''
Many clients, faced with a list of private providers, are likely to abandon
treatment altogether, said Sudders.
''My experience is what happens is people don't take the referrals,'' Sudders
said. ''They say, `We will manage the best we can.'''
It was in the early 1960s, the age of the space race and the ''war on poverty,''
that John F. Kennedy signed a bill that would create a permanent framework of
community mental-health care centers. In Massachusetts, unlike many other
states, the network was developed almost to completion, but the initial mandate
- to offer services to an unrestricted population - has been altered radically.
After years of budget cuts and waves of people removed from public mental
hospitals, community health centers' resources are almost entirely devoted to
clients with catastrophic mental illnesses such as schizophrenia, said Dr. Paul
Appelbaum, chairman of psychiatry at University of Massachusetts Medical School.
''Many of the people who are not in the DMH-priority population are nonetheless
very ill,'' he said. The shift away from their needs is ''ironic, given that
many of them are somewhat more functional and the return to society from their
treatment is likely to be greater than the severely mentally ill.''
Jason Potter, for example, credits mental-health services with keeping him in
school. Two years ago, when his mother died, he was so frayed by grief and
stress that he thought he might be forced to drop out of classes at the
University of Massachusetts at Boston, surrendering his dream of attending law
school.
Potter's family had grown up receiving public assistance - his mother was a home
health aide and his father did odd jobs - and the blow of his mother's death
broke his stride. He stopped sleeping and couldn't concentrate.
For two years, he's had a weekly appointment with a counselor at South End
Community Health Center, paid for out of flexible funds supplied by the
Department of Mental Health to the center.
Without the therapy sessions, ''I think I wouldn't be able to handle the stress.
I wouldn't be able to function'' and likely would have dropped out of school,
said Potter, who is 27. And, he said, most of the patients who have crossed his
path at the center have similar problems.
''Most poor people have anger and depression,'' he said.
Ray Walden, the clinic's director and Potter's therapist, said he would
eventually have to find a new funding source or refer Potter to a private
hospital.
''I don't know how we're going to do it. This is a guy I've known for a long
time,'' he said.
Since the budget cuts were announced, Laurie Goldman, a psychologist, has turned
away several people who came into the South End center asking for therapy
appointments. One man had recently been released from jail and was required to
see a therapist as a condition of his parole - but he couldn't find one who
would see him.
''This man was begging to be seen for therapy,'' Goldman said. Unable to help
him, Goldman wrote a note to his parole officer explaining that the man had
sincerely tried to arrange a therapy session.
Medicare and Medicaid cuts have thrust new work on local clinics, she said, and
the additional burden of budget cuts put staff members in the ethically
precarious position of turning needy clients away.
''I have worked with so many people who have tried to kill cats, who have tried
to kill people,'' she said. ''What happens to the people who can't get seen is
that they go off their medication. If they don't think it's going to have an
effect on the wealthy people in the suburbs, think again.''
Ellen Barry can be reached at barry@globe.com.
Source:
http://www.boston.com/dailyglobe2/252/metro/Cuts_end_free_mental_help_for_many_poorP.shtml
This "Mental Health E-News" posting is a service of the New York Ass'n of
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