Mass. Governor Backs Off Threat To Slash Day-Treatment Programs

The Massachusetts Psychiatric Society (MPS) helped bring about a reprieve for the state’s 40 psychiatric day-treatment programs.

Gov. Mitt Romney (R) had included the programs in a package of proposed Medicaid cuts designed to address the state’s budget deficit of approximately $3 billion.

The proposed cut in the programs, which served 3,400 people in 2002, would have saved the state $1.1 million. According to Massachusetts Health and Human Services Secretary Ronald Preston, the governor changed his mind and spared the programs for one year as a result of the testimony of people with mental illness, their family members, and other advocates.

Preston told a Boston Globe reporter, “We have heard probably more about the psychiatric day-treatment program than any other cut. . . . What these people were saying is that they were living on the edge, and this was making a real difference.”

Bruce Bird, Ph.D., chief executive officer of the North Suffolk Mental Health Association, told Psychiatric News that a coalition of nonprofit service agencies, people with mental illness and their families, and other mental health professionals had worked for several months to educate the press and state officials about the impact of the potential cuts.

He said, “During the critical period, more than 2,000 people a day were calling the governor’s office to protest the cuts.”

Advocates pointed out that cutting back on day treatment would result in increased costs for treatment in emergency rooms and in the number of homeless people.

Bird said that he and others recognize the need to document the efficacy of day-treatment programs and are working with research institutions to develop data that will substantiate their cost-effectiveness.

The North Suffolk Mental Health Association provides crisis, outpatient, community, and home-based services to residents of Boston and seven nearby communities.

Elizabeth Childs, M.D., president of MPS, testified in front of Preston and other state officials that “mental illness. . .is particularly devastating for patients and families without resources. . . . Removal of the safety net for these most vulnerable citizens and their families is catastrophic.”

Growing Tally of Uninsured

Childs, who is director and chief of psychiatry at Carney Hospital in Dorchester, told the state officials that the number of uninsured is growing, “further burdening an uncompensated care pool, which has an estimated shortfall of $250 million.”

She testified, “Providers. . .who continue to provide services to this population face pressure either to abandon their mission. . .or risk financial collapse and closure, further limiting access.”

David Matteodo, executive director of the Massachusetts Association of Behavioral Health Care Systems, told Psychiatric News that as of April 1 Massachusetts would eliminate Medicaid coverage for about 50,000 unemployed, low-income adults, which would expand the number of the uninsured and place further pressure on hospitals and other sources of inpatient care (Psychiatric News, February 7).

APA President Paul Appelbaum, M.D., told Psychiatric News, “States around the country are facing cuts in their Medicaid and mental health budgets that threaten devastating consequences for persons with mental illness. The Massachusetts experience demonstrates the value of reacting loudly and rapidly to such cuts and the importance of forming coalitions. It is not a foregone conclusion that people with mental illness must suffer disproportionately when times get tough.”

Health Budget Cuts Likely

MPS and other mental health care advocates were gearing up for additional challenges at press time, when state officials were expected to release the proposed budget for Fiscal 2004. That budget will be implemented July 1. The governor also plans a reorganization of health and human services programs.

Childs told Psychiatric News, “We have to be realistic. We know there will be cuts across the entire spectrum of programs. But, she added, “We need to make certain that people with mental illness are not affected disproportionately. People on Medicaid don’t complain and often don’t have families to advocate for them.”

Childs agreed with Appelbaum’s assessment of the importance of coalitions. She said that MPS is working with other groups on a Mental Health Coalition Day on which psychiatrists and others will educate legislators about the impact of reorganization of state mental health programs and other issues.

State legislators are divided, according to Childs, about whether to try to increase various state taxes to deal with the budget deficit.

After President George W. Bush denied a request for financial assistance for federally mandated programs, the National Governors Association (NGA) refused to endorse his proposal for Medicaid “reform.”

The NGA announced on February 25 that it would seek financial assistance from Congress to deal with state budget crises (see story on Original article: page 8). ▪