Cutting Mental Illness Services At What Cost?

When budgets start getting slashed in a recession, sometimes the poorest, neediest people are hit the hardest. In Massachusetts, this has meant the closing of mental health clinics that serve the poor:

When Governor Deval Patrick stood before cameras on Beacon Hill in October to announce the elimination of 1,000 jobs and scores of state services, he solemnly warned, “People will feel these cuts.” Five miles away, at this mental health clinic that served some 370 poor and mentally ill patients last year alone, Jepson and Thiboult would feel the truth of those words.

The Boston Globe’s front-page story about this topic was a good read, detailing the difficulty many people with mental illness will have now that one of their treatment supports is being removed. The heart-felt article focuses on the human aspect of these cutbacks, easy enough to do so when a simple weekly appointment is the differentiation between a person having a somewhat “normal” life and homelessness.

And some of the cutbacks are silly, when looked at from a global perspective:

That this relatively small out-patient clinic is a casualty of the budget crisis is a sign of just how desperate and confusing times have become. The state saved about $390,000 when it laid off four clinicians and dropped a part-time psychiatrist’s slot. However, when asked by the Globe, state officials acknowledged that the clinic’s shutdown also meant the loss of about $290,000 in annual patient insurance payments.

So this clinic is operating with a $100,000 deficit. What about simply cutting back on services rather than closing down the whole clinic? It doesn’t even pass the common-sense test, and yet this is sometimes how government functions. Cut off the nose to spite the face, and push otherwise-functioning citizens back into the throes of their mental illness. Which means that some of them will turn around and require even more state services, likely making it all a wash if anyone were to actually take such things into account.

But the comments to the article online are also interesting. One was a left by a clinical social worker who worked in a similar clinic in northwest Boston a few years back, who had this to say (amongst other things):

Third, the mental-health policy makers are not being honest with the public about a lot of debates we have internally to our own profession. For example, there are those in our profession who feel that, with the advance of medications, the usefulness of long-term counseling has waned. In other words, a 20-minute monthly meeting with a medicating clinician and participation in a “club house” group setting (which provides peer counseling, socialization, job training and support, and more, staffed by bachelor’s level clinicians) is all that is really needed. So, if this is the case, then why should the state pay for biweekly counseling from a master’s trained counselor like me?

Well, some would argue medications alone are surely not a good treatment option for people who often need more — social skills training, grounding, learning how to prioritize, dealing with stress in pro-social ways, etc. Just because someone is “chronically” mentally ill doesn’t mean their need for a weekly psychotherapy appointment goes away because some of their symptoms are being treated with a medication.

But, as the commenter notes, the problem is there is little consensus in this field, and bickering amongst competing state agencies for limited funding. An agency has little incentive to focus on the best care for their patients when their own health (or very existence) is a constant battle in the Legislature.

The problem in Massachusetts is one faced by many states — too much bureaucracy competing for too few dollars, often with operating mandates that overlap in coverage and populations served. A streamlining and consolidation of multiple agencies would likely be beneficial, but because of entrenched political agendas, it is just one more government “waste cutting” pipe dream.

All the while, ordinary people trying to live a somewhat ordinary life have one of their lifelines cut.

Read the full article: Healing, interrupted